Degenerative
Disc Disease |
When talking
back pain, it is
important to talk about the intervertebral disc. It is not commonly known that
the intervertebral disc undergoes the most dramatic age-related changes of all
connective tissue. By the third decade of life, much of the distinction
between the annulus fibrosis (outside of the disc) and the nucleus pulposus
(jelly middle) is lost, as the latter is progressively replaced with
fibrocartilaginous tissue.
But is it the disc causing the
back pain?
In an elaborate study by Gresham
and Miller in 1969, the fourth and fifth lumbar discs were dissected out
during autopsies on people with no history of back pain.
Between the ages of 14 and 34
years, 90 percent of the discs were found to be normal.
At ages 35 to 45, degeneration
was evident in 75 percent.
After the age of 46, every single
fifth lumbar disc was degenerated, and only 25 percent of the fourth lumbar
discs were normal.
This study showed that it is not
the degenerated discs that cause
low back pain.
Many patients are distressed at
being told that they are suffering from one or more degenerated discs. This
suggests an irreversible and crippling phenomenon. The term
"degenerated" should be discarded because
disc degeneration is
universal as age advances, and often causes no symptoms. There must be
other structures in the back that are causing the symptoms. The structures
causing
back pain are most often the
ligaments.
The low back is composed of
muscles and ligaments. The posture is held erect by four particular sets of
muscles. These muscles include the
abdominal muscles, the back extensor
muscles, and a set of paraspinal muscles that lie to the side of the vertebra.
There are also important muscles that control hip, leg, and pelvic motion. The
most important of these is the iliopsoas muscle. These muscles have a
significant influence on the function of the back. The
supraspinatus and interspinatus ligaments go from vertebra to vertebra. There are also strong
ligaments that go from the vertebrae to the ilium (iliolumbar ligaments),
along with the ilium to sacrum (the
sacroiliac ligaments).
Cumulative trauma either by
sports participation or heavy labor vocations over the course of years can
result in small tears of these ligaments. One major trauma or injury can also
be of such severity that healing never occurred. Since the ligaments do not
heal, the intervertebral discs do not have the support that they need. This is
why there is such a high degree of degenerative disc disease in the
lower
back, which is essentially 100 percent by age 46. Degenerative
discs are the result of
ligament laxity or instability in the lumbar vertebral
segments. The instability and
Ligament laxity cause the chronic low back pain
and send athletes by the droves to chiropractors.
Manipulation is helpful to
realign the vertebrae, but does nothing to regenerate the damaged ligament.
Prolotherapy must be given to repair the ligament tissue to allow the
vertebrae to stay in place permanently.
Prolotherapy is the treatment of
choice for treating low back pain.
Prolotherapy injections are typically given into the
ligaments connecting the vertebra, along with
injections into the ligaments
between the ilium and sacrum. This helps to tighten the connections between
the pelvis and
lumbar spine and assists the muscles in providing stability to
the back. It is amazing how many people end up avoiding surgery once they have
Prolotherapy because Prolotherapy gets rid of the pain and stabilizes the
back. Unfortunately,
back surgery usually causes the muscles and ligaments to
become even weaker. A surgery that was supposed to strengthen the area
actually ends up weakening it to the point that the non-surgerized back is
stronger than the back that was surgically repaired.
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