Causes:

Lumbar disc injuries and degeneration are a common injury to the low back. These injuries are usually the result of prior minor injuries to the low back that accumulate, distort the structural integrity and lead to degeneration/desiccation/integrity loss to the lumbar discs over time. Another common cause can be a physically short leg, which also causes distortion to the structural integrity and leads to degeneration/desiccation/integrity loss to the lumbar discs over time.

Anatomy:

The discs of the spine are primarily fibro cartilage that are between each of the vertebra from the second cervical vertebra down to the 5th lumbar vertebra/Sacrum(Pelvis). These fibro cartilage pads provide the spine with flexibility, space for peripheral nerves to exit the spine and axial force distribution. They are not, as commonly thought, “shock absorbers”. The sagittal curves in the spine provide axial force absorption.

The disc itself has an extremely dense and hard center called the nucleus pulposus, which is held in the center of the disc by concentric rings of tissue called the annulus fibrosis.

Symptoms:

When the disc degenerates and loses structural integrity, the nucleus of the disc pushes through the annulus and causes different disc conditions that create pain and nerve dysfunction/pathology. The symptoms from a disc pathology (in order of severity) include but are not limited to:

– Local pain in the low back, axial disc decompression therapy is the first step.
– Radicular Symptoms, which include:

  1. Numbness and tingling in the leg or foot usually on one side, but sometimes bi-laterally. Axial disc decompression therapy is the first step.
  2. Pain in the leg or foot (sciatica), again usually on one side, sometimes both sides. Axial disc decompression therapy is the first step.
  3. Weakness in the leg or foot (“drop foot”) with the onset of loss of muscle mass. A consult with a surgeon is indicated in advanced cases.
  4. Cauda Equina Syndrome, which causes “saddle anesthesia” in the buttock, crotch and inner thighs. Also, the inability to urinate, defecate and sexual impotence. These symptoms are a medical emergency and surgery is indicated right away to prevent permanent damage.

Below is an image describing different disc pathologies

Below is a diagram of the path of the nerve roots of the low back and what parts of the lower extremity are affected by disc pathologies in specific areas.

Treatment/Rehabilitation:

Typically, only the most extreme disc pathologies (sequestrations) require a surgical intervention. Utilizing non-invasive axial disc decompression therapy in conjunction with structural rehabilitation, in the vast majority of cases, is the safest and most long-term effective approach to treating these disc conditions. This approach is the first step in rehabilitating this type of injury, there are two more steps that complete the process for a stable and healthy long-term prognosis.

After the symptoms have “centralized”, which means that they have receded up the leg and they are just localized to the low back. This shows that the impinged nerve and the disc in the low back is healing. Once the local pain has subsided as well, the second step that needs to be utilized is the reformation of the sagittal (front to back) and coronal (side to side) balance of the spine so that the degeneration that caused the issue is stopped from progressing at an advancing rate. This is done with different forms of traction to the spine and postural exercises in order to restore structural integrity. If this is not done, the chances of the condition re-emerging soon are high.

Likely the condition will establish a pattern of increasing in severity, frequency and duration over time. The structure of the spine being compromised puts abnormal pressure on the disc, therefore causing the issue to come right back and progressively worsen. This is when surgery becomes the only option. The final step of the rehabilitation process is strengthening the structural changes made so the condition is fully rehabilitated. Here we use spinal stabilization exercises, doctor prescribed spinal orthotics and specific postural exercises. If (patient compliance after rehab is always a big “IF”) the patient utilizes these tools after rehabilitation to keep the condition stable, the prognosis is good.

Healthy Structure = Healthy Tissue:

Below is a diagram of the “ideal” structure of the spine in the sagittal (front to back) plane. Restoring as much of this “ideal” structure as possible (which depends on the amount of degeneration already in the spine) is vital to a good long-term prognosis and the avoidance of surgical intervention. To orient yourself with the image, the top is the neck and the bottom is the top of the pelvis. The left side is the front of the spine and the right side is the back of the spine. These curves form front to back, alternating from cervical (lordosis) to thoracic (kyphosis) to lumbar (lordosis), create a “balance” and provide shock absorption to the spine against gravity. This is the primary reason that our practice name is Vital-Balance.

Below is shown the effects of coronal (right to left) imbalance to the low back and pelvis caused by a short leg. Balancing leg length and the pelvis/low back is another factor in improving the long-term prognosis of this condition.

I want to make clear that the above represents the vast majority of cases that present to our clinic. These are not the only reason these problems develop. In many cases it is a combination of the above causes and in some cases, there is another level of complexity or genetic predisposition. However you do develop the problem, we are able to accommodate and rehabilitate (with the proper equipment, technology and clinical experience almost all cases of lumbar disc injuries.

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