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micro trauma of the disc wall

Perhaps the most important traumatic spine disorder of all is the most subtle and ongoing: micro trauma of the disc wall (the outer annulus) suffered by the lower lumbar discs.

Even at the best of times the lumbar discs have a high maintenance load. The high compressive forces, potentiated by bending activities that increase the intra-discal pressure of the disc's nucleus against the back wall from within, coupled with the back walls of the discs pulling thin as the back of the spinal interspaces open up, all exact a high toll. The forces of destruction are great and amount to constant micro trauma of the disc wall. 

The researchers Moseley & Butler describe discs as extremely tough 'living adaptable force transducers' or LAFTs. But they also say that all discs routinely have a shaggy and frayed appearance from the constant duress and fibre disruption they endure. 


A stiffer, less compliant disc is easily traumatised by a chance errant movement


The intervertebral discs barely have a blood supply (see anatomy of the spine) and recover poorly when injured. For this reason, the back disc wall - the most taxed part of the disc - is protected by several layers of ligaments, perfectly designed to absorb errant fluke movements as they pierce the back from the outside in. Even so, its easy to 'rick' the back and - if you are unlucky, or over-stressed, or over-worked, or tired, or you've sat for too long, or even if you've been sitting in a draft - you can do something to hurt the back with the most mundane and inconsequential of tasks. 


Un-planned for, or poorly executed body movements, are the most likely cause of micro trauma of the outer annulus of the lumbar discs on a cumulative scale


The injury takes place on the microscopic scale, where multiple often-minor incidents cause damage, literally fibre-by-fibre. The damage, the consequent scarring, then more damage I believe plays an integral part of the disc’s overall breakdown. 

With too much sitting and not enough activity, the disc's tough disc wall becomes bunched down and non-compliant; too stiff to roll with the punches. It becomes an easy target for further ricking incidents; a stiffer than normal outer rim of the disc is repeatedly ‘hurt’ or traumatised by mundane everyday activity on a minor scale. This process is described in more detail in the pages on non-specific back pain. 



You may be interested to know that the concept of disc healing in the treatment of low back pain is gathering impetus in the scientific world since Professor M A Adams, Manos Stefanakis PhD and Patricia Dolan published the following, much cited paper in Clinical Biomechanics: 'Healing of a painful intervertebral disc should not be confused with reversing disc degeneration: Implications for physical therapies for discogenic back pain' 2010.

This was followed by the two more recent papers below, co-authored by myself, Professor Adams and Manos Stefanakis PhD and published in Physical Therapy Reviews

Narrative Review
'Healing of painful intervertebral discs:implications for physiotherapy
Part 1 — the basic science of intervertebral discs healing' 2012
Click here for Abstract and download

Narrative Review
Healing of painful intervertebral discs:implications for physiotherapy
Part 2 — pressure change therapy: a proposed clinical model to stimulate disc healing' 2012.
Click here for Abstract and download

The second paper describes using the BackBlock to stimulate disc healing. 


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