Health Care

by Dr. Anthony Abbruzzese

How Does A Disc Herniate? Dr. Anthony Abbruzzese states that "A healthy disc is tough, resilient and resembles gristle. As a disc degenerates it looses its toughness and assumes the consistency of soft crab meat" This is the process of degeneration. As degeneration progresses the structural integrity of not just the disc but also that of the vertebral segment is compromised. This situation leads to segmental "dysfunction" much like "shimmy" in a car body. This "shimmy" directs stress to the zygoapophyseal joints (facet joints) causing them to also degenerate.

Disc degeneration is easily recognized in post mortem tissue but the magnetic resonance imaging (MRI) technique is a particularly sensitive means of showing this. The reason for this is that "normal" discs are about 85% water. As discs degenerate they loose their water content. An MRI scan is actually a scan of hydrogen ions in the body. Since almost all hydrogen ions are found in body water (H2O) a MRI is basically a very sensitive "water content" scan of all body tissues.

Intervertebral discs are one of only two body structures in adult life which do not have their own blood supply. The other one is the cornea of the eye. The cornea obtains its nutrition from tears while the disc obtains its nutrition from the diffusion of nutrient solutes across the porous endplates of the adjacent vertebrae - aka -the more we move around and stay active, the more hydtarted our discs are.

The diffusion of nutrients across the endplate of the vertebrae can be enhanced by "pumping" activities (types of exercise) and by decreasing intradiscal tension (by segmental traction or distraction). In the case of individuals born with abnormal endplates (i.e. juvenile discogenic disease) the challenge to maintain healthy discs is greater and the liabilities of poisoning discal cells (i.e. smoking) is greater. Disc Degeneration versus Degenerated Tires: In many ways the simile between degenerated discs and degenerated tires is valid. In order for a human being to be successful for long-term (about 80 years) ambulation on a high gravity planet the individual has to have been careful in parenteral selection so that their spinal column genetic makeup will be adequate to deal with the insults and injuries along the way. If initial fabrication of the spine is flawed incapacitation and disability will result. Tires, if sound, can be recapped. Spines only continue to be worn down by the daily insults of life and occupation, occasional traumas, and the process of aging. Genomic testing to determine spine liabilities early in life will be the future equivalent of tire testing before use. Its a shame we don't have this now because because valid self-administered spine health maintenance programs presently exist. Tires are stressed when under inflated and run at high speeds in high temperature environments. In the same way human spines are stressed by labor intensive jobs as well as occupations such as trucking where compressional loading and vibratory factors conspire to injure discs. The simile with tires ends with the observation that humans can actually, on a daily basis, perform health maintenance programs capable of enhancing and improving spine nutrition and function whereas tires can only become more run down over the passage of time. How Does Disc Herniation Start? Unless due to acute trauma a typical disc herniation begins with an unhappy disc. The circumstances that promote this state of affairs is, as can be seen, are usually multiple leading to a loss of disc integrity. Once degeneration exists it usually doesn't take much for a disc herniation to start. Very often the first step in this process is a twist "injury" producing a tear in the disc annulus. Why Is There Back Pain? In the September 2000 Issue of the Oprah Magazine an article "The Real Source of Your Back Pain" written by Emma F. Segal quotes physician Art Brownstein. His answer to the question "What causes most back problems?" was "Muscle strains and sprains." Another quote from Doctor was: "It is a common misconception that back pain starts with a disc problem." These statements are poor responses to the questions asked and are misleading to the public.

It is an anatomic fact the the surface of the brain given over to representing the back is remarkably small. This poor representation is the reason that back pain is non-specific and so poorly localized in comparison to large brain areas for fingers, tongue, etc., allowing more specific localization.

There is no question but that one can "strain or sprain" the ligamentous or muscular components of the spine but most back pain, spasm, and incapacitation are secondary to degenerative changes in the spinal column reflecting congenital abnormalities and well as acquired insults and injuries.

There are many treatment options for a herniated disc ranging from chiropractic to physical therapy to pain medications to spinal decompression to surgery to manipulation under anesthesia to epidurals...and the list goes on and on and on. So which treatment option should you choose? I would start by consulting with your family doctor, chiropractor, or other health care provider.

About the Author

Dr. Anthony Abbruzzese is a Chiropractic Physician located in Columbus, Ohio. Dr. Anthony Abbruzzese obtained his Bachelor's Degree of Science in Human Biology and Doctor of Chiropractic from The National University of Health Sciences at Chicago, Ill.