Are you frustrated by your chronic lower back pain? I'm Dr Mare Moolman from South Africa -
chiropractor. I will be talking on internal disc disruption also known as discogenic pain syndrome.
If one had to Google common cause of lower back pain, a list like this may be found: soft tissue
strain injury, loss of core muscles, loss of flexibility, obesity, herniated disc, scoliosis,
osteoporosis, spondylolistheses, osteoarthritis and a few more that I haven't mentioned, but
typically the list will not include internal disc disruption or discogenic pain syndrome.
The following material can be read in greater detail
if you go into chirogeek.com and read Dr Gillard's page on discogenic pain syndrome.
In 1986, Dr HV Crock told the International Spinal Society that internal disc disruption
could cause lower back pain, even lower limb pain, without the presence of spinal nerve root
compression. He came up with the term internal disc disruption. In 1995,
a dream team of Volvo-award-winning authors tested Crock's theory. They calculated that
30 to 50 percent of people who suffer from lower back pain have internal disc disruption.
Famous multi-time Volvo-award-winning author Professor Nikolai Bogduck MD
believed that internal disc disruption is the most common cause of chronic lower back pain
and may often be overlooked by the treating physician.
Please note, I'm a chiropractor and not a neuroanatomist, so some latitude, please.
Between the vertebra we have a shock absorber - a spacer - we call a disc. The disc, on the outside,
has the annulus fibrosis which are between ten and twenty rings (the lamellae) that holds the nucleus
pulposus in the middle. The nucleus pulposus is a gel-like substance made mainly from water.
Nutrition for the disc is via pump mechanism or osmosis. As the disc compresses
waste products and water are pushed out and as it expands water and nutrients are reabsorbed.
The nervous system of the disc ... We have our brain, the spinal cord
coming down the spinal cord and off the spinal cord are the spinal nerves
exiting, and in the lower back the spinal nerves go down into the legs.
Interestingly, there's a little nerve that backtracks off the spinal nerve
called the sinuvertebral nerve. It backtracks to the disc
and it has nociceptors or little nerve endings that reach up into the outer third of the disc.
This nerve was identified in 1850. So what we have is a closed hydraulic system with its own nutrient
and nerve supply. So how does the system fail? How does injury occur to your disc?
You could have a car accident where there is severe trauma to the disc. Compression,
maybe even twisting. You could have from very heavy lifting - a boat, caravan ....
You could have torsional twisting work, like somebody working with a spade or an axe all day.
And you could have just from bad posture, i.e. chronic leaning forward all day,
squashing the front of the disc. And you could have - just from bad genetics - a dicey disc.
Typically the fissure starts from the centre or the disc, from the nucleus pulposus. The
injury occurs and a little fissure or a tear starts to move backwards towards the
sinuvertebral nerve. This fissure moves further and further and, as it moves further and further,
it starts breaking the lamellae one after the other as the fissure moves further and further.
Something else though has happened. Due to the
trauma to the nucleus pulposus, there has been cell death.
With the splitting one ring after the other of the lamellae more cell death has occurred.
Degeneration has started. A toxic soup is now starting to form from this death of these cells.
So, as we put more and more mechanical strain on this disc, the fissure moves further and
further. Interestingly, there will be two forms of pain. Mechanical - as we squeeze, cough, sneeze
we compress the disc and this fissure moves further and starts mechanically pushing
against the sinuvertebral nerve causing pain. The other form of pain is chemical. The fissure
has now become a pathway for the toxic soup to reach the sinuvertebral nerve. As we cough,
sneeze, twist, lift, the toxic soup can now reach the sinuvertebral nerve
and irritate and inflame the nerve. We have now what I understand to be internal disc disruption
with pain or, said another way, the body has given us the first warning with pain.
Internal disc disruption is a common, debilitating and painful condition
and, intriguingly, most health care providers are unaware of the condition. Typically the patient
has been to a physiotherapist - no real help - been to a chiropractor - no real help - been
to a GP, had an X-ray - X-rays do not show internal disc disruption - been to a specialist,
had an MRI - MRIs are inadequate at diagnosing internal disc disruption.
The only relief the patient has is from strong medication, but this is only temporary.
The distraught patient still does not have the correct diagnosis and, therefore,
not the correct management plan. I hope, for those of you in health care, you'll read further
about this condition. And, for those of you who possibly suffer from internal disc disruption,
this talk and future talks may help you to understand your condition better.
If there is interest in this subject area, I will do further talks on diagnosis,
followed by evaluation, management and possible healing of internal disc disruption.
Thank you for listening to my talk.