Degenerative Disc Disease
In between every vertebra in the spine should be a nice thick disc made of tough fibers called the Annulus Fibrosis. Inside these discs is a jelly-like substance called the Nucleus Pulposus. These discs have several purposes, one is to allow movement between each vertebra and another is to act as a shock absorber during daily activity. The height of the disc plays a crucial role in the size of the openings in between the spinal joints where the nerves exit the spine. These holes are called the Intervertebral Foramen, and the bigger the better.
Due to abnormal stress loads, injury, and a lack of proper spinal motion spinal discs begin to dehydrate and lose their height. Accumulatively these discs make up 25% of the total height of the spine. As this process continues and the discs become thinner and thinner people can literally become shorter and shorter. As the vertebrae get closer together the body responds by growing bone spurs around the edges of the vertebral endplates in an attempt to stabilize the involved segments. This poses a real problem for the diameter of the intervertebral foramen. As that hole narrows the exiting spinal nerve is pinched in the process.
Given enough time, a pinched nerve will begin to atrophy, a.k.a. shrink. This significantly reduces its capacity for transmission of nerve impulses consequently decreasing things like deep tendon reflexes, the ability to walk, the ability to feel, etc. This type of nerve damage causes numbness in the legs and feet. Some of these issues can become surgical cases as bone literally has to be removed to reduce the impinged nerve. However, if caught early enough this type of degeneration can be slowed down with a corrective chiropractic care plan.
The nerves that exit the lumbar region of the spine not only supply the organs of the reproductive and digestion systems but come together to form a garden-hose size nerve called the Sciatic nerve. It runs all the way down through the buttock, the back of the leg, into the foot, and clear up to the big toe! Irritation and pressure on this nerve can result in not only agonizing pain but also disability as some lose function of their foot. This condition is called “Drop Foot” due to the inability to lift the front part of your foot up while walking. People with this condition tend to swing their leg out in front of them during their walking gate and many times end up using a cane.
In between the 24 vertebrae of the spine are thick discs made up of a tough fibrous outer ring (Annulus Fibrosis) and a jelly-like substance (Nucleus Pulposus) in the center. These discs act as shock absorbers, allow intervertebral movement, and create space between each vertebra (Intervertebral Foramen) for the spinal nerves to exit. Many times due to abnormally high-stress loads, poor biomechanics, and inadequate core strength a tear can develop in the tough ring of fiber and create a fissure. The jelly substance will then travel the path of least resistance through that fissure and bulge out into the spinal canal creating a “Bulged Disc”. A herniated disc is when the jelly material completely penetrates the fibrous region of the disc and seeps out into the spinal canal.
This bulged disc can place pressure on the spinal nerves exiting the spinal cord and cause severe pain and radiation down the leg. Many patients refer to it as a “burning” or “hot” pain. Not all bulged discs cause nerve impingement or leg pain, however, the injury to the disc itself during the injury can be enough to debilitate someone as inflammation sets in and the disc begins to swell. These scenarios can make it extremely difficult to sit down, bend forward, put socks and shoes on, walk, sleep, or even think clearly for several days or weeks. Studies have shown these injuries can inhibit certain paraspinal muscles along the spine required for stability leading to future occurrences as that region of the spine is now vulnerable to injury.
Facet Joint Dysfunction (Facet Syndrome)
On the backsides of the vertebrae in the spine are a series of spinal joints called “facets”. They are small flat areas of articulation, and the direction and angle of these facets determine the range of motion that region of the spine has. These joints are referred to as “synovial joints”, meaning they are freely moving and have a lubricating sac between them. In fact, the audible”cracking” sound occasionally heard during an adjustment is the release of negative pressure from those joints and the accumulation of gases in the fluid of that sac. This phenomenon is referred to as Tribonucleation.
These facet joints can become inflamed with repetitive extension movements of the lumbar spine like bending backward. When the lumbar spine goes into extension these facet joints close together and become irritated, sometimes the lubricated sac can even become pinched creating an incredibly sharp pain. The good news is that this condition responds excellently to chiropractic care because these joints are opened up with a chiropractic adjustment. The adjustment literally gaps the joint reducing the friction caused by a build-up of pressure from tight muscles and poor biomechanics.
Spondylolisthesis is a forward shifting of the spinal column over the top of a vertebra below. It actually occurs as a result of a fracture within a vertebra. Specifically, a fracture of a structure called the Pars Interarticularis, causing what is known as a pars defect. There are multiple types of this condition defined by their origin which include traumatic, degenerative, dysplastic (congenital), and isthmic spondylolisthesis which develops typically between the ages of 5-7 years old. This injury is also common among student high dive athletes and gymnasts. The fracture typically happens during a hyper-extension of the lumbar spine, a severe backward bending action.
Many people are actually unaware they have this condition until the shifting begins to advance into further stages. This forward shifting has five different grades of severity with five being the worst. As the spinal column shifts forward significant back pain can ensue. This condition is frequently caught on X-ray and it is important to be aware that specific lifestyle modifications can help manage it.
Sacroiliac Joint Dysfunction (SI Joint Dysfunction)
There are two SI joints formed between the sacrum and the ilium. The sacrum is the triangle wedge-shaped bone in between your two hip bones. This is a complicated joint as it is partially mobile and partially not. According to the scientific literature, only 1-3mm of movement occurs in the joint however it is a very common pain generator. Pain can be caused by both a lack of motion as well as too much motion. Inflammation of this joint known as sacroiliitis can cause severe sharp pain on one or both of the bony prominences in your lower back that are off to each side. This joint irritation is common among pregnant women due to the hormone relaxin which causes the ligaments of the pelvis to become lax as the women’s body prepares for child delivery. Specific chiropractic adjustments and exercises can be extremely helpful in achieving relief from this condition and improving the journey through pregnancy in general.