Wednesday, 26 October 2016

Low Back Pain due to Slipped Disc

Disc damage or slipped disc/slip disc can be one of the diagnoses for neck or back pain. There are different types of disc damage that can result in pain such as ruptured or herniated disc, degenerated disc, excessive torsional injury and compression injury of the disc. Most of the disc injuries involve damages and abnormalities not only the disc, but also the soft tissue structures around the disc.

Excessive rotational or torsional stress may cause injury to the facet joints, the annulus fibrosus, or most commonly both. The annulus fibrosus is under maximal stress when the disc is being loaded in a bent and twisted position. Therefore, people who always injured their back when they lift heavy objects in a forward bending position with the upper body rotating to one side.

Learn more about slipped disc or herniated disc.

Repetitive torsional injury to the disc may lead to tears seen on MRI. Annulus fibrosus with tears are more susceptible to nucleus pulposus herniation. An inflammatory reaction may be provoked in response to the annular tear and this will result in pain from chemical irritation. This chemical nociception normally presents as a diffuse back pain that may or may not be referred to the lower limbs. Any movement of the lumbar spine, especially forward bending and twisted, can aggravate the lower back pain from excessive rotational stress.

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Friday, 21 October 2016

Slipped Disc/Slip Disc in the Spine

Many years ago, the intervertebral disc was thought to have no nerve supply and therefore incapable of producing pain when irritated or damage. However, recent research has shown that the outer one-third or sometimes the outer half of the posterior annulus fibrosus is innervated by sensory nerves. Therefore, the outer layer of the posterior annulus fibrosus is capable of producing pain when it is damaged or irritated.

Learn more about slipped disc or disc bulge.

Traditionally, there were two major types of disc injury which can result in local spinal pain with or without radicular signs and symptoms. One of the injuries is disc herniation or extrusion. Disc herniation occurs when the center nucleus pulposus is no longer contained by the outer annulus fibrosus and is extruded through a tear in the annulus fibrosus. Nerve root impingements and spinal canal encroachment can happen as a result of disc herniation. The other type of injuries is known as degeneration of the disc. Disc space narrowing, vertebral endplates degenerative changes and bone spur formation are the common imaging findings of disc degeneration. All these degenerative changes can result in spinal canal or neural foraminal narrowing. Nerve root impingement or irritation due to spinal canal or neural foraminal encroachment can lead to pain and paresthesia at the site of injury.

According to the recent research, a disc without herniation or degeneration is capable producing pain. This discogenic pain can be a result of torsional injury or compression injury of the annulus fibrosus.

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Sunday, 16 October 2016

Chiropractic and Physiotherapy for Lower Back Pain

The source of lower back pain can be coming from the structures in the lumbar spine or referred from the adjacent joints such as the hip joint. A detailed examination of the hip joint in patients with low back pain is necessary to rule out abnormalities of the hip joint such as labral tears, rim lesions and osteoarthritic changes of the joint. Abnormalities of the hip joint may present as low back pain or both the hip joint and lumbar spine can be the main sources that contribute to the lower back pain. Therefore, both conditions that coexist must be managed and treated at the same time to achieve maximum medical improvement in the shortest period of time.

Any structures of the lumbar spine that are capable of producing pain are called nociceptive (pain-producing) structures. Vertebral venous plexus, dura mater, ligaments of the vertebral arches, muscles and fascia, vertebral bodies, laminae, apophyseal joints, and annulus fibrosus of the intervertebral disc are the common structures that can result in low back pain when these structures are being irritated.

Irritation and damage of the intervertebral disc and facet joints are the most common causes of lower back pain. However, as the condition progresses, abnormalities of the adjacent soft tissues must be considered as the sources of lower back pain. Abnormalities of the ligaments of the intervertebral joints, muscles, fascias, and neural structures must be taken into consideration when treating chronic lower back pain.

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Tuesday, 11 October 2016

Chiropractic and Physiotherapy for Low Back Pain

Spondylolysis or stress fracture of the pars inter-articularis is commonly seen in athletes who involve in gymnastics, fast bowling (cricket), throwing sports and tennis due to repeated hyperextension with or without rotation of the body. Fracture of the pars inter-articularis on both sides can result in spondylolisthesis, slipping of the vertebra over another segment. Spinal canal stenosis is more commonly seen in older patients and they often complain of pain aggravated by walking and relieved by rest. Examination of the hip joint must be included for lower back patients as abnormalities of the hip joint such as labral tears or joint contracture may present with signs and symptoms similar to lower back pain with radicular pain in the leg.

There are a few anatomical structures in the lumbar spine which are capable of producing pain when they are damaged or irritated. These include nucleus pulposus, annulus fibrosus, facet joints, ligaments, muscles, nerve and synovium that are found in the lumbar spine. Health care practitioners should be able to identify more than one abnormality in these structures when a person presents with low back pain.

People who are aged between 20 and 50 have an increased risk of lower back pain. There is a higher incidence of low back pain and sciatica in smokers compared to non-smokers. People working in a field that requires a lot of physical demand that involves bending or twisting are more prone to lower back pain. Physical work with high exposure to vibration can lead to increased risk of low back pain and sciatica. However, sedentary occupation with long hours sitting or standing also showed a higher percentage of low back pain.

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Thursday, 6 October 2016

Chiropractic and Physiotherapy for Low Back Pain

Low back pain is so common in the general population and among athletes that it can affect up to 85% of the population at some time in their lives. About 90% of them show improvements over a 3 months period, but up to half of them will have at least one recurrent low back pain attack. Low back pain is considered as one of the most common causes of disability in people below the age of 45. It is very difficult for health care providers to pin-point a precise anatomical and pathological diagnosis in lower back pain. However, health care providers should be able to detect any abnormality that is present and provide appropriate treatment to correct that abnormality. In most cases, there can be more than one abnormality that results in the low back pain.

Learn more about back pain.

There are a few severe conditions with obvious signs and symptoms in which a definite diagnosis can be made. And these severe conditions must be ruled out before any treatment and management can be preceded. Acute fractures due to direct trauma, for example, fracture of the transverse process or compression fracture of the vertebra must be ruled out. There will be significant soft tissue damage associated with these fractures.

The diagnosis of nerve root compression can be made when patients present with typical excruciating radicular pain shooting down the leg, with or without low back pain. Sensory symptoms such as numbness, tingling sensation or burning sensation may be present. There may be associated muscle weakness and reflexes are often abnormal. Herniation of the nucleus pulposus of the intervertebral disc is one of the most common causes of nerve root compression in back pain patients.

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Saturday, 1 October 2016

Spinal Intervertebral Disc and Chiropractic

Intervertebral discs are one of the joints that contribute to the movements yet provide stability to a functional spinal unit. One functional spinal unit consists of two adjacent spinal vertebrae, the intervertebral disc and surrounding soft tissues (e.g. ligaments) that connect them together. Intervertebral discs are made up of the inner nucleus pulposus, outer annular fibrosus and cartilaginous endplates at the top and bottom surfaces that are in contact with the adjacent vertebra.

The matrix of the nucleus pulposus is mainly water, collagens and proteoglycans. As the nucleus pulposus is mainly made up of water, it is able to distribute forces evenly in all dimension when the weight is being placed on it. The annulus fibrosus contains layers of lamellae and collagen fibers. This multi-layered annulus fibrosus aligned in various different angles provide the tensile strength and flexibility to the spinal columns. The cartilaginous end plates of the adjacent vertebrae are rich in microscopic blood vessels that supply nutrients to the spinal discs.

Learn more about slipped disc and chiropractic.

Degenerative changes in the intervertebral disc are shown to occur in the early decades of life. As the disc degenerates, there can be significant changes in the structures of the intervertebral disc, associated ligamentous damage and structural alterations in the spinal columns. These degenerative changes can lead to severe neck or back pain with or without radiculopathy such as numbness, tingling sensation and weakness.

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Monday, 26 September 2016

Lower Back Pain and Degenerative Disc Disease

Degenerative disc disease of the lumbar spine is one of the most common causes that is associated with lower back pain. It has been shown that the degeneration and deterioration of the lumbar disc can lead to a symptomatic lower back condition. A progressive degenerative disc disease can result in acute or chronic back pain with an associated clinical instability of the spinal segments. This can lead to abnormal spinal segmental movement, misalignment of the spinal joints, spinal stenosis.

The basis of initial evaluation involves plain radiographs (X-rays) of the lumbar spine. Reduced disc height and narrowing of the facet joints are very common findings on the X-rays in degenerative disc disease and osteoarthritis of the spine. Osteophytes and sclerosis of the upper and lower endplates are frequent radiographic findings for degeneration. Narrowing of the lateral recesses and the spinal canal can be visible on CT or MRI of the spine. Radial or concentric tears, cystic spaces and disruption of the annulus fibrosus can be identified with MRI which is showing better resolution for soft tissues.

Learn more about degenerative disc disease.

Instability of the spine results in a lack of normal spinal segmental displacement pattern under physiologic loads. Hence, there is an increased risk of neurological deficits, incapacitating spinal deformity and pain.

According to Kirkaldy-Willis and Farfan, there are three functional phases of degenerative disc disease:
  1.        Temporary dysfunction without instability;
  2.        Unstable phase;
  3.        Stabilisation phase following calcification of ligaments and spondylophyte support.

During the early phases of degenerative disc disease, there is an increased microscopical structural deterioration resulting in an increased functional impairment.

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