It is estimated that at any given time, about 40% of the adult population experiences lower back pain. That means, today when you walk on a busy street full of pedestrians, four out of ten people you see are experiencing some degree of lower back pain. 50-85% of all people will experience lower back pain at some time in their lives.
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For many cases of low back pain, the source of the pain emanates for the intervertebral disc, or IVD. This is the fibro-cartilagenous material that connects vertebrae together and is responsible for bearing most of the weight placed on the spine. Its architecture is designed to absorb shocks using the incompressible nature of water (hydrostatic pressure), which is mostly contained in the nucleus pulposus of the disc. The nucleus serves to redistribute and dampen the forces placed on the spine so as to avoid damage. This comes in handy when walking, jumping, sitting, standing, and of course picking up heavy things.
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Problems arise when the disc weakens, allowing internal derangements to occur. Basically this means shifts in the shape of the disc that alter the proper alignment and movement of the spinal joint segment, and/or block or partially block nerve pathways, causing nerve root impingement and pain down the leg.
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One of the home care accessories I prescribe for my low back pain patients is the PosturePump™ Spine Retrainer. This innovative device helps to rehydrate weak and bulging disc derangements by increasing the space between vertebrae using an air bladder controlled by a hand aspirator. As the disc volume increases, a negative pressure develops and a pressure gradient forms, which draws fluids (capillary blood), nutrients, oxygen and reparatory cells into the disc. This can help the disc regenerate, and the lumbar extension forced by the PosturePump™ Spine Retrainer can mechanically force the posterior disc bulge back to center at the same time, relieving symptoms.
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Even if you don’t have a bulging disc, the PosturePump™ can serve as a good preventive measure to keep your discs healthy and strong.
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Watch the video to see how this works.
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If you have recurrent pain of any type, stay tuned for further posts…you just might run into something that will make a significant impact on your quality of life. Please consider sharing this information, as it may be helpful to someone in your social circles. Thanks for reading!
Whiplash is the colloquial term for a neck sprain strain injury that comes about from the head and neck being “whipped” back and forth as the result of a short-lived acceleration and deceleration of the body. Perhaps the most common event that can create this is a car collision; specifically a rear end car collision. Other things that can cause it are roller coaster rides and other amusement park rides; bungee jumping; horsing around and similar types of accidents.
Let’s discuss whiplash from a car accident. You’re sitting in traffic, and all of a sudden you hear a loud screech and feel something powerful crash into the back of your car. You hear crunching metal, and maybe even shattered glass. Your back sinks into your car seat as your car is thrust forward from the impact, and your body suddenly stops and reverses direction. You instinctively grip your steering wheel and stiffen your arms to protect yourself, which braces your torso somewhat but because of the flexibility of your neck and the weight of your head, your neck bends back sharply and recoils violently forward, then back again until it rests. In that split second, your neck muscles, not having enough time to react do not protect your cervical (neck) spine and suffer microtears. Swelling sets in; then soon after, neck stiffness. Depending on the force of the impact and other factors such as the speed and mass of the car that struck you; the amount of denting/deformation of your car, and your body type other areas can experience injury as well. This includes the upper shoulders, mid and lower back, jaw, wrists, knees and ankles. Most pain in a whiplash, however, is centered in the neck, upper shoulders and upper back.
I made a video on what to do for whiplash that illustrates a good home care procedure to alleviate the pain and rehab the neck. If you’ve suffered a whiplash injury to your neck, and were cleared by the emergency room of any red flags, the goals will be:
Reduce pain and swelling
Reduce scar tissue build up by doing gentle, active stretches, even during the pain period
Restore joint (verbebral) biomechanics and neck range of motion
Strengthen surrounding muscles in the neck
Restore proper neck curvature
You’ll also want to get enough protein (whey protein is the best, followed by eggs and fish), foods high in anti oxidants, and drink enough fluids during your injury rehabilitation. Taking 2000 mg Vitamin C is also a good idea, as it has shown to be helpful in wound regeneration. Lastly, get out in the sun and expose your neck and back for about 20 minutes. Sunlight stimulates Vitamin D synthesis and may have other beneficial effects on the cellular level.
If you were in a car accident and want extra reassurance, find a chiropractor who has experience treating soft tissue injuries. Don’t just go with the office that has the loudest advertising– make sure you are comfortable with the office and the doctor first after asking a lot of questions. I have treated whiplash injuries in San Francisco for over 15 years and have had great success. One of my most useful pieces of equipment for treating acute sprains and strains such as whiplash is the Solaris phototherapy unit, which uses therapeutic light between 660-800 nm wavelength. Light at this frequency actually speeds up wound healing at the cellular level by increasing ATP production (basically, increasing cellular metabolism, which includes waste removal). Once the pain and swelling is down, I initiate manual therapies to restore joint biomechanics and to rehabilitate the surrounding soft tissues to reduce the risk of chronic pain.
If you happen to live or work near San Francisco and were injured in a car accident, you can contact my office at (415) 627-9077.
The short answer to the first question is “yes” if the bulge is not severe and the body still has in place the mechanisms to keep the disc living and healthy (see below).
The other answer to the first question is “no” if the disc bulge is the result of breakdown of the nutrient-delivery mechanism to the disc. If this is the case, it is a matter of time before the disc totally degenerates. Physical therapy, chiropractic, spinal decompression and exercises can slow it down, but one cannot do these things indefinitely and often enough to stop the progression.
It’s important to know that your spinal discs are mostly avascular; meaning, don’t have a direct blood supply. Discs get their nutrients (water, oxygen, glucose, minerals, vitamins) via slow absorption from the capillaries directly underneath the vertebral end plates. At the end of the day, your discs flatten from the effects of gravity. As you sleep, they soak up fluids and expand, so that by the time you wake up in the morning you are at least 5 mm taller than when you first went to bed. This is called the diurnal cycle of fluid movement in and out of the disc and is the major means of nutrient delivery.
At the center of the disc is the nucleus, which has tiny cells that make the proteoglycan molecules responsible for attracting and holding onto water. This maintains a hydrostatic pressure that allows the disc to bear about 80% of the weight applied to its spinal level. These cells, similar to chondrocytes that make collagen in the joints, are the most active when the pressure in the disc is about 3 atmospheres. If the pressure is higher (obese individuals, those who carry heavy weight frequently at work) or lower, the cells make less of these molecules, putting the disc at greater risk of drying out. Injuries to the internal part of the disc or vertebral bodies can increase the volume of the nucleus, drastically reducing its hydrostatic pressure and slowing down proteoglycan synthesis. This is one of the pathways of degenerative disc disease, or DDD as the posterior (facet) joints, which are not designed for bearing much weight take on the responsibility of the disc and quickly wear down, forming the familiar osteophytes (bone spurs) seen on X-ray and MRI studies.
Here are the basic risk factors for developing DDD/ bulging discs:
1) History of Structural Damage to the Disc or Vertebra
Single event trauma to the spine resulting in damage to the vertebral end plates . An example would be a parachuter landing hard on the ground on his feet. This can cause a small injury, or even a significant compression fracture to the bony end plates– the surfaces to which the disc attaches. This is bad news, because nutrients to the disc (blood, oxygen, glucose) traverse through these end plates from the top and bottom of the disc. If it is damaged, the area calcifies and “shuts the gate,” depriving the disc of critical nutrients needed to stay healthy. This sets the stage for a slow procession of degeneration over the years which will have phases of back pain, stiffness, disc bulging, stenosis, and in severe cases leg pain, leg weakness and altered sensation.
Repetitive, axial loads to the spine. An axial force is one that travels straight down the spine, while standing. If you are in a job that requires frequent heavy lifting, especially above the shoulders; or requires you to carry 50 or more pounds of gear most of the day, you are placing axial loads on your spine. Similar to #1, it can slowly damage the vertebral end plates and damage the nutrient delivery system to the disc.
2) Hereditary Factors – there are respected studies that strongly suggest a genetic component to DDD. One study showed that there is a 50% greater chance of developing severe disc degeneration in the relatives of past disc surgery patients. Another study found mutations in the genes responsible for the synthesis of proteoglycan molecules, which are responsible for water retention in the disc. If the disc cannot attract and hold onto water, it cannot maintain its hydrostatic pressure. As a result, it loses its ability to distribute weight and slowly dessicates (dries out).
3) Occupation. This is pretty obvious. Those who work with heavy machinery or require heavy lifting are more prone to developing bulging discs.
4) Smoking. Smoking damages the fine blood vessels that the disc depends on to deliver nutrients. It also generates a lot of free radicals, which can damage the disc further. Some surgeons require patients to be “smoke-free” for at least three months prior to surgery.
So, here are the lessons to take here. First, if you have a parent who suffers from bulging discs and degeneration, realize that you have a 50% greater chance of developing them on your own. You may have a mutant gene that is making defective collagen in your disc, making it a ticking time bomb ready to go off in the near future. Your best bet is to minimize the expression of this gene, and a good way to do it is to eat as healthy as you can; ditch the toxins (smoking, excessive alcohol and sugar); avoid getting overweight, and maintain positive thoughts (may affect gene expression to your benefit).
Secondly, avoid unnecessary axial forces to your spine. Stay away from things that involve hard landings on your feet, and don’t lift weights in a way that places pressure to your lower back.
Have you been told by your doctor that you have a bulging disc in your spine? Then read on, and make sure to watch the video a few paragraphs down.
First of all, understand the following as it pertains to disc, or disk bulges:
1. Bulging discs can only be diagnosed from an MRI (magnetic resonance imaging) study, not an x-ray study. If a doctor told you that you have a bulging disc just by looking at your x-ray, find another doctor fast.
2. A certain amount of disc bulging is normal, or typical in the population. The primary function of a spinal disc is to assist the spinal column in supporting the weight of the body. Since it is viscoelastic (can change shape, due to its fluid behavior), a disc will naturally bulge outwards when standing, like pressing down on a donut. If you had your MRI in the late afternoon, gravity will have acted on your discs for many hours already (unless you were lying down the whole day, which is obviously unlikely), and will show discs with slight bulging, even when you are recumbent (most MRI machines are recumbent; i.e. the patient lies down during the study).
3. What really matters is if there is injury to the disc, and whether or not it is obstructing nerve tissue in any way.
The architecture of a disk can be imagined as a slice of an onion, but with a jelly center, encased tightly by a vertebra above and below. If an injury event causes that jelly center to punch through successive rings in a focalized (as opposed to broad) spot, but the last couple of rings remain intact, you have a disc protrusion. If the jelly punches all the way through the outer ring and is still connected to the disc, it is called a disc prolapse. If the jelly center punches through the outer ring and breaks off and settles in the spinal canal, it is called a sequestered disc.
These can be painful, as there is internal injury to the disc and the protrusion can potentially press against an exiting nerve root or spinal cord, depending where it is located. Pressure to an exiting nerve root in the lower spine most often causes same side leg pain, numbness and/or weakness. Disc prolapses and sequestered discs are usually addressed via spinal decompression surgery or discectomy (total or partial removal of disc); disc bulges are usually first handled conservatively via manual therapy and exercises.
A disc injury can also not involve bulging. An annular tear or fissure is when the rings of the disc separate circumferentially (along the perimeter), instead of split radially (outwards from center). These can be equally painful, as they are deep and difficult to heal.
If you have a disc bulge, there is still hope for recovery without surgery. It all depends on your body’s ability to heal itself. In this sense, those who have a greater chance of recovering from a bothersome disc bulge have an otherwise healthy spine: no to minimal arthritic changes, good bone density, healthy ligaments and tendons (basically, younger patients) good spinal flexibility, well-conditioned spinal musculature, and not overweight.
Here is a video of stretches/ maneuvers you can do that may help reduce the size of a disc bulge before it progresses to a surgical case. Warning, do not attempt to do these exercises if they cause a significant, sharp increase in pain. Do them slowly and pay attention to the changes in pain characteristics during the exercise. If you notice reduced pain with a certain movement, then continue.
1. Place yourself on movement restrictions for at least a few months: no heavy lifting, no jumping, no prolonged sitting, no frequent bending at the waist.
2. Eat a healthy diet consisting of plants and animals only; i.e. minimize processed food including grain foods. Flood your body with the necessary vitamins, minerals, and anti-oxidants to give it a boost as it attempts to repair your bulging disc.
3. Lose the weight, if you you are overweight. This alone will take significant pressure off of your injured disc. Eating a protein and good fat based diet along with lots of plants is a natural, healthy way to drop the pounds without having to rely on exercise too much.
4. Stretch your back frequently. Lie on your back, knees bent with feet on the floor. Take a deep breath in and gently and slowly arch your lower back as your stomach rises; exhale and flatten your back against the floor; repeat 10 times 4x/day.
Another exercise you can do is lie on your back and hold both knees tightly to your chest. Try to shape your spine in an egg-shaped curve, especially the lower spine. Hold for 20 seconds; repeat five times. Alternatively, you can get a large exercise ball (Swedish exercise ball) and lie on top of it, with your lower back at the very top. The curvature of the ball will slightly traction apart the disc.
5. Ask your doctor if you are a candidate for using an inversion therapy table. Last May, I wrote an extensive post about when to use an inversion therapy table for back pain. While this can stretch the spinal discs using gravity, it is not for everyone.
As your pain decreases, it usually means that the bulge is decreasing in size. At this point, you can do light back extensions: stand with feet 6″ apart. Place both palms behind your hips, and gently arch your back. Hold for ten seconds; repeat five times, several times a day.
Alternatively, lie on your stomach. Make a triangle with your hands (hands open, touch index and thumb fingertips together) and place under your chest. Push up (extend your elbows) and arch your lower back, while arching your neck back as well (this is called the cobra position in yoga). When you do lower back extensions, the backs of the vertebra pinch together and force the bulge towards the center of the disc.
Remember to do these exercises slowly with good form and control; remember to breathe. If any of them cause an increase in pain, it means you are not ready for them quite yet, and discontinue.
As you age, the tendons and ligaments in your body get weaker/looser, which changes the dynamics of your joints. It’s probably related to the decrease in human growth hormone levels as we age.
Tendons attach muscles to bones, while ligaments attach the ends of bones forming a joint. The area that you will notice first when your ligaments weaken are your feet, as they bear all the body’s weight when standing.
I’ve noticed that my feet have flattened over the last ten years (I didn’t have big arches to start with). When your feet flatten, a couple of things can occur:
1. You will walk slower. The foot arch is like a mechanical spring device that is integral to bipedal locomotion: in mid-step, it loads up potential energy (using the plantar fascia– a broad ligament in the sole of the foot), and in toe-off helps push off the foot from the ground and initiates forward leg swing (think of a steam catapult on an aircraft carrier, assisting jets to take off and fly). When your feet flatten, you lose a lot of this ability and have to rely more on your leg muscles to walk.
2. You can develop calluses under your metatarsal joints (ball of the foot). The flattening effect places more pressure on these joints when you stand.
3. You can develop foot pain and fatigue.
4. You can develop ankle, knee, hip, and lower back pain.
#s 2, 3 and 4 are more likely if you are overweight.
If you have any of the above symptoms, and have flat feet, here are the things you can do to lessen the effects:
2. Eat bone broth soup to give your body a ready supply of the building blocks of collagen, which is the main component of connective tissue.
3. Get foot reflexology treatment. I go to this local Chinese massage center that does Asian foot massage. It is one of those painful pleasures– after soaking your feet in a hot water tub for 15 minutes, the therapist kneads out all the sore spots under your feet, including the small muscles of the toes. My feet feel great afterwards.
4. Roll a golf ball under the sole of your feet: back and forth, and in circles. Do this while you’re sitting, and control the deepness of the massage by varying the amount of pressure you place on the golf ball. Great exercise to do while sitting at your desk; your co-workers won’t even know you’re doing it as they pass by.
5. Walk barefoot outside, as much as you can. This exercises the intrinsic muscles of the foot, and all the small joints. You do not get this benefit if your feet are constrained in a shoe.
6. Consider wearing a foot shoe, like the popular Vibram Five Fingers brand. This lets your toes move independently when walking, which exercises the foot muscles, and is the next best thing after going barefoot.
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I’ve been fielding a lot of questions about bulging discs lately. Here are some of the questions I get:
