Pain science, lifestyle factors, and generalized systemic exercise are in vogue these days. And for good reason. They can make a significant impact on peoples health and well being.
However, as often happens in health fads, the baby was thrown out with the bathwater.
Pathoanatomy became taboo. Practitioners became afraid of mentioning anything anatomical because of the possible detrimental psychological effect on a patients expectations and perceived pain.
But what happens when the non-pathoanatomy focused approach doesn’t work…?
The Intervertebral Discs
The discs between the bones in your spine are important.
“The intervertebral disc (IVD) is a tough, composite biomaterial which acts as a viscoelastic weight-bearing cushion and is a major contributor to the spinal flexibility and mechanical stability properties of the spine.
These networks imbibe water into the IVD resulting in the generation of an internal hydrostatic pressure which equips the NP with the ability to act as a viscoelastic cushion to counter compressive axial spinal loading.”
In other words, it works as a dynamic keystone to provide an adaptable and strong base for all human movement and postures.
So it’s easy to see how an injury to this tissue could cause a problem.
Disc Healing
There’s plenty of evidence that many people have intervertebral disc injuries and don’t have any pain.
There’s also evidence that many of these tears spontaneously heal over a year (the outter layer tears). There are new studies coming out to determine which ones will heal and which ones won’t (large herniations actually heal better, more nucleus populous is better, etc…see reference below).
So it’s not always a problem, but when it is, it can cause a lot of frustrating pain.
Why does the disc become a problem? Isn’t the body great at healing itself?
The problem is that the inside of the disc is avascular. Which limits it’s ability to heal.
“Repair of the outer third of the experimentally injured AF [annular fibrosis] is a universal finding but this repair process does not extend into the inner regions of the AF”
*Note the lack of blood supply (vascularization) to the inner disc in the adults. Much like the meniscus in the knee.
Hydrodynamic Dysfunction
As mentioned earlier, the intervertebral disc is a very important component of spine stability and movement.
When damaged it can cause a lot of problems.
Furthermore, these don’t always heal. And if ignored, could get worse.
“Rim lesions also propagate in some cases along the track of the original defect as far as the contralateral AF [annular fibrosis] or between adjacent annular lamellae leading to delamellations which may induce circumferential defects. Propagation of outer annular defects into the NP as radial defects are also frequently seen. All of these defects have previously been described in pathological human IVDs and severely impact on the biomechanical competence of the IVD.”
Or in other words, if the pathoanatomy and pathobiomechanics are ignored, it could get worse.
Just like ignoring an ankle sprain or rotator cuff strain could lead to poor healing and recovery, ignoring a spine injury can make it worse.
The Good News
The body is extremely resilient.
There is great amount redundancy allowing for healthy compensations.
And most importantly in this case, the bio-hydromechanics and anatomy can be predictable.
With a proper evaluation, the right movement patterns and exercises can be found that will fully resolve the symptoms of a disc injury.
Usually after we resolve these injuries, people are able to return to all their normal hobbies, activities, and exercises without any modifications.
Summary
If your back pain isn’t getting better, or keeps coming back, there may be something more going.
The good news as mentioned above, is that it might simply be a hydrodynamic/mechanical issue, which is something we can easily fix.
Contact us if you need any help.
