Rants From a Chiropractor: Part 2

Written by: Jeffrey Sergent, DC


Low Back Pain and my Personal Struggle

Let's start at the beginning.  The lower back vertebrae, cartilage, ligaments and muscles are beautifully constructed architecture.  My favorite thoughts on the architecture come from one of my favorite researchers, Stu McGill, PhD.  Professor McGill asks a simple question: If you were an engineer how would you create a structure that needs to resist shear, bending and compression? The common sense answer would describe a stiff bonded pole like structure, think cement cylinders that hold up highways and bridges. Well now, that same structure needs to bend and rotate slightly. Engineering would create multi sections that allow for limited motion and say that this concept is crazy to make possible. Our bodies, our low backs in particular, are designed to take compression, resist shear forces, and allow for bending and rotating. This is possible due to the core systems. See my 'Core Defined' article for my definition of the core.

Disc Bulge of 15/s1 centrally.

Now let's go into my personal story of my struggle with low back pain and sciatica (leg pain). How did I manage to do this to myself with my knowledge of the spine and mechanics? The short answer… I got cocky. The thing with intervertebral discs is that we know they fail. They fail from repetitive movement, most notably flexion and rotation. Day in and day out I was showing people what they were doing wrong at home or with their movement. I would stupidly then do my Core exercises and lifting with good form, thinking that would fix the damage I was doing all day. Like I said… cocky. So cocky I thought somehow my discs won't fail like my patients, because I have great trunk stability, good hip mobility and balance. I was wrong and that wrong caused my disc to not only bulge but fragment in.


In the pictures to the left, the top shows a disc bulge of l5/s1 centrally. You can see the nerve, the line coming down from the bulge is the s1.  The bottom is just to the right of center and reveals a fragment, the cloudy part off the 

A fragment.

disc bulge. This fragment is surrounding the nerve root. Due to the bulge and fragmentation I had right leg pain, numbness and weakness without lower back pain.

Disc injuries come in a variety of shapes and sizes. The size and shape do not correlate to the amount of pain or symptoms. This is a great area of discussion in the pain community (a great nerd fest).  The amount of tissue damage does not equal pain. Actually with disc injuries the more significant the bulge the quicker recovery. Sometimes a small bulge can cause severe symptoms, while a large bulge causes less pain and less direct quality of life issues.  This again is a newer concept within spine literature. The hypothesis is that the larger bulges send more signals of immune mediators to start the re-absorption process. 

Going back to my case, I had a moderate bulge with large fragments; this caused severe stenosis, or narrowing of the opening for my nerve. Due to the size and compression being done to my nerve you would think I would have severe back and leg pain. In reality, I had calf pain, cramping in my foot and calf, weakness in the calf and numbness in the lateral (outer) foot.

Below is a good representation of disc herniations and the type of pain they most likely would create.

 

www.necksolutions.com

Citations:

1.J Craniovertebr Junction Spine. 2013 Jan;4(1):16-20. doi: 10.4103/0974-8237.121619.

Clinical correlation of magnetic resonance imaging with symptom complex in prolapsed intervertebral discdisease: A cross-sectional double blind analysis.

Bajpai J, Saini S, Singh R.

2. J Neurosurg Spine. 2013 Dec;19(6):678-87. doi: 10.3171/2013.9.SPINE13349. Epub 2013 Oct 18.

Predictive value of MRI in decision making for disc surgery for sciatica.

el Barzouhi A¹, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-Hague Spine Intervention Prognostic Study Group.

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.