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Spine Care

Back Clinic Chiropractic Spine Care Team. The spine is designed with three natural curves; the neck curvature or cervical spine, the upper back curvature or thoracic spine, and the lower back curvature or lumbar spine, all of which come together to form a slight shape when viewed from the side. The spine is an essential structure as it helps support the upright posture of humans, it provides the body with the flexibility to move and it plays the crucial role of protecting the spinal cord. Spinal health is important in order to ensure the body is functioning to its fullest capacity. Dr. Alex Jimenez strongly indicates across his collection of articles on spine care, how to properly support a healthy spine. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.


The Beneficial Properties Of Yoga For The Body

The Beneficial Properties Of Yoga For The Body

Introduction

When many individuals look for ways to relax after a stressful event in their daily lives, many people have an exercise regime that allows them to take their minds off of their hectic lives. When finding the proper exercise, it is best to consider that everybody is different and has different fitness levels. Many individuals could be dealing with chronic issues that affect them drastically and with so much pain in their bodies. When these chronic issues overlap with muscle and joint pain, it can make the body dysfunctional while potentially being involved in environmental factors. Yoga is a low-impact exercise that helps tone muscles, relax tension in the body, and focus on deep breathing. Today’s article looks at the benefits of yoga for the body, how chiropractic care works together with yoga, and different yoga poses can help manage various chronic issues. We refer patients to certified providers specializing in musculoskeletal treatments to help many individuals with musculoskeletal problems affecting their bodies. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

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The Benefits of Yoga For The Body

Have you been dealing with chronic stress affecting your quality of life? Have you been dealing with bladder or gut issues constantly? What about feeling muscle stiffness in your back, neck, shoulders, or pelvic regions? Some of these symptoms are signs that you could risk developing musculoskeletal problems associated with pain. Dealing with musculoskeletal issues related to pain can make a person feel miserable and have stress affecting their bodies. Yoga is a low-impact exercise that doesn’t put pressure on the joints and will provide a full-body workout through strengthening and stretching weak muscles. Yoga has many benefits for many individuals that are dealing with the following:

  • Muscle weakness
  • Back pain
  • Neck pain
  • Pelvic Pain
  • Arthritic symptoms
  • Cardiovascular issues
  • Chronic stress

Studies reveal that environmental factors are involved in non-specified chronic pain in the spine, overlapping musculoskeletal disorders causing many individuals to try to find relief. Many individuals incorporate yoga because it is a safe and effective way to alleviate various forms of back, neck, or pelvic pain causing issues to the body. Yoga utilizes gentle stretching and strengthening of weak, injured muscles while increasing blood circulation to promote healing in the body. 

 

Chiropractic Care & Yoga

When people are dealing with health conditions or injuries that have affected their bodies, it can make them feel frustrated and think their injuries are taking forever to heal. Many individuals don’t realize that incorporating yoga practices provides impressive health benefits while mirroring the similar foundations of chiropractic care. Both chiropractic care and yoga provide many beneficial results to an aching body that needs a good stretch and ready the body to heal itself naturally. Chiropractic care includes spinal manipulation to the spinal joints while reducing inflammation and strengthening weak muscles. Yoga allows the body to increase its flexibility and stamina, reduces stress and blood pressure, and provides a better sense of breathing and balance.


Yoga For Chronic Pain-Video

Have you felt muscle stiffness in your neck, back, or body? Have you felt sluggish or overly stressed from your day-to-day lives? Do you want to improve your balance? If you have been experiencing these issues affecting your quality of life, why not incorporate yoga as part of your exercise regime? The video above shows that yoga poses for chronic pain affect the body, including the neck, back, and pelvic regions. Studies reveal that yoga can help relieve intense neck pain while improving pain-related function disability. Yoga allows the muscles to not only relax but strengthen them as well. Yoga can also help improve the body’s range of motion through deep breathing and give more awareness of how the body holds tension in places a person hasn’t realized they were holding onto.


Yoga Poses For Different Issues

When a person does yoga, they will go through various poses and repeat them constantly as their body begins to get used to the movements. This allows the body to challenge itself and helps the individual focus more on deep breathing. A good example would be an individual taking a yoga class due to experiencing pelvic pain. By going through each yoga pose, many individuals suffering from pelvic pain will reduce the pain intensity while improving their quality of life. Below are some yoga poses that anyone can do to reduce pain associated with their back, neck, or pelvis.

Bridge Pose

  • Lie on your back
  • Bend both knees while placing the feet on the floor at hip-width apart
  • Arm on the sides with palms facing down
  • Press feet to the floor and lift the hips as you inhale
  • Engage the legs and buttock 
  • Hold 4-8 breaths and exhale to lower the hips back to the ground slowly

 

Cobra Pose

  • Lie on your stomach with hands near the chest just under the shoulders and fingers facing forward
  • Keep elbows close to sides
  • Press hands on the floor and slowly lift your head, chest, and shoulders while slightly bending the elbows by inhaling
  • Exhale to go back down slow and rest your head

 

Cat-Cow

  • Be on all fours, hands under the shoulders and knees under hips (Think like a table)
  • Inhale to lower your core to the floor as your head looks up to the sky
  • Exhale slowly to lower your chin to the chest as you round your back
  • Continue fluid motion for a minute

 

Forward Bend

  • Be in a standing position, and feet are at a hip distance apart
  • Lengthen the body as you lean forward while keeping the knees slightly bended
  • Place hands on either legs, yoga block, or the floor (Whichever makes you comfortable)
  • Tuck the chin into the chest, letting the neck and head relax
  • Gently rock your head side to side to relieve tension in the neck and shoulders
  • Slowly roll up to a standing position allowing the arms and head to be the last to rise

 

Supine Spinal Twist

  • Lie on your back while your knees bent and feet flat on the floor
  • Extend arms out of the side and place palms down on the floor
  • As you inhale, breathe into the gut and lower limbs
  • Exhale to lower knees on the left side (Look at the opposite way to slowly stretch the neck and shoulder muscles)
  • Pay attention to the stretches for 5 breathes as well as the lengthening sensations on the ribs
  • Return the knees to the middle and repeat on the right side

 

Child’s Pose

  • Sit back on the heels with the knees together (For added support, you can use a rolled-up blanket under your knees)
  • Bend forward and walk hands in front of you
  • Gently rest your forehead on the floor
  • Keep arms extended in the front while focusing on relieving tension in the back as the upper body falls to the knees
  • Stay in that pose for 5 minutes

 

Conclusion

Incorporating yoga as part of an exercise regime allows the individual to focus on deep breathing while calming the mind. Yoga is a low-impact exercise that helps strengthen weak muscles associated with pain and inflammation. Yoga provides a full-body workout that benefits many people dealing with chronic pain. Utilizing yoga as part of a daily practice might help individuals learn to be calm and practice mindfulness.

 

References

Busch, Fred. “Healing Benefits of Yoga.” Spine, Spine-Health, 27 Jan. 2004, www.spine-health.com/wellness/yoga-pilates-tai-chi/healing-benefits-yoga.

Crow, Edith Meszaros, et al. “Effectiveness of Iyengar Yoga in Treating Spinal (Back and Neck) Pain: A Systematic Review.” International Journal of Yoga, Medknow Publications & Media Pvt Ltd, Jan. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4278133/.

Li, Yunxia, et al. “Effects of Yoga on Patients with Chronic Nonspecific Neck Pain: A Prisma Systematic Review and Meta-Analysis.” Medicine, Wolters Kluwer Health, Feb. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6407933/.

Saxena, Rahul, et al. “Effects of Yogic Intervention on Pain Scores and Quality of Life in Females with Chronic Pelvic Pain.” International Journal of Yoga, Medknow Publications & Media Pvt Ltd, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5225749/.

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Fatigue Ankylosing Spondylitis Back Clinic

Fatigue Ankylosing Spondylitis Back Clinic

Fatigue Ankylosing Spondylitis: Fatigue is a significant complaint for individuals dealing with ankylosing spondylitis. Ankylosing spondylitis is chronic inflammation of the spine’s joints that can cause them to become fused or locked up. The process can cause the spine to stiffen, limiting movement, reducing flexibility, and generating a severe hunched posture. Symptoms can include back pain, stiffness, and the inability to take a deep breath if the ribs are involved. Fatigue can have a variety of causes, but in ankylosing spondylitis, inflammation and cytokines play a significant role. The underlying cause of ankylosing spondylitis is still being researched, but it currently affects around 300,000 Americans.

Fatigue Ankylosing Spondylitis

Fatigue Ankylosing Spondylitis

Most individuals with ankylosing spondylitis experience pain in the lower back but can also feel pain in their hips and neck, have abdominal pain, or experience problems with vision. Inflammatory back pain is usually strongest in the morning but can also come from inactivity.

Spinal Condition and Extreme Exhaustion

The inability to move along with a decreased spinal range of motion impacts body functionality, sleep quality, and respiratory function affecting energy levels and leading to mild to severe fatigue. Studies have shown that 50% – 85% of individuals with ankylosing spondylitis experience fatigue.

Fatigue is brought on by inflammation, as the body generates the same chemicals when fighting a cold or flu; an individual’s body constantly works to reduce inflammation, leaving them drained and unable to perform ordinary tasks. Inflammatory diseases take a significant toll on the whole body, leading to an increased risk of depression and increased fatigue levels.

Exercise, Massage, and Diet

Many individuals find that their symptoms flare up after long periods of inactivity, like sleeping. This can make wanting to fall and stay asleep complicated, exacerbating fatigue and vice versa, creating a vicious cycle. Even though it can be challenging to move, gentle exercise is recommended. Exercise can help slow the disease progression, build muscle, and improve sleep. It is recommended to speak with a spine specialist, doctor, chiropractor, physical therapist, or exercise trainer about a customized exercise treatment program.

Many individuals with ankylosing spondylitis find therapeutic massage helpful in temporarily relieving pain, and stiffness, reducing stress and improving flexibility from increased blood circulation. A combination of gentle chiropractic massage, exercise, ergonomic adjustments, and rheumatology treatment is recommended for many cases. An anti-inflammatory diet comprised of foods like fatty fish, fruits, nuts, and leafy green vegetables can fight inflammation and decrease fatigue.


AS Causes, Symptoms, Diagnosis, Treatment, and Pathology


References

Cornelson, Stacey M et al. “Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.” Journal of chiropractic medicine vol. 16,4 (2017): 300-307. doi:10.1016/j.jcm.2017.10.002

Li, Ting, et al. “Fatigue in Ankylosing Spondylitis Is Associated With Psychological Factors and Brain Gray Matter.” Frontiers in medicine vol. 6 271. 21 Nov. 2019, doi:10.3389/fmed.2019.00271

Zhang, Jun-Ming, and Jianxiong An. “Cytokines, inflammation, and pain.” International anesthesiology clinics vol. 45,2 (2007): 27-37. doi:10.1097/AIA.0b013e318034194e

Sacroiliac Dysfunction Causes More Than Back Issues

Sacroiliac Dysfunction Causes More Than Back Issues

Introduction

Maintaining healthy joints is crucial to preventing injuries from affecting the body. Incorporating physical activities, eating healthy foods, staying hydrated, and getting a routine check-up are ways to ensure that the body is functional, including the joints. The joints in the body act like shock absorbers that soften the impact of any injuries that the body has sustained. However, as the body ages, so do the joints, causing them to become hardened and cause problems in the body. In today’s article, we will look at sacroiliac dysfunction, what issues it affects besides back pain, and how chiropractic care manages sacroiliac dysfunction. We refer patients to certified providers specializing in musculoskeletal therapies to help those with sacroiliac dysfunction. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

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What Is Sacroiliac Dysfunction?

 

Are you experiencing pain in the pelvis? Do your hips seem tighter than usual? Do you feel muscle stiffness when you twist from side to side? Some of these issues are signs that you might be experiencing sacroiliac dysfunction. Around the pelvic region lies the sacroiliac joint, a weight-bearing solid joint connecting the pelvis to the sacrum. It is surrounded by tough ligaments that support the body as it distributes the weight from the upper body to the lower body. However, like all the other joints in the body, any injury or condition can cause this joint to be unstable and succumb to the pain, causing sacroiliac dysfunction. Sacroiliac dysfunction or sacroiliac joint pain is defined as one of the potential causes of axial low back pain. When there are issues affecting the sacroiliac joints, it’s associated with about a quarter of most low back pain cases. This is due to the problems that overlap with pain associated with the low back. Studies reveal that dysfunction in the sacroiliac joint can relate to leg or back pain, making diagnosing the problem difficult. Back pain associated with sacroiliac dysfunction causes the pelvis to be hypermobile, causing the risk of developing radiating groin pain. Leg pain associated with sacroiliac dysfunction causes muscle tension and stiffness to the low back, legs, or buttock region, mimicking sciatica-like symptoms.

What Other Issues Does It Affect?

Many individuals may not realize that when they are experiencing sacroiliac dysfunction, symptoms show that they overlap with lumbar spine pathologies. However, sacroiliac dysfunction can also affect the pelvic region of the body. Studies reveal that when the muscles around the body’s pelvic area become inflamed or irritated, it can cause stiffness in the sacroiliac joints, thus developing the risk of pelvic pain. Pelvic pain is usually defined as non-menstrual pain that causes functional disability to the lower extremities. Around the pelvic region, the lower sacral nerves provide extensive neurologic connections to the structures throughout the pelvic area that maintain normal pelvic organ function. When issues like sacroiliac dysfunction become the risk of pelvic pain, it may potentially involve pelvic symptoms like constipation. Studies reveal that constipation is significantly associated with a high prevalence of pelvic organ prolapse and low urinary tract symptoms. Other issues that sacroiliac dysfunction correlates with are:

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Inflammatory issues
  • Hip pain
  • Pelvic pain
  • Low back pain
  • Piriformis syndrome

An Overview Of Sacroiliac Joint Pain- Video

Are you experiencing radiating from your lower back down to your leg? How about stiffness in your hips? Are you feeling constipated or have a sense of fullness in your bladder? You may suffer from sacroiliac dysfunction in your pelvic region if you notice these symptoms. The video above explains how to understand sacroiliac joint pain. The sacroiliac joint connects the pelvis and sacrum, surrounded by tough ligaments and muscles that help support the body by distributing weight from the upper body to the lower body. When issues affect the sacroiliac joints can overlap other risk profiles like low back pain, leg pain, and pelvic pain. This can make diagnosing sacroiliac dysfunction difficult because the symptoms are similar to other issues. For example, hip pain is associated with piriformis syndrome while potentially being involved with sciatica. How would hip pain be correlated with piriformis syndrome? The piriformis muscle can become overused and injured and can entrap the sciatic nerve (which runs from the lumbar spine, through the hips, and down to the leg), causing radiating, throbbing pain. Other times referred pain in the low back can affect different areas in the body due to sacroiliac dysfunction. Luckily, there are treatments available to manage sacroiliac dysfunction.


How Chiropractic Care Manages Sacroiliac Dysfunction

 

When issues of sacroiliac dysfunction become associated with leg or back pain, physicians often misdiagnose it as a soft tissue issue rather than a joint issue. Many doctors might rule out various medical conditions before including sacroiliac dysfunction as part of the diagnosis. Some treatments like massage therapy can help loosen up the tight muscles surrounding the joints relieving the pain and discomfort. At the same time, chiropractic care utilizes spinal manipulation and mobilization to the affected spinal area. Since the sacroiliac joint is an essential part of the musculoskeletal system, chiropractors specialize in this area. Through practical, non-invasive methods, chiropractic care has proven to not only relieve pain in the spine but can also help rehabilitate the spine. Chiropractors are specially trained to guide the individual through several phases of care that help loosen the stiff muscles and strengthen the joints. Chiropractic care will help decrease the pain from returning to the body and let the individual return to their health and wellness journey.

 

Conclusion

Maintaining healthy joints is crucial to prevent injuries from affecting the body. The sacroiliac joints are part of the musculoskeletal system that connects the pelvic bone to the sacrum. This joint is surrounded by tough ligaments and muscles that support the upper and lower half of the body through weight distribution. When the sacroiliac joint becomes unstable, it can succumb to pain, thus becoming sacroiliac dysfunction. Sacroiliac dysfunction sometimes mimics low back and leg pain, making it difficult to diagnose. Co-morbidities like pelvic pain correlate to sacroiliac dysfunction, causing somato-visceral pain in different body areas. Treatments like chiropractic care can help strengthen the stiff muscles and joints in the body through spinal manipulation and mobilization in practical, non-invasive treatment. Chiropractic care can help rehabilitate the spine while decreasing the pain from returning to the body.

 

References

Jonely, Holly, et al. “Chronic Sacroiliac Joint and Pelvic Girdle Dysfunction in a 35-Year-Old Nulliparous Woman Successfully Managed with Multimodal and Multidisciplinary Approach.” The Journal of Manual & Manipulative Therapy, Maney Publishing, Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4459139/.

Raj, Marc A, et al. “Sacroiliac Joint Pain.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 12 Feb. 2022, www.ncbi.nlm.nih.gov/books/NBK470299/.

Singh, Prashant, et al. “Pelvic Floor Symptom Related Distress in Chronic Constipation Correlates with a Diagnosis of Irritable Bowel Syndrome with Constipation and Constipation Severity but Not Pelvic Floor Dyssynergia.” Journal of Neurogastroenterology and Motility, Korean Society of Neurogastroenterology and Motility, 31 Jan. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6326213/.

Yeomans, Steven. “Sacroiliac Joint Dysfunction (SI Joint Pain).” Spine, Spine-Health, 7 Feb. 2018, www.spine-health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-joint-pain.

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Poor Breathing Quality Chiropractic Care

Poor Breathing Quality Chiropractic Care

The body is a set of complex systems, including bones, organs, nerves, muscles, and tissue. Breathing disorders are increasing, including chronic bronchitis, asthma, emphysema, and other conditions. Viscerosomatic reflexes include poor breathing quality brought on by allergies, breathing disorders like COPD that can cause intense coughing, sneezing, hunching, arching of the back, and heaving that causes back pain and referred pain.

The brain sends electronic impulses to the different areas of the body through the spine/nervous system. If the nerves get shifted, stretched, compressed, or knocked out of position, the brain could start sending messages of pain and discomfort, which can also cause other body systems to malfunction. If the body is constantly transmitting pain signals, it can disrupt sleep, dietary habits, and overall well-being. Misalignment can disrupt the information delivered by the nervous system, leading to inflammation, irritation, and imbalances in the body.

Regular chiropractic maintains the nervous system to operate the way it was designed. Proper alignment of the spine and body will improve the nervous system’s health and function, encouraging the brain to release endorphins achieving pain relief, and leading to optimal health. When the nervous system performs optimally, the other systems will follow, including better breathing quality.

Poor Breathing Quality and Chiropractic Improvement

Poor Breathing

Breathing difficulties are widespread with various causes that include:

  • Allergies
  • Environmental pollutants
  • Viral and bacterial infections that cause inflammation
  • Physical health
  • Anxiety
  • Digestive problems
  • Untreated illness or condition
  • An overactive immune response can all contribute to poor breathing quality.

Individuals might not notice that their breathing quality is poor but instead notice they are:

  • Frequent exhaustion
  • Having to stop constantly in the middle of activities.
  • Experience brain fog.
  • Memory issues/forgetfulness.
  • Physical performance – endurance, flexibility, and muscle is deteriorating.

The breathing quality impacts how well the body’s systems can carry out their essential functions and be prepared for unexpected events. The body adjusts oxygen intake capacity in line with the energy required to perform physical activity. All bodily systems, including the cardiovascular, immune, and muscular systems, depend on the respiratory system to generate energy.

Better Breathing Benefits

Achieving improved lung function can help with:

  • Digestion
  • Sleep
  • Cognitive activities
  • Heart health
  • Waste elimination
  • Immune protection against viruses, bacteria, fungi, and other diseases.

Chiropractic

A crucial part of the respiratory system’s function is transporting nutrients and oxygen throughout the body. Chiropractic treatment releases tension by moving muscle fascia and the spine that may have become stuck, compressed, or shifted out of position, causing poor posture and injury. Chiropractic eliminates toxins and cellular waste from tight, knotted areas by breaking up stagnant tissues.

Circulation Improvement

Chiropractic increases circulation, allowing fresh blood, lymphatic fluid, nutrients, and oxygen to enter the deprived tissues. These regions include:

  • Muscles in the shoulder, neck, back
  • Bones and joints across the spine
  • Body tissues
  • Ligaments
  • Tendons

Chiropractic treatment can be manual/mechanical traction/decompression, combined with therapeutic tissue massage, exercise, and diet recommendations.


Decompression De La Espalda


References

McCarty, Justin C, and Berrylin J Ferguson. “Identifying asthma triggers.” Otolaryngologic clinics of North America vol. 47,1 (2014): 109-18. doi:10.1016/j.otc.2013.08.012

Purnomo, Ariana Tulus, et al. “Non-Contact Monitoring and Classification of Breathing Pattern for the Supervision of People Infected by COVID-19.” Sensors (Basel, Switzerland) vol. 21,9 3172. 3 May. 2021, doi:10.3390/s21093172

Schend, Jason, et al. “An Osteopathic Modular Approach to Asthma: A Narrative Review.” The Journal of the American Osteopathic Association vol. 120,11 (2020): 774-782. doi:10.7556/jaoa.2020.121

Viscerosomatic Pain & The Spine

Viscerosomatic Pain & The Spine

Introduction

The body has many nerve roots that are intertwined and coming out from the spinal cord, which is part of the nervous system. One of the main components of the nervous system is the vagus nerve, which is part of the parasympathetic nervous system as it helps inform the brain about the state of the inner organs in the body. The vagus nerve helps maintain the body’s metabolism and homeostasis from diseases and injuries that occur either inside or outside the body. Many inner organs, muscles, or tissues get affected when a person has suffered from an injury or developed infections in their body. They can cause many symptoms that can dysfunction the body. It can affect the spine, nerve roots, internal organs, and joints, making the individual feel a sense of hopelessness. Today’s article will look at the unique connection of viscerosomatic reflexes and how it affects the body, as well as how viscerosomatic pain can affect the spine causing the individual many spinal issues. We refer patients to certified, skilled providers specializing in osteopathic and chiropractic treatments. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

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What Are Viscerosomatic Reflexes?

 

Have you experienced pain in your arms, legs, or back? How about feeling dysfunctional in your urinary tract? Have you noticed that not only your chest has started to hurt but also your gut and lower back? Many of these are signs of you having pain due to your viscerosomatic reflexes in your body. Research studies have defined viscerosomatic as regular visceral activity in the body stimulated by the somatosensory nerves that can help recognize abnormal viscerosomatic reflexes. These nerves are connected to the central nervous system, which travels through the spinal cord and can affect the body. The best example is when a doctor is giving a reflex test and uses a rubber mallet to hit the knee to see if a person still has reflexes in their body. Since the vagus nerve is part of the parasympathetic nervous system, when it becomes damaged, it can cause numerous effects on the body research studies have found that any visceral disturbances that are affecting the human body can cause an increase in muscle tension and decrease the pain in the corresponding spinal ligament that can restrict the muscle mobility to the tissues and affecting either the motor or sympathetic nerve. This causes the body to experience pain affecting one part of the body to the corresponding affected nerve.

 

How Does It Affect The Body?

Since the body has so many connections like the gut-brain axis, which helps regulate the body’s metabolism and homeostasis, the endocrine system that allows the transport of hormones to the rest of the muscles, tissues, and organs through the nerve roots, and the nerve roots themselves are connected as they help with the sensory-motor function with the arms and legs, so the body can move around. When these connections are being damaged and start to affect the rest of the body, it can lead to other health problems that do affect the body. Research studies have found that when the body is suffering from visceral pain in the organs can affect different areas. A couple of examples include:

  • Bladder issues affecting the perineal area
  • Cardiovascular disorders causing arm and neck pain
  • GI disorders causing discomfort

Even though visceral pain’s effects are not life-threatening, it can dampen a person’s mood by causing a negative impact associated with distress, sleep, and work disturbances, and even causing sexual dysfunction in the body.


An Overview Of Viscerosomatic Reflexes-Video

Have you experienced cardiovascular issues that are causing arm and neck pain? Have you been feeling some discomfort in your gut or your pelvic area? Have you been experiencing pain that is negatively impacting your quality of life? This could be due to viscerosomatic pain affecting your body and causing these symptoms. The video above explains how the viscerosomatic reflexes are connected to their corresponding muscles and organs. When the body is suffering from issues that affect the related muscles, it is known as viscerosomatic pain. Research studies have shown that individuals suffering from viscerosomatic pain will have multifaceted problems in the viscerosomatic reflexes. This type of pain does affect the spinal neurons causing the visceral neurons to become overly sensitive in the body and the affected areas.


How Does Viscerosomatic Pain Affect The Spine?

 

Research studies have found that viscerosomatic can affect the spine by affecting the gut system. Many individuals that are suffering from IBS (irritable bowel syndrome) will often complain about being in pain in their torso areas. They don’t realize that processing the visceral and somatic stimuli can cause the gut to become hypersensitive and affect the spinal cord neurons to overlap. Another research study has mentioned that pelvic pain in an individual can cause more symptoms that involve many organ systems causing visceral symptoms combined with somatovisceral convergence. When viscerosomatic pain affects many body parts, it can be difficult for a diagnosis to be conducted. 

 

Conclusion

The body has many nerve roots that connect the body by branching out of the spine and providing sensory-motor functions to the corresponding muscles and tissues. When the body becomes injured, it can cause nerve not only damage to the body but also affect the muscles and organs. This is known as viscerosomatic pain and can be challenging to diagnose due to its being multifaceted with multiple symptoms. This pain can cause the affected organs to become hypersensitive and impact a person’s quality of life. When the body starts healing from viscerosomatic pain, the effects will become less for the individual as they heal the affected organs.

 

References

Bath, Megan, and Justin Owens. “Physiology, Viscerosomatic Reflexes.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 May 2022, www.ncbi.nlm.nih.gov/books/NBK559218/.

Hoffman, Donna. “Understanding Multisymptom Presentations in Chronic Pelvic Pain: The Inter-Relationships between the Viscera and Myofascial Pelvic Floor Dysfunction.” Current Pain and Headache Reports, U.S. National Library of Medicine, Oct. 2011, pubmed.ncbi.nlm.nih.gov/21739128/.

Sengupta, Jyoti N. “Visceral Pain: The Neurophysiological Mechanism.” Handbook of Experimental Pharmacology, U.S. National Library of Medicine, 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC3156094/.

Sikandar, Shafaq, and Anthony H Dickenson. “Visceral Pain: The Ins and Outs, the Ups and Downs.” Current Opinion in Supportive and Palliative Care, U.S. National Library of Medicine, Mar. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3272481/.

Silva, Andréia Cristina de Oliveira, et al. “Effect of Osteopathic Visceral Manipulation on Pain, Cervical Range of Motion, and Upper Trapezius Muscle Activity in Patients with Chronic Nonspecific Neck Pain and Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.” Evidence-Based Complementary and Alternative Medicine : ECAM, Hindawi, 11 Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6252226/.

Verne, G Nicholas, et al. “Viscerosomatic Facilitation in a Subset of IBS Patients, an Effect Mediated by N-Methyl-D-Aspartate Receptors.” The Journal of Pain, U.S. National Library of Medicine, Sept. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3489925/.

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Dehydrated Discs: Rehydration and Decompression

Dehydrated Discs: Rehydration and Decompression

Dehydration affects the body physically and mentally but also affects the health of the spine’s discs. Spinal discs that lack proper hydration begin to compress, collapse between vertebrae, or cannot refill correctly, causing further compression and increasing the risk of spinal injury. Dehydrated discs can cause injuries like herniated disc/s, degenerative disc disease, and spinal stenosis. Chiropractic treatment offers spinal decompression that will restretch and realign the spine allowing the injury/s to heal and proper disc rehydration.

Dehydrated Spinal Discs: Rehydration and Decompression

Spine Support

As crucial as the spine is within daily activities, it is vital to understand its mechanics. The spinal vertebrae discs work to absorb shock when bending, twisting, or flexing to ensure the bones do not rub together. Within each disc is the nucleus pulposus, made up of 85 percent water that provides movement when the spine rotates and moves in various directions. This high water content in the discs helps the spine function. The discs naturally lose some water as the body ages, but dehydration can also occur when individuals do not intake enough water from drinking or in food. If the dehydration is severe, the risk of injury increases or can aggravate existing spine conditions. The loss of hydration in an adult spine can cause a loss of disc height daily. Without proper rehydration, other medical issues can begin to present.

Symptoms

Depending on which discs are affected, the pain or numbness can travel from the neck into the shoulders, arms, and hands or from the lower back down through the legs. Symptoms can include:

  • Back stiffness
  • Burning or tingling sensations
  • Reduced or painful movement
  • Back pain
  • Weakness
  • Numbness in the low back, legs, or feet
  • Changes in knee and foot reflexes
  • Sciatica

When the body is dehydrated, it can be difficult to replenish the water in the discs thoroughly, as well as nutrient levels through a consistent loss of fluid. Dehydration disrupts the balance which can lead to an increased risk of injury and increased degeneration. Causes of disc dehydration include:

  • Trauma from an auto accident, fall, work, or sports injury.
  • Repeated strain on the back from consistent lifting, reaching, bending, twisting, etc.
  • Sudden weight loss can cause the body, including the discs, to lose fluid.
  • Ankylosing spondylitis.

Spinal Rehydration

The entire body relies on proper hydration with direct water consumption to rehydrate the body but also incorporating fruits and vegetables to aid in hydration. These foods include:

  • Watermelon
  • Cantaloupe
  • Lettuce
  • Tomatoes

These foods are made of more than 90% water and contain essential nutrients and help the spine function more efficiently. Proper water consumption is based on age, body size, and activity level. However, to fully heal desiccated discs, spinal injuries, or back pain, chiropractic decompression, and manipulation adjustments are recommended. Non-surgical motorized spinal decompression treatment is gentle. The therapy lengthens and decompresses the spine reversing the pressure within the damaged disc/s creating an intradiscal vacuum that relieves the pressure off the nerve and helps reshape and rehydrate the damaged disc/s.


DOC


References

Djurasovic, Mladen, et al. “The influence of preoperative MRI findings on lumbar fusion clinical outcomes.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 21,8 (2012): 1616-23. doi:10.1007/s00586-012-2244-9

Karki, D B et al. “Magnetic Resonance Imaging Findings in Lumbar Disc Degeneration in Symptomatic Patients.” Journal of Nepal Health Research Council vol. 13,30 (2015): 154-9.

Twomey, L T, and J R Taylor. “Age changes in lumbar vertebrae and intervertebral discs.” Clinical Orthopedics and related research,224 (1987): 97-104.

Videman, Tapio et al. “Age- and pathology-specific measures of disc degeneration.” Spine vol. 33,25 (2008): 2781-8. doi:10.1097/BRS.0b013e31817e1d11

Spinal Decompression Therapy Alleviates Wear & Tear Herniated Discs

Spinal Decompression Therapy Alleviates Wear & Tear Herniated Discs

Introduction

For keeping the body upright and on the move, the spine plays an essential role in allowing the body to do these ordinary functions. The S-shaped curve enables the body to rotate from side to side, bend back and forth, and twist without feeling discomfort. The spine is enveloped with ligaments, nerve roots, spinal discs, and soft muscle tissues originating from the spinal column; these components protect the spinal cord from being injured. When the back suffers from unforeseen circumstances or starts to naturally age, the spinal discs in the spine will lose their structure, causing them to shrink and become herniated, depending on how severe the pain is. Fortunately, there are treatments available for herniated discs. Today’s article will focus on wear and tear herniation on the spine, how it affects the back, and how decompression therapy can help herniation. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

FreeReport-Herniations

What Is Wear & Tear Herniation?

Have you been experiencing pain shooting from your lower back to your feet? Does it hurt when you are doing daily activities like walking or running? Have you been experiencing muscle stiffness in your lower back or your neck? You might be suffering from a disc herniation from wear and tear from your spine. Research studies have defined that herniation on the spine happens when the spinal discs between the spinal joint columns are damaged. Natural wear and tear on the spine when the muscles have been overworked due to heavy lifting or when the outer layer of the spinal discs starts to crack under pressure, letting the inner layers protrude out of alignment of the spine and press on the nerve roots that are connected to the spine.

 

Additional information has provided that disc herniation is usually associated with DDD or disc degeneration disease and contributes to low back pain. When a herniated disc starts to affect the spinal column and press on the spinal nerve roots extending all over to work with the back muscles providing motor and sensory function for the body to move, it increases the inflammatory pathways to cause radiating pain to the body. Wear and tear herniation also causes the inner walls of the spinal disc to become weak due to dehydration when the outer layer is cracked. Research studies have also mentioned that the cervical and lumbar regions of the spine are susceptible to disc herniation due to spinal pathologies that affect the spine itself. Spinal pathologies can include RA (rheumatoid arthritis), fractures, osteoporosis, and infections associated with herniated discs that can cause significant issues on the back and make a person in more pain than they already are. 

 

How Does It Affect The Back?

Disc herniation is associated with low back pain, but other spinal issues that cause disc herniation will affect the back even more, when it is not treated. When disc herniation starts to affect the spine, it affects the back, especially the lower back. Research studies have shown the spinal disc in the spine begins to protrude out, inflammation and nerve compression begin to affect the lower back, causing lumbar radicular pain. Other research studies have shown that lumbar disc herniation causes changes in disc height in the spine while shrinking the dural sac. This causes the spinal joints to rub against each other. At the same time, the herniated disc protrudes to compress the spinal nerve roots, thus sending sudden, throbbing pain all over the back, making the individual miserable.

 


Spinal Decompression Therapy For Herniated Disc-Video

Have you been experiencing aches and pains along your lower back? How about throbbing pain along your sciatic nerve? Does your neck or back feel stiff after suffering from an injury? These are all signs of low back pain associated with disc herniation, and spinal decompression can help alleviate these symptoms. Spinal decompression, as shown in the video above, helps many individuals suffering from low back herniation associated with low back pain. Many decompression machines help suffering individuals with a lumbar disc herniation through gentle pulling on the spine to restore the disc space and take pressure off the surrounding nerves. Decompression helps rehydrate the spinal disc’s outer layer and allows the substances to repair the outer layers. Spinal decompression therapy has many beneficial factors as part of a person’s wellness treatment. This link will explain how spinal decompression offers impressive comfort for many people who suffer from wear and tear herniation.


How Decompression Therapy Can Help Wear & Tear Herniation

 

With lumbar disc herniation affecting the lower back, many treatments are available for restoring the spine from herniated discs. Research studies have provided that non-invasive spinal decompression is very effective for many miserable individuals from herniation on their spine. Spinal decompression allows the affected herniated discs to be reabsorbed back into the spine, allowing the spinal disc height to increase. This type of therapy allows the herniated disc to be taken off the compressed roots and reduces pain signals from affecting the lower half of the body. Additional research studies have found that decompression allows the negative pressure to pull the herniated discs back to the spine and is safe for individuals suffering from lumbar pain. The main goal of decompression therapy is to provide relief to suffering individuals by alleviating spinal and low back issues from their backs. 

 

Conclusion

Overall, disc herniation is caused by natural wear and tear of the spine due to overusing the back muscles in the body. When this happens, the herniated discs are compressing the nerves causing low back pain and spinal issues, causing radiating pain to travel all over the body. Treatments like spinal decompression allow the herniated discs to be pulled back into the spine gently and take the irritating pressure off the nerve roots. When people start to take care of their spine’s health through decompression, they will feel so much better in the long run.

 

References

Al Qaraghli, Mustafa I, and Orlando De Jesus. “Lumbar Disc Herniation – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 30 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK560878/.

Dydyk, Alexander M, et al. “Disc Herniation – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 18 Jan. 2022, www.ncbi.nlm.nih.gov/books/NBK441822/.

Kjaer, Per, et al. “Progression of Lumbar Disc Herniations over an Eight-Year Period in a Group of Adult Danes from the General Population–a Longitudinal MRI Study Using Quantitative Measures.” BMC Musculoskeletal Disorders, BioMed Central, 15 Jan. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4714478/.

N;, Demirel A;Yorubulut M;Ergun. “Regression of Lumbar Disc Herniation by Physiotherapy. Does Non-Surgical Spinal Decompression Therapy Make a Difference? Double-Blind Randomized Controlled Trial.” Journal of Back and Musculoskeletal Rehabilitation, U.S. National Library of Medicine, 22 Sept. 2017, pubmed.ncbi.nlm.nih.gov/28505956/.

Oh, Hyunju, et al. “Effects of the Flexion-Distraction Technique and Drop Technique on Straight Leg Raising Angle and Intervertebral Disc Height of Patients with an Intervertebral Disc Herniation.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Aug. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6698474/.

Yang, Hao, et al. “Low Back Pain Associated with Lumbar Disc Herniation: Role of Moderately Degenerative Disc and Annulus Fibrous Tears.” International Journal of Clinical and Experimental Medicine, e-Century Publishing Corporation, 15 Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4402739/.

Zielinska, Nicol, et al. “Risk Factors of Intervertebral Disc Pathology-a Point of View Formerly and Today-A Review.” Journal of Clinical Medicine, MDPI, 21 Jan. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC7865549/.

Disclaimer

Spine Conditions and Diabetes

Spine Conditions and Diabetes

Spine Conditions and Diabetes: Uncontrolled diabetes can wreak havoc on multiple organ systems, including:

Diabetes and severe blood sugar fluctuations can lead to back pain and spinal conditions. The negative impacts on the body from diabetes can be destructive as it is a state of chronic inflammation.

Spine Conditions and Diabetes

Spine Conditions and Diabetes

Spinal conditions being researched and their link to diabetes can affect each condition and its development differently.

Spinal Stenosis

  • Spinal stenosis is when the spine’s openings foramina begin to shrink and narrow, causing the nerve roots that branch off the spinal cord to have less space to function.
  • The stenosis can compress one or more lumbar spinal nerves.
  • Pain, tingling, weakness, and/or numbness in the legs can begin to present.

Spinal Epidural Abscess

  • Spinal epidural abscess is an infection between the vertebral bones and the spinal cord membrane.
  • Diabetes increases the risk of infection and increases the risk of developing an abscess.
  • Hypertension and obesity can also increase the risk of infection.

Lumbar Disc Degeneration

  • The back contains spinal discs between each vertebra that are the shock absorbers.
  • Lumbar disc degeneration occurs when one or more discs begin to break down.
  • The disc’s deterioration causes changes in the lumbar/lower back structure.
  • The degeneration also causes back pain.

Disc degeneration is a normal part of aging and is expected. However, those who have lived with diabetes for over ten years have a higher risk of developing advanced lumbar disc degeneration. To prevent disc degeneration and/or minimize the adverse effects, it’s essential to maintain blood sugar levels.

Vertebral Osteomyelitis

  • Vertebral osteomyelitis is a rare spinal infection resulting from a spinal injury or post-surgical complication/s.
  • It is a bacterial infection that can travel to the spine from another location.
  • Diabetes increases susceptibility to infections.
  • For example, an individual with diabetes could have a foot ulcer, lower back pain, and a fever, symptoms that could indicate the development of vertebral osteomyelitis.

Chiropractic and Decompression Therapy

Spinal decompression is an effective non-surgical technique that can relieve back pain, leg pain, and symptoms associated with spinal conditions and disorders. It works by gently creating traction/pulling force with a specialized mechanical decompression table combined with chiropractic massage and adjustments. Benefits include:

Pain relief

  • Decompression relieves tension in tight, spasming, or injured muscles.
  • Stimulates the nervous system to release chemical signals that bring pain relief.

Heals spinal disc tissues

  • Decompression creates a vacuum force on the spinal discs, helping to circulate much-needed fluids, cells, and other substances to the damaged tissue/s.

Restores spinal disc and joint alignment

  • Stress, poor posture, poor body mechanics, and other factors can cause joints to shift out of place or the discs to herniate.
  • The vacuum force helps realign the joints and discs.
  • Prevents further pain and inflammation.
  • Restores mobility and function.

Relieves pressure on nerves

  • Spinal nerves can get pinched when discs, bones, or other tissues compress the small spaces causing inflammation and pain.
  • Non-surgical decompression increases the space around the nerves, allowing the nerves to heal.

Injury Medical Chiropractic and Functional Medicine Clinic offer spinal decompression as one of many treatment approaches to restore a high quality of life.


DOC Decompression Table


References

Anekstein, Yoram, et al. “Diabetes mellitus as a risk factor for the development of lumbar spinal stenosis.” The Israel Medical Association journal: IMAJ vol. 12,1 (2010): 16-20.

Eivazi, Maghsoud, and Laleh Abadi. “Low back pain in diabetes mellitus and importance of preventive approach.” Health promotion perspectives vol. 2,1 80-8. 1 Jul. 2012, doi:10.5681/hpp.2012.010

Heuch, Ingrid et al. “Associations between serum lipid levels and chronic low back pain.” Epidemiology (Cambridge, Mass.) vol. 21,6 (2010): 837-41. doi:10.1097/EDE.0b013e3181f20808

Rinaldo, Lorenzo, et al. “Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain.” Clinical diabetes: a publication of the American Diabetes Association vol. 35,3 (2017): 126-131. doi:10.2337/cd16-0011

Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

Epidemiology

Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

Radiography

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

Diskography

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

  • Anderson, Paul A. et al. Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007. Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
  • Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
  • Ricci, Judith A. et al. Back Pain Exacerbations And Lost Productive Time Costs In United States Workers. Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology,  and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
  • Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
  • Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
  • KOELLER, W et al. Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression. Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
  • Lieberman, Isador H. Disc Bulge Bubble: Spine Economics 101. The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
  • Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
  • Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • Lumbar Disc Disease: Background, History Of The Procedure, Problem. Emedicine.Medscape.Com, 2017, emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia 45.1 (2010): 1722. PMC. Web. 1 Oct. 2017.
  • Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology. emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

Do’s and Don’ts After Chiropractic Adjustment

Do’s and Don’ts After Chiropractic Adjustment

Everybody is different in how the body reacts to a chiropractic adjustment. Body misalignment often leads to spinal misalignment or vice versa. Misalignments occur over time; individuals do not notice until soreness and pain begin presenting. Depending on the injury and/or condition, getting the full potential from a chiropractic adjustment means knowing the dos and don’ts following treatment. This involves maintaining a healthy posture, staying hydrated, getting proper rest, and staying active.

Do's and Don'ts After Chiropractic Adjustment

Adjustments

Adjustments are highly effective for the body. Benefits include:

  • Pain relief.
  • Restored full range of motion.
  • Increased strength.
  • Increased energy.
  • Improved sleep.
  • Lowered blood pressure in individuals with hypertension.

Do’s and Don’ts

Stay Properly Hydrated

  • One of the best things for the body is plenty of water every day. Water helps:
  • Circulate nutrients and oxygen to your cells.
  • Flush bacteria from the bladder.
  • Assist with digestion.
  • Prevent constipation.
  • Normalize blood pressure.
  • Stabilize heartbeat.
  • Cushion the joints.
  • Protect organs and tissues.

Stay Active

  • It is not recommended to take on intense workouts after an adjustment but to remain active to keep the muscles, tendons, ligaments flexible and strengthen the body during healing.
  • Activities should be done in moderation and include:
  • Walking
  • Jogging
  • Biking
  • Swimming

Proper Rest

  • Getting the proper amount of sleep is essential for the body to heal to the optimal level.
  • The body getting used to the adjustment can be an exhausting process.

Maintain Healthy Posture

  • Proper posture is essential to keep the body in healthy alignment and prevent further/new injuries.
  • A chiropractor and physical therapist will educate and train individuals on maintaining healthy, active postures.

Stretching

  • Stretching is prescribed as part of the treatment to maintain flexibility and strength.
  • A chiropractor will recommend and show how to perform specific stretches and exercises between adjustments.

What to Avoid

Recommendations on what to avoid after a chiropractic adjustment.

Explosive Movements

  • Stay active but limit any explosive movements for a few days after the adjustment.

Avoid Sitting Too Much

  • Too much sitting, even with a lumbar support chair, can cause the muscles to tighten pulling on the spine.
  • When sitting, get up and move around every 20 minutes.

Paying attention to the recommended do’s and don’ts will help expedite the healing and create new healthy habits.


Body Composition


Dairy Products

Conventional vs. Organic and Grass-fed Dairy

  • Studies have found that dairy cows consuming a diet of grass and hay significantly improved nutrient profiles of produced milk.
  • Milk from grass-fed cows has a higher omega-3 content when compared to organic and conventional grain-fed cows.
  • Omega-3s protect against:
  • Inflammation
  • Heart disease
  • Metabolic conditions

Fermented Products

References

Bourrie, Benjamin C T et al. “The Microbiota and Health Promoting Characteristics of the Fermented Beverage Kefir.” Frontiers in microbiology vol. 7 647. 4 May. 2016, doi:10.3389/fmicb.2016.00647

Licciardone, John C et al. “Recovery From Chronic Low Back Pain After Osteopathic Manipulative Treatment: A Randomized Controlled Trial.” The Journal of the American Osteopathic Association vol. 116,3 (2016): 144-55. doi:10.7556/jaoa.2016.031

Maher, C G. “Effective physical treatment for chronic low back pain.” The Orthopedic clinics of North America vol. 35,1 (2004): 57-64. doi:10.1016/S0030-5898(03)00088-9

Will, Joshua Scott et al. “Mechanical Low Back Pain.” American family physician vol. 98,7 (2018): 421-428.

Post Spine Surgery Physical Therapy

Post Spine Surgery Physical Therapy

Post spine surgery physical therapy or PT is the next phase after a discectomy, laminectomy, fusion, etc., to gain optimal mobility and ease the transition for a full recovery. A chiropractor and physical therapist team will help with proper muscle training and activation, pain and inflammation relief, postural training, exercises, stretches, and educate the individual on an anti-inflammatory diet. Physical therapy post spine surgery reduces:

  • Scar tissue
  • Inflammation
  • Muscle weakness
  • Muscle tightness
  • Joint stiffness

Post Spine Surgery Physical Therapy

The therapy also identifies and treats any issues that caused or contributed to the spinal damage/injury. A study found physical therapy to improve postoperative ambulation, pain, disability, and decreased surgical complications.

Post Spine Surgery Physical Therapy Goals

Physical therapy goals are to return the individual to full function before chronic pain or injury. These include:

  • Decrease pain and stress around the surgical site.
  • Loosen and stretch the muscles surrounding the surgical site.
  • Strengthen the back and neck muscles.
  • Stabilize the back and neck muscles.
  • Learn to move around safely.
  • Prepare for everyday physical activities like standing up or sitting down, lifting, and carrying objects.
  • Improve posture.

The therapy team will develop a customized treatment/rehabilitation plan as well as post-surgical recovery at home to help the individual and family to understand what to expect, including psychological factors like not wanting to perform the exercises or stretches to avoid pain, frustration, anger, depression, and wanting to give up. However, individuals can maximize the benefits to ensure an optimal outcome before surgery by pre-conditioning identifying structural and functional issues contributing to the injury.

Physical Therapy Involves

Therapy can be done at home, in a hospital or rehab setting, or at a chiropractic/physical therapy clinic. Therapists use:

  • Massage
  • Heat or cold therapy
  • Thermotherapy
  • Electrotherapy
  • Ultrasound

Also included are active therapies like:

  • Therapeutic stretches
  • Therapeutic mobility exercises
  • Therapeutic resistance training

A physical therapy session can last 45 minutes to an hour. It’s essential to discuss hopes and expectations post-surgery and after the therapy has finished. The therapists will explain the healing process, the treatment progression, and any questions a patient may have. Understanding the treatment process will help the individual want to engage in the treatment plan. The therapist team will also interface with the surgeon to prevent adverse outcomes.

Optimal Health

The physical therapy team will help the individual feel better with each session and stay motivated. Having a solid relationship with the therapy team makes it easier to share goals, worries, and challenges that the team can adapt to as progress is made. To gain the most from the therapy:

  • Try working with a therapist that the surgeon recommends can be helpful as they already have a working relationship.
  • Keep communication open between the surgeon and team.
  • Adhere to any precautions and restrictions set by the surgeon and therapy team.
  • Maintain recommended exercises at home between sessions.
  • Ease into activity and avoid overexertion.

Post spine surgery physical therapy helps accelerate the healing process and serves to help individuals regain their quality of life.


Body Composition


Power Of Protein

Protein is an essential component of muscle development, bone density, muscle mass, and lean tissue when building a healthy body. Protein is necessary for all the body’s physiological functions.

References

Adogwa, Owoicho et al. “Assessing the effectiveness of routine use of postoperative in-patient physical therapy services.” Journal of spine surgery (Hong Kong) vol. 3,2 (2017): 149-154. doi:10.21037/jss.2017.04.03

Atlas, S J, and R A Deyo. “Evaluating and managing acute low back pain in the primary care setting.” Journal of general internal medicine vol. 16,2 (2001): 120-31. doi:10.1111/j.1525-1497.2001.91141.x

Gellhorn, Alfred Campbell et al. “Management patterns in acute low back pain: the role of physical therapy.” Spine vol. 37,9 (2012): 775-82. doi:10.1097/BRS.0b013e3181d79a09

Jack, Kirsten et al. “Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review.” Manual therapy vol. 15,3 (2010): 220-8. doi:10.1016/j.math.2009.12.004

Lindbäck, Yvonne et al. “PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol.” BMC musculoskeletal disorders vol. 17 270. 11 Jul. 2016, doi:10.1186/s12891-016-1126-4

Compression Fracture

Compression Fracture

Sometimes the bones or vertebrae of the spine can crack and collapse under their weight. This is known as a compression fracture, vertebral compression fracture, or VCF. There are almost 1 million compression fractures every year, usually because the bones become weakened and crack under the weight of the vertebrae above them. These fractures can cause spinal weakness affect posture and the ability to stand up straight. They are often the cause for individuals to hunch over, also called kyphosis.

Compression Fracture

Compression Fracture

Compression fractures are small breaks or cracks in the vertebrae. The breaks occur in the vertebral body, the thick rounded part on the front of each vertebra. These fractures cause the spine to weaken and collapse. With time, these fractures affect posture as the spine curves forward. The fractures are often found in the middle/thoracic spine in the lower area. They often result from osteoporosis but can also happen after a trauma like an automobile accident, work, sports injury, or a tumor on the spine.

Symptoms

Compression fracture symptoms range from mild to severe or no symptoms. Many individuals can stand or walk without pain. They are often discovered when X-rays are taken for another condition. Symptoms include:

  • Back pain can come on suddenly and last for a significant time, often diagnosed as chronic back pain.
  • It usually develops between the shoulders and the lower back.
  • The pain and discomfort decrease when lying down and worsen when standing or walking.
  • Decreased mobility or flexibility in the spine. Individuals are unable to twist or bend.
  • Hunched over appearance, known as dowager’s hump or hunchback.
  • Loss of height from the vertebrae compression and the spine curving.
  • Pinched nerves
  • Nerve damage can cause tingling, numbness, and difficulty walking.
  • Loss of bladder or bowel control with severe, untreated fractures.

Individuals At Risk

  • Individuals who have had a compression fracture are more likely to have another one.
  • Women over 50 have a higher risk due to osteoporosis.
  • With age, the risk increases for men and women.

Diagnosis

A doctor will perform an examination and ask about symptoms. The exam will include:

  • Checking spinal alignment.
  • Posture analysis.
  • Gently palpates different areas of the back to identify the source of pain.
  • Examine for signs of nerve damage that include numbness, tingling, or muscle weakness.

A doctor will order imaging studies to examine the backbones, muscles, and soft tissues. Imaging studies include:

  • CT scan, X-ray, or MRI of the spine.
  • DEXA scan is a type of X-ray that measures bone loss bone density.
  • A myelogram is a procedure used along with imaging studies. A contrast dye is injected into the spine before the scan making the images easier to see.
  • A triple-phase bone scan is an imaging study that takes three sets of pictures.

Treatment

Compression fracture treatment focuses on relieving pain, stabilizing the vertebrae, and ongoing fracture prevention. Treatment depends on the severity of the fracture and the individual’s overall health. Treatment can include:

Pain Medication

  • A doctor can recommend over-the-counter non-steroidal anti-inflammatory medication.
  • A doctor may prescribe muscle relaxers or prescription medication.
  • Follow instructions carefully when taking medications.

Back Brace

  • A special type of back brace helps to support the vertebrae.
  • The brace can also relieve pain by reducing how much the spine moves.

Strengthening Meds

Vertebroplasty or Kyphoplasty

  • This minimally invasive procedure relieves pain, stabilizes the bones, and improves mobility.
  • During vertebroplasty, the doctor inserts a needle in the vertebra and injects bone cement.
  • During kyphoplasty, the doctor inserts an inflatable device that they fill with cement.
  • Both are outpatient procedures allowing the individual to go home the same day.

Individuals over 65 or that have osteoporosis or a history of cancer are recommended to see their doctor. Individuals who present with sudden back pain that doesn’t get better after a day or two are advised to see a doctor and evaluate for back pain so the doctor can determine the cause and develop a treatment plan.


Body Composition


Vitamin D To Build Muscle

Skeletal Muscle Mass decreases as the body ages, primarily due to decreased physical activity. Vitamin D has been reported to influence muscle quality. This could be helpful for adults as they age. Muscle loss diminishes functional performance on activities that require strength and coordination. When this loss of muscle mass becomes significant, it becomes a condition known as sarcopenia. Treatments include:

  • Healthy diet
  • Exercise
  • Vitamin D supplementation
  • All were found to slow down muscle loss and help regain muscle mass and strength.
  • Vitamin D supplementation is effective, especially in older adults whose blood levels are low.
References

American Academy of Orthopaedic Surgeons. Osteoporosis and Spinal Fractures. (orthoinfo.aaos.org/en/diseases–conditions/osteoporosis-and-spinal-fractures/) Accessed 10/25/2021.

American Association of Neurological Surgeons. Vertebral Compression Fractures. (www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Vertebral-Compression-Fractures) Accessed 10/25/2021.

Bischoff-Ferrari, H A et al. “Vitamin D receptor expression in human muscle tissue decreases with age.” Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research vol. 19,2 (2004): 265-9. doi:10.1359/jbmr.2004.19.2.265

Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK448171/

Hassan-Smith, Zaki K et al. “25-hydroxyvitamin D3, and 1,25-dihydroxyvitamin D3 exert distinct effects on human skeletal muscle function and gene expression.” PloS one vol. 12,2 e0170665. 15 Feb. 2017, doi:10.1371/journal.pone.0170665

McCarthy, Jason, and Amy Davis. “Diagnosis and Management of Vertebral Compression Fractures.” American family physician vol. 94,1 (2016): 44-50.

Chiropractic and Spinal Health

Chiropractic and Spinal Health

Chiropractic and spinal health. Most individuals seek out chiropractic care only after an injury and when pain presents. Because traditional medical care tends to focus on treating disorders and diseases, individuals are used to seeking care only when something is imbalanced. For many, chiropractic is known for its ability to resolve back and neck pain, correct postural misalignments, manage acute or chronic conditions and accelerate the healing of injuries. Chiropractic is different in that it is a tool for increasing overall wellness and vitality when no injury or imbalance is present.

Chiropractic and Spinal Health

Chiropractic and Spinal Health

Chiropractic is an invaluable treatment that raises the baseline of an individual’s health by:

  • Increasing performance
  • Extending lifespan and longevity
  • Improving overall comfort
  • Increasing agility in the body

Chiropractic helps to achieve these transformational results by improving the function of the:

  • Circulatory system
  • Immune system
  • Respiratory system
  • Muscular system
  • Nervous system
  • Skeletal system

Circulation Increased

The circulation system includes the heart and its chambers, arteries, veins, lungs, lobes, and capillaries. The structures within this system move blood, nutrients, and waste throughout the body. The quality of health and life depends on the level of functioning in this system. The better and more efficient the tissues receive clean blood, nutrients, and oxygen, the better the body is able to utilize these building blocks to achieve whatever function is required. The slower and more unclean these building blocks, the lower quality of function. The nervous system is the communication system that includes the brain, spinal cord, and nerves that run throughout the body. Everything in the body and the work functions as a result of this communication system.

The circulatory system relies on the communication that runs through the nervous system, which is housed in the spine. If the spine is misaligned, moving improperly, or sustaining an injury, it can interfere with the function of the communication. Regular chiropractic care increases the health levels of the nervous system by keeping the spine as healthy and flexible as possible. The muscles are kept loose, which promotes blood flow, and the flow and movement of waste in the lymphatic system. Individuals that receive regular adjustments report:

  • Enhanced perception of sensations in their extremities.
  • Warmer hands and feet.
  • Improved cognitive response and clarity.
  • Decrease or eliminate tingling and numbness.
  • Maintaining the proper range of motion of the spine also facilitates better function and movement of the whole body.

Immune Response Improvement

Regular chiropractic improves immune responses that leads to improved response against foreign invaders and disease, fewer instances of illness, exhaustion, fatigue, and inflammation. When expert chiropractic and spinal health intervention is delivered it helps to realign bones and joints, alleviate muscle tension, and restore nerve function. The body immediately experiences a decrease in stress, downregulation of stress hormones and chemicals in the body leads to a reduction in inflammation.

Increased Mobility & Flexibility

Chiropractic helps to improve physical mobility and flexibility in the muscular and skeletal systems. This is accomplished through manual manipulation to restore ideal posture and achieve a balanced skeletal structure. Manual manipulation is also used to soften and relax tense muscles which have developed abnormalities to compensate for incorrect posture. When skeletal structure, muscular imbalances, and strain are corrected, the result is improved mobility and flexibility.

Pain Symptoms Are Decreased

Pain originates from the nervous, muscular, and skeletal systems. Chiropractic can help with back pain, neck pain, shoulder pain, migraines, nerve and sciatic pain, and other conditions and forms of discomfort. The origin of the pain can include:

  • Postural imbalance
  • Muscle tension
  • Damage from accident or injury
  • Spinal degeneration

Chiropractic and spinal health care helps soothe and de-inflame the comprised areas, allowing the natural healing systems to intervene and promote long-term reduction of discomfort and pain.

Bending, Standing, Sitting Activities Improve

For many individuals, bending, standing, and sitting are normal movements they engage in every day. This can be part of work occupation, school, house chores, etc, and for many these movements and positions can become painful over long durations of time and when it is repetitive. Regular chiropractic and spinal health treatment can restore optimal posture in the body, soothe strained and tense muscles, and resolve disrupted nerve energy flow which often leads to nerve pain like sciatica.


Body Composition


Pregnancy Hypertension

Hypertension in pregnancy falls into one of three categories. It can range from benign and easily controlled to serious with increased medical risks. This makes monitoring blood pressure important to individual health risks. The risks for hypertension in pregnancy include:

  • Early delivery
  • Decreased oxygen to the placenta
  • Potential heart disease

The main types of hypertension in pregnancy.

Chronic hypertension

Chronic hypertension is a pre-existing condition known prior to pregnancy.

  • Individuals that are aware of elevated blood pressure before becoming pregnant, a doctor will diagnose the individual with chronic hypertension.
  • A doctor will use diagnostic criteria to determine if chronic hypertension is present prior to getting pregnant.

Gestational hypertension

Gestational hypertension develops during pregnancy.

  • Gestational hypertension is not preventable and typically returns to normal levels postpartum.
  • However, risk increases for later developing chronic hypertension is higher if gestational hypertension presents.
  • According to Mayo Clinic, gestational hypertension is diagnosed by the following criteria:
  1. At least 20 weeks gestation
  2. Blood pressure is greater than 140/90 on two occasions
  3. Must be documented more than four hours apart
  4. No other organ damage is present

Preeclampsia

Preeclampsia is the most serious.

Preeclampsia develops after 20 weeks of pregnancy and is associated with a sharp spike in blood pressure levels. Notable symptoms include:

  • Sudden fluid swelling
  • Chronic headaches
  • Changes in vision
  • Nausea
  • Vomiting
  • Weight gain
References

Brown, Richard A. “Spinal Health: The Backbone of Chiropractic’s Identity.” Journal of chiropractic humanities vol. 23,1 22-28. 8 Sep. 2016, doi:10.1016/j.echu.2016.07.002

Bussières, André E et al. “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative.” Journal of manipulative and physiological therapeutics vol. 41,4 (2018): 265-293. doi:10.1016/j.jmpt.2017.12.004

Maher, Jennifer L et al. “Exercise and Health-Related Risks of Physical Deconditioning After Spinal Cord Injury.” Topics in spinal cord injury rehabilitation vol. 23,3 (2017): 175-187. doi:10.1310/sci2303-175

Meeker, William C, and Scott Haldeman. “Chiropractic: a profession at the crossroads of mainstream and alternative medicine.” Annals of internal medicine vol. 136,3 (2002): 216-27. doi:10.7326/0003-4819-136-3-200202050-00010

Gentle Yoga Poses After Spinal Fusion Surgery

Gentle Yoga Poses After Spinal Fusion Surgery

Recovery and rehabilitation after spinal fusion surgery take time. Gentle yoga poses can help expedite recovery from spinal fusion surgery and are recommended in a rehabilitation program. The spine is the body’s central support structure that allows the body to stand upright, bend, and stay balanced. However, an individual may need to have vertebrae fused to repair painful back problems. Spinal fusion is a surgical procedure that permanently connects/fuses two or more vertebrae into a single bone. The procedure is done to help:

  • Correct a deformity
  • Improve stability
  • Reduce pain

At the beginning of the recovery process, the doctor may recommend light physical activity like walking. As the spine continues to heal, moderate exercise is essential for optimal recovery. Doctors are recommending gentle yoga to increase mobility, flexibility and regain strength.

Gentle Yoga Poses After Spinal Fusion Surgery

Gentle Yoga and Spine Surgery Recovery

Yoga has become a way to stretch the body, exercise, promote physical and mental well-being. There are different styles of yoga, ranging from gentle stretching to advanced poses. Yoga focuses on stretching, coordination, and balance. When stretching the body, the range of motion is improved. Yoga also helps improve balance and increases strength to reduce the risk of falls and injuries. Gentle yoga after spinal fusion benefits include:

  • Pain relief
  • Stress reduction
  • Improved mental health
  • Increased flexibility and strength
  • Improved balance
  • Increase in energy levels

Gentle yoga after surgery focuses on an improved range of motion/coordination of the arms and legs with the torso. This allows the spine to safely flex, not become stiff, and avoid strain, leading to fuller activity.

When To Begin Yoga After Spinal Fusion?

A reduced range of motion and loss of muscle mass is expected in the weeks and months following surgery. The healthcare/rehabilitation team will address this through exercise and physical therapy once the doctor clears the individual to begin rehabilitation training. The doctor will use some form of diagnostic imaging to determine if the vertebrae have fully fused before giving the ok for exercise. Most individuals can begin light physical activity four to six weeks after the procedure. If the fusion surgery was fused in only one place, individuals could start gentle yoga poses within two to three months. For a multi-level fusion surgery, individuals may need to wait four to six months after the procedure before they can safely begin.

Yoga Recovery Program

It’s essential to take it slow and steady when first beginning yoga after spinal fusion. As the body continues to heal, gradually add more challenging poses and stretches to the routine. This is a graduated recovery program separated into stages to help the individual build back strength and flexibility. In the first stages of recovery, gentle poses that have minimal effects on the spine are recommended. These include:

A few weeks to a month later, with the doctor’s clearance, the individual can advance to poses that stretch/flex the spine a little more, including:

Eventually, individuals can slowly increase the challenge further, with poses like:

Garudasana – Eagle pose
Gomukhasana – Cow Face pose
Vasisthasana – Side plank pose

It’s crucial to listen to the body as a guide when moving through the poses, no matter what stage of recovery. The fusion needs time to heal and stabilize, so any poses that involve twisting movements and flexing should be avoided. Seek advice if there is confusion about how or whether or not to proceed. It is recommended to work with an experienced yoga teacher after spinal fusion. A knowledgeable instructor can guide with the poses, inform which poses to avoid and make modifications to get the most out of the gentle poses.


Body Composition


How Heat Affects Basal Metabolic Rate

Gender, height, and age influence Basal Metabolic Rate. These are factors individuals cannot control or change. However, individuals can increase the calories the body burns by regulating body temperature. Both the internal and external temperatures influence metabolic rate. The chemical reactions that contribute to metabolism happen more quickly if the temperature is higher, as the body works harder to restore normal temperature balance. For example, when a fever is present, the Basal Metabolic Rate will jump up to a much higher rate than usual to increase the speed of cellular metabolic reactions to combat the fever and get the body back to a healthy state. When it comes to external temperature, it’s only prolonged exposure to heat that raises the Basal Metabolic Rate.

References

American Academy of Orthopedic Surgeons. (June 2018). “Spinal Fusion.” orthoinfo.aaos.org/en/treatment/spinal-fusion/

Gillooly, James F, and Andrew P Allen. “Changes in body temperature influence the scaling of VO2max and aerobic scope in mammals.” Biology letters vol. 3,1 (2007): 99-102. doi:10.1098/rsbl.2006.0576

National Center for Complementary and Integrative Health. (February 2020) “Yoga for Health: What the Science Says.” www.nccih.nih.gov/health/providers/digest/yoga-for-health-science

National Center for Complementary and Integrative Health. (April 2021) “Yoga: What You Need to Know.” www.nccih.nih.gov/health/yoga-what-you-need-to-know

Syringomyelia Spinal Cord Disorder

Syringomyelia Spinal Cord Disorder

Syringomyelia is a disorder in which a fluid-filled cyst/syrinx forms within the spinal cord. It is progressive, meaning that the cyst grows with time causing compression and damage to the spinal cord. The cyst usually begins in the neck/cervical spine but can develop in any area along the spinal cord. There are several possible causes; however, most are associated with a condition known as Chiari malformation. This is where the skull and neck come together, and either the skull is too small or shaped in a way that causes brain tissue to come out and settle in the spinal canal.

Syringomyelia Spinal Cord Disorder

Syringomyelia Causes

Syringomyelia can be caused by or from complications of:

  • Congenital disabilities like Chiari malformation
  • Chiari type I malformation develops during the fetal developmental stage and causes the lower part of the brain or cerebellum to stick out from its standard location.
  • Hemorrhage/bleeding
  • Inflammation of the spinal cord from virus or bacterial infection like meningitis
  • Spinal cord injury
  • Spinal cord tumor

Symptoms

A damaged spinal cord disrupts communication between the brain and the body. Symptoms differ for every individual, but common syringomyelia symptoms include:

Symptoms usually develop slowly, but exercise, coughing, or some form of strain can cause sudden onset.

Diagnosis

Physical and neurological exams are performed to determine loss of feeling or inability to move around normally, like walking. Diagnostic tests of the spine will include a CT scan with contrast dye and/or an MRI. Early detection can help before it progresses, causing further damage, and delaying treatment can cause irreversible spinal cord injury. It is recommended at the first sign of symptoms to contact a doctor.

Treatment

Some individuals who have syringomyelia may have no symptoms. These individuals can go about their everyday lives but are recommended to be cautious with neck and back strain. For individuals experiencing symptoms, the primary treatment objectives are to:

  • Stop or control damage to the spinal cord
  • Preserve function
  • Prevent disability
  • Treatment options include:
  • Draining the cyst
  • Surgical removal of the cyst
  • Chiropractic and physical therapy could be included in the treatment plan to help the individual rebuild lost muscle strength and regain flexibility.

All too often, individuals with this disorder experience treatment delay/s because symptoms can be nonspecific or vague. Education is the key, and individuals can be diagnosed sooner by paying attention to the body’s warning signs.


Body Composition


Does too much protein hurt the kidneys?

While protein restriction can be appropriate for treating existing kidney disease, research shows that high protein intake in healthy individuals does not disrupt or cause damage to the kidneys or kidney function. The amino acids in protein are more likely to be excreted through urine when not being used. However, there are certain risks associated with consuming too much protein, and it is recommended to keep track of protein intake. Eating more protein:

  • Makes the body feel full longer
  • Can help curb overeating
  • Is essential for recovery and growth

When achieving daily caloric goals, maintaining a balance of nutrients like carbohydrates and healthy fats is essential for overall health.

References

Batzdorf, Ulrich. “Primary spinal syringomyelia. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2005.” Journal of neurosurgery. Spine vol. 3,6 (2005): 429-35. doi:10.3171/spi.2005.3.6.0429

Di Lorenzo, N, and F Cacciola. “Adult syringomyelia. Classification, pathogenesis and therapeutic approaches.” Journal of neurosurgical sciences vol. 49,3 (2005): 65-72.

Fernández, Alfredo Avellaneda et al. “Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis, and treatment).” BMC musculoskeletal disorders vol. 10 Suppl 1, Suppl 1 S1. 17 Dec. 2009, doi:10.1186/1471-2474-10-S1-S1

Naftel, Robert P et al. “Worsening or development of syringomyelia following Chiari I decompression: case report.” Journal of neurosurgery. Pediatrics vol. 12,4 (2013): 351-6. doi:10.3171/2013.7.PEDS12522

Roy, Anil K et al. “Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management.” Neurosurgical focus vol. 31,6 (2011): E15. doi:10.3171/2011.9.FOCUS11198