When I see a patient in my office for pain relief, what is the one most common finding I hope is not there? The answer is compression. Typically musculoskeletal back pain comes from some sort of muscle spasm or imbalance. Each of the joints in the spine, of which there are 48, can be stressed in 8 different directions — up, down, right or left sideways, right or left rotation, and twisted up right/ down left or its opposite up left and down right. That is right when I check your spine but I actually check 384 possible malpositions just in the spine. When you add in the skull, shoulders, elbows, hands, sacrum, pelvis, hips, knees, feet, and various soft tissues, the number of ways your body can find to complain and generate pain is amazing. All of these findings, however, respond to an adjustment with my Activator adjusting tool fairly easily. But there is one other finding that does not respond so easily — compression.
Between each of your vertebrae is a soft cushion called a disc. Most people have heard of the issues of having a blown disc, bulging disc, ruptured disc, or degenerated disc. Often these concerns result in a nice visit to the orthopedic surgeon. But before that happens there is usually a lengthy period of heavy pain. Part of that lengthy time period is due to the long process of getting a diagnosis, beginning with your primary physician, then x-rays, then a round or two of physical therapy, then finally an MRI finding to actually confirm a disc problem before you get the referral to the orthopedist. An interesting aside, in England this process takes so long, like over two years, that ruptured discs heal before the patient gets an appointment with an orthopedist. This is how it was discovered a few years back that ruptured discs could heal. Before that, it was believed that they could not heal on their own. Unfortunately, this is not true for bulging discs.
The picture I just painted about discs is about acute injuries of otherwise healthy discs. The typical picture is of someone in their 30s or 40s that had a lifting injury or a little too much weekend sports warrior. But there is something going on in the background that starts around age 25 and simply progresses until it changes the disc so much that disc ruptures and bulges are no longer a concern once you hit your late forties. That something is called degenerative disc disease. Traditional medicine will tell you that it is simply your joints wearing out, kind of like osteoarthritis. But the story is a little more complex than that. To understand we have to take a closer look at the structure of the disc.
To understand a disc, imagine an onion cut in half. It has lots of layers in concentric rings. A disc is like that except that the center of the rings is missing and in its place is a central lump of jelly. That lump acts as a hydraulic cushion for absorbing the up-and-down compressive motion of the spine as we move. The weight of the spine puts constant pressure on this jelly in the discs. Over the course of the day, it squeezes water out of the jelly making the disc thinner. At night, as you lay down, that pressure is removed and the disc re-absorbs water making the disc plump back up to normal height. You can actually measure this by checking your height when you first wake up and comparing it to your height before you go to bed. You will be shorter after a day of being upright.
But what happens if the tiny pores that the water squeezes through going out and back in get blocked up? That is precisely what happens with degenerative disc disease. The pores get blocked up with calcium that keeps the water from getting back into the discs at night, so the discs dry up and get thin. Doctors call this desiccation. Thin discs don’t cushion the spinal joints properly, so they are now damaged, inflamed, and arthritic. Even more importantly that disc forms part of the canal the nerves from the spine exit and travel to your legs or arms or central body parts. Without that proper space for the nerve, they get inflamed and send pain or numbness radiating down your leg or arm. This is what concerns me when I see a patient. If they have compression of the spinal joints due to the discs getting thin then they are likely to have some degree of direct nerve root irritation that I can do nothing about.
Sometimes I might find that a similar compression of the disc has happened simply due to the spinal muscles on both sides of the spine getting too tight and squeezing the joint together. In these cases, the pores are not clogged with calcium and if I use a tool called a disc spreader, I can release the spasm and open the joint back up again. I use the same tool in cases where a disc is bulging on one side due to an unbalanced muscle spasm. Pulling the discs apart right at that inflamed segment can offer great relief. How well it stays in place depends on the amount of injury to the onion-like layers of the outer part of the disc. Normally there are 20 to 25 layers to the wall of the disc. When a bulge forms some of those layers crack deep inside the disc allowing the jelly to seep into the layers creating the bulge. If too many layers are cracked then the correction will not last long.
Some of you may be thinking “why does the disc not heal up?” That is a good question that has a good answer. Discs have no blood supply because the pressure of the spine on the center of the disc is too great. Blood just can’t fight that level of pressure. So all the nutrition the disc needs have to come in as the disc rehydrates at night. If the outer layers of the disc are clogged up with calcium then there is no way for the disc to get the nutrition it needs to heal. If you get a tear through all the outer layers of the disc as you do in an actual rupture then the high pressure is no longer there. Like a car tire that is blown, the inner disc no longer has high pressure. In these cases, white blood cells can migrate into the damaged disc to eat up the damaged tissue. Unfortunately, the repair crew lays down scar tissue which is not flexible, so the disc no longer can absorb shock like it used to. This is what they found in England that I wrote about above.
Why does calcium show up in the first place? Well, calcium is electrically attracted to areas of inflammation anywhere in the body. That is why your inflamed arteries form a calcium plaque. That is why tendons, ligaments, and bursa accumulates calcium after injury. Technically your discs are a type of ligament tissue. So if we don’t take extra good care of our back, the accumulated micro injuries form sticky scar tissue and calcium accumulation. Standard medicine considers this to be normal aging. They expect us to beat ourselves up over time and we just have to expect our parts to wear out. I find this absurd. How many times have I heard a patient who has told me that they have to have a hip replacement because the hip has just worn out? I will ask them how their other hip is and they will say it is fine. I then ask how is it that only one hip has worn out since they use both legs all the time. The truth is they had an injury or several injuries to the bad hip in the past that never healed completely. That is the real reason one hip needs to be replaced.
Our discs are the same way. If we have bad posture while sitting, it will inflame the joint capsule and discs in the low back. If you have had an auto accident that injured your neck and you did not do a full rehabilitation of that neck, it will develop degenerative changes over time. If you do not engage in regular exercise of all your body parts, they degenerate. The same issue occurs when we have a poor diet. If we eat too much or too many carbs combined with excess fats, we will produce systemic inflammation which will affect our muscles and joints, as well as a lot of other areas. If you are not getting sufficient restorative sleep, the same issues result. No one can be perfect all the time, so we all will have some level of degeneration in our bodies. The question is how much?
So now you know why I don’t like to find compression in a patient’s spine. I usually mean that they have some level of degenerative change in the area I am working on. I can’t reverse these kinds of changes. That means the pain relief we are seeking won’t be complete or lasting. There is simply too much permanent damage. We can improve it in the short run, and we can do special stabilizer muscle exercises to support it, but we can not change the underlying real problem.
Take care,
David