Dr. Doug Pooley
Debunking the Myths about Disc Deterioration - It's Impact on Back & Neck Pain
It amazes me sometimes just how little health care providers know and understand about the human body and how it works. It seems that with all of our research and science, we have managed to ignore thousands of years of evolution which has ultimately led to this fantastic machine called the human body. A marvellous self-regulating entity with the inherent ability to grow, thrive and repair with little or no outside effort.
All tissue in the body is alive and purposeful, there are no spare parts and every component has a job to do in helping to maintain the functional integrity of the whole and this includes the “Inter-vertebral Discs”.
The “IVD” is a shock absorber positioned between the bodies of the vertebrae of the spine and play’s a vital role in the promotion of proper functional mechanics required to allow balanced pain free movement of the vertebral segments.
Each disc is made up of approximately 25 concentric rings of cartilage with a ball bearing like gel center. It is a magnificent feat of functional engineering that allows for flexibility and weight distribution while protecting the integrity of the spinal segments and delicate nerves that extend out from the spinal column. Although there is no direct blood supply to the adult human disc, it receives it’s nutrition by a process called imbibitions. (it acts like a sponge drawing in nutrients from surrounding tissues.) This is living tissue and like all other tissues in the human body is capable of self-repair. The disc itself is in fact stronger than bone. It is so well designed that in cadaver studies, it was found that it was easier to damage bone than it was the disc.
Like every other body part, the discs are designed to last a lifetime. Their protective/mobility function is so important, that in many respects they are among the toughest tissue in the body. Having said that, the fact is, that they can and do break down raising the question why and in what circumstances?
So what do we know for sure?
We know that significant trauma to the spine especially involving twisting and bending tend to be the most threatening to the health of the disc and can result in a weakening or tearing of the outside annular rings or frank herniation where the central core extrudes into or through the outside confining rings of cartilage. Although catastrophic, thankfully this is rare. So why do most disc breakdowns occur?
Most disc deterioration occurs as a result of slow progressive breakdown of functional mechanics in the spine and surrounding tissues resulting in micro trauma that ultimately weakens and overwhelms the ability of the disc to properly function. In plain English...wear and tear secondary to abnormal weight distribution associated with changes in function of the joints, muscles and other soft tissues. In other words; parts not working in their intended design. A good analogy is with a car. If the wheels are out of alignment on a car, it is not long before the tires begin to wear abnormally and the ball joints start to fail. The same thing essentially happens with the discs. When the spine stops functioning properly, the related components come under stress. Over time breakdown occurs eventually resulting in disc deterioration and the development of reactive osteo-arthritis.
This is assumed to be a bad thing. Nobody wants to hear that they have a disc injury or developing arthritis and it would be ridiculous to imply that this is in any way a good thing, but does that mean it is in fact a bad thing? The human body has evolved over thousands of years to this magnificent machine that you live in today. It is a complex of purposeful parts and functions, all of which have a role to play in maintaining the life- integrity of the whole. There are no superfluous activities with every action and reaction being completely purposeful, even the development of reactive arthritis and changes in disc function and structure. Is this the body’s innate intelligence at work attempting to support a weakened or damaged area in an effort to maintain mobility and function? I suggest that it is.
An MRI is considered the foremost in diagnostic testing for reactive changes in the spine and associated tissues. Since the advent of MRI technology; the diagnosis of disc related injury (disc deterioration, bulge, herniation etc.) has exploded, as the suggested cause of presenting neck, back or leg discomforts. In fact, there were so many positive MRI studies indicating changes in the discs, that independent examinations were conducted on asymptomatic (no symptoms) samples of individuals to determine the actual prevalence of disc related changes among the general population. In fact published studies have shown that as high as 60% of asymptomatic subjects who underwent MRI study of the low back showed evidence of some level of disc breakdown....yet no symptoms or other clinical signs.
What’s the take-away here?
Let’s put the science aside for a moment and look at the facts:
The disc is living tissue which like all living tissue has a purpose and is capable of some repair.
The disc functions as a flexible cushion between the vertebrae to promote proper function and mobility.
The disc is constructed of some of the most durable tissue in the body.
The disc is built to last a lifetime but appears to be purposely designed to breakdown in support of other more critical tissues and to maintain mobility.
The disc breaks down in response to changes in load, functional changes in spinal mobility and nutrition.
The health of the disc is impacted by injury, posture, sedentary lifestyle, obesity, smoking and poor nutrition.
Maintaining proper disc health is largely a reflection of correct spinal function. Once mobility is in any way compromised, there is an immediate impact to the related intervertebral discs. Keeping the spine and related tissues functioning in a balanced and symmetrical fashion is critical to the long term health of the disc. As explained above, failure to do so will inevitably end in functional breakdown with associated disc deterioration and arthritic changes. Correction of faulty spinal mechanics by a chiropractor can play an invaluable role in maintaining efficient disc health and reducing stress to other supportive tissues. Periodic assessments to evaluate mobility and structural function are appropriate and conducive to an active and pain free lifestyle.