When your back goes out…
When most people say "my back went out the other day", they mean they had a sudden onset of lower back pain usually while doing something easy like picking up the newspaper. Standing up straight is impossible, practically every movement hurts and your only choice is to get off your feet or grin and bear it while walking crooked. Some describe this as a "slipped disc". After a few days, the pain subsides, you can stand up straighter and certain motions hurt less. After two or three weeks, you have forgotten all about it.
What does it mean when your "back goes out"? Where does it go?
Here's the truth: discs cannot slip. The disc (intervertebral disc) resides between each of the bones in your lower back. A paradox in construction, it is tough yet gooey, stiff yet flexible and firm yet soft. The yin and yang of the spine, the disc has two main parts: the inner core known as the nucleus and the outer strapping known as the annulus. The disc is not a slippery material and cannot pop out of your spine like a cork out of a champagne bottle (when you herniate a disc, the nucleus has broken through the annular wall). When your "back goes out", you most likely have torn or sprained some of the outer strapping (annulus) of your disc.
The outer annulus has a blood supply (unlike the gooey core). And wherever you find blood you will find nerve. When the annulus tears, the nerve fiber becomes sensitized to tension and pressure from the chemical inflammatory process. Movement hurts. Sitting hurts. Everything hurts. This is very similar to an ankle sprain and, in fact, the annulus is a ligament both in structure and function. When your back goes out, you have sprained the annulus. The only question is how badly.
Generally, the first few episodes of "throwing your back out" are several months or years apart. Then, the frequency increases. Soon, your back is going out almost as frequently as you take out the trash. If you are not careful, these episodes will lead you to the surgeon's operating room.
One reason the episodes increase in frequency is that the tear has not healed enough before you return to your routine activities. For most people in the US this is sitting. Sitting is the enemy of back pain. The pressure in your disc while sitting is almost as high as bending over. It is this pressure that causes the problems. Imagine walking out to your car one morning and noticing that the right back tire has a small bulge in it. The tire looks a little flat too. Would you add air to the tire? Would you pump more air into an already compromised tire? If you do, the tire may blow. This is what sitting does to your injured disc. The increased pressure pushes the fibers apart, reduces badly needed nutrient flow and lowers the pH level making it more acidic (and as a general rule, acid is not well liked by your body except of course in your stomach).
The first episode is the one to really pay attention to if you would like to stay off the operating table. When you reach just the wrong way, pick up the newspaper or brush your teeth and cannot stand up straight, it is time to get some help. Think about it. How sturdy is your spine if brushing your teeth "throws your back out"?
The outer rim of the annulus, where the first tears occur, can heal but it needs some help. A poor blood supply coupled with a low rate of energy use makes healing difficult. Two things that help your annulus heal is the rate of blood flow in the spine called the perfusion rate and maintaining adequate disc height . Walking is a great start but more importantly, limit your sitting time. And if you must sit, invest in a chair that allows you to tilt backward. This will lower the disc pressure. Remember, too much pressure is not healthy for your injured spine,
No comments:
Post a Comment