What is an Annular Tear?

Annular Tear Definition:
An annular tear is a hole or rip somewhere in the interwoven layers of the annulus fibrosus, the tough ligament that forms the exterior capsule of an intervertebral disc.

Intervertebral discs are pressurized cushions found between each bone of the spine. These discs act as shock absorbers and allow the spine to bend in several directions. Each one consists of the annulus fibrosus and, inside the capsule, the nucleus polposus, which consists of a soft, gel-like substance. The nucleus and the inner layers of the annulus have no blood supply or nerve fibers. It is only the outer layers of the annulus that are supplied with many nerve fibers and so are sensitive to pain. Annular tears, therefore, are often asymptomatic, which means that their existence does not necessarily produce any symptoms.

The peripheral layer of the annulus consists of the outer layers. Damage to this layer is usually caused by an injury, and can lead to disc degeneration. The concentric, or central, layer is found between the outer and inner layers. Tears to this layer are also usually as a result of trauma. The inner, radial, layer begins at the center of the disc and extends to the peripheral layer. Annular tears can happen in any layer, and symptoms, if present, can therefore be felt anywhere along the spine and sometimes in the limbs as well.

Annular Tear Causes:
The normal aging process is commonly responsible for annular tears. With time and usage the annulus becomes thinner, losing elasticity and becoming vulnerable to damage. Small holes gradually get larger and, if large enough, the material of the nucleus can start to leak out of the capsule.

Contact sports, with the vigorous bending, twisting and collisions that take place, also often lead to annular tears. Any strenuous activity or occupation involving heavy lifting or lots of bending may cause tiny injuries that may, over time, escalate into a larger tear.

Another common cause for such injury is being overweight. As the spine supports most of the weight of the body, excessive load can compress the discs and increase the risk of tears appearing in the annulus.

Annular Tear Symptoms:
When enzymes contained in the gel-like substance of the nucleus leak out through the annulus and reach the peripheral layer with its many nerve endings, there is a strong inflammatory chemical reaction. This is when pain begins to be felt as a result of having a tear.

If the disc is herniated (the disc is bulging out between the vertebrae, or has actually ruptured), the pain may be experienced as a sharp stabbing sensation, tingling similar to pins and needles, numbness of the skin, or weakness in the limbs, depending on the location of the damaged disc. Pain is typically felt in the back, but can also be felt in one or both legs. There may be some swelling due to inflammation.

Increasing the pressure on the disc will make the pain worse, as will sitting, coughing, sneezing, bending or lifting. Standing will make the pain better.

Annular Tear Diagnosis:
Your medical history will be taken by your health care provider, and a physical examination performed. You will be asked questions relating to the onset and severity of your symptoms. An x-ray may be taken to rule out any fracture of the bones.

The best test for diagnosing an annular tear is a CT (computed tomography) scan. Dye can be injected into the nucleus of the disc, which then shows up clearly on the scan. An MRI scan is not as good at showing a tear, but may be useful in identifying the location of the damaged disc. A nerve conduction study may be performed.

Annular tears are classified according to severity and extent, ranging from 0 for a perfectly normal disc, to 6 for the worst tear and leakage of the nucleus.

Annular Tear Treatment:
Most tears heal by themselves, with some self-treatment, and never need surgery. Scar tissue forms in the outer layers of the annulus, forming a plug through which the nucleus material cannot leak. Unfortunately, the plug does not extend through all the layers, probably because of the lack of a blood supply to the central and inner layers, which leaves the disc vulnerable to future tears.

Self-treatment:

• Cold compresses, applied for 15 minutes at a time, several times a day, are helpful during the first day or two, followed by hot compresses.
  
• Acetaminophen (Tylenol), NSAIDs such as ibuprofen (Advil) or naproxen (Aleve) will provide pain relief and the reduction of inflammation.
• Try to avoid staying in bed. Prolonged inactivity will lead to weaker muscles and more pain.

Your doctor will provide stronger pain medication if necessary. You might also be given an epidural injection of a corticosteroid to relieve pain and reduce inflammation. These injections can provide relief for many weeks, but because of possible side effects, can only be given a limited number of times.

A physiotherapist will have a variety of treatment options available, and will tailor the treatment to your particular needs. Such options might include massage, electrical stimulation, ultrasound, hydrotherapy and spinal realignment. You will also begin supervised low impact exercises, and be given advice on exercises to perform at home, leading to a gradual resumption of your normal activities.

Surgery is rarely needed, but if required will probably be one of three procedures. One would seal a leaking tear, another would be performed to shrink the disc enough that the size of the tear was reduced, and the third would be the removal of the damaged disc and fusion of the two vertebrae.

Annular Tear Prevention:
Nothing can be done to stop aging, and many annular tears do not produce any painful symptoms. However, staying as healthy and active as possible will reduce the risk of damage to the spine.

• Exercise to build muscle strength and improve flexibility.
• If you smoke, stop. Nicotine reduces the ability of the disc to absorb nutrients and will therefore hasten degeneration.
• Maintain a healthy weight.

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What is a Herniated Disc?

Herniated Disc / Slipped Disc Definition:
A herniated disc occurs when the spongy, gel-filled cushion between two bones of the spine bulges or slips out of place. The spine is made from 33 bones, stacked to form a tunnel, within which lie the spinal cord and nerves. The vertebrae are separated by discs which acts as shock absorbers, and allow the spine to be flexible. These discs are made up of a hard outer capsule (annulus fibrosus) and a soft, spongy middle (nucleus polposus).

Herniated discs are sometimes called ruptured discs, although there is a difference. When a disc bulges out between the vertebrae, it is termed herniated. If the nucleus inside the disc breaks through the capsule, it is known as a ruptured disc. Sometimes pieces of a ruptured disc, called free fragments, become detached and get lodged in the spinal canal. These are often reabsorbed by the body and cause no problems.

Herniated discs are a very common spinal abnormality, and often bulge away from the spinal cord, causing no problems at all. Herniated disc symptoms such as pain and numbness are only experienced when the herniated disc presses on a nerve in the spinal canal. Most occurrences of this condition are in the lower back (lumbar spine), between the 4th and 5th lumbar vertebrae. They can also happen in the neck (cervical spine) and, rarely, in the upper back (thoracic spine).

Herniated Disc / Slipped Disc Causes:
The normal aging process is responsible for many herniated discs. This is termed disc degeneration. As the body ages, the outer capsule of the disc starts to dry out and become less flexible. This loss of elasticity causes tiny cracks or tears to appear, and the nucleus (the spongy gel) can form a bulge in the capsule or even break through.

Another, less common, cause is injury. A sudden strain on the lower back might cause a disc to herniate. Repetitive actions such as pulling, lifting with poor posture, playing some sports, or even constant exposure to vibration when driving can also be causes of this condition.

Slipped Disc Risk factors:

Low Back Pain

Definition:
Most people will experience some sort of back pain during their life, usually in the lower back (lumbar spine), as this area of the spine bears most of the weight.

The spine has 33 bones, each separated by an intervertebral disc. Attached to the spine are muscles, ligaments, tendons and blood vessels, and running through the tunnel formed by the spine are nerves and the spinal cord. Bearing in mind how much lifting, straining, twisting and other movements we perform throughout the day, it is hardly surprising that occasionally some part of the lower back will be injured.

Low Back Pain Causes:
The aging body is responsible for many instances of low back pain. The intervertebral discs begin to deteriorate and lose the ability to adequately cushion the vertebral bones. They can become herniated or ruptured. Ligaments attaching bone to bone thicken and lose elasticity, increasing the risk of strain or sprain.

Daily life contains many possibilities for injury to the lower back. One of the most common is failing to maintain correct posture when lifting heavy objects. Standing incorrectly, or sitting in a poor position for a long time, or even sleeping in a bad position will increase strain on the back. Normal activities such as gardening or playing golf, especially after a long period of inactivity, place a huge strain on weakened muscles. A person's job may also be a factor. Driving a jackhammer or heavy industrial machinery which cause a lot of vibration will again put the lower back at risk of strains or tears to the muscles and ligaments.

Fractures, either through accident or a condition such as osteoporosis, are likely to cause low back pain. Pregnancy, with the associated increase in weight and strain on the body, can be a cause, as can various female reproductive disorders. Many diseases or conditions, especially arthritic conditions, can trigger low back pain, as can some skeletal abnormalities such as scoliosis or kyphosis.

Being middle-aged or older, smoking, being overweight, and performing heavy work or exercise after extended inactivity all increase the risk of developing low back pain.

Low Back Pain Symptoms:
Low back pain is what it says it is: pain in the lower back. The ways the pain is experienced are many and varied. It might feel dull or be sharp and 'shooting'. It could be constant, or come and go. It might feel like burning or pins-and-needles. It could range from mild to severe and the severity could change. You might experience muscle spasms, cramping or stiffness, or possibly weakness or numbness.

When low back pain is the result of a nerve being pinched, as happens when you have suffered a herniated disc, the pain will radiate down one leg, anywhere from the buttock to the foot. It will feel worse when sneezing, coughing or straining to pass a stool.

Pain resulting from an arthritic condition will most likely feel worse in the back and hip. It probably starts gradually, becomes increasingly painful and generally lasts a few months. It will feel worse after rest and first thing in the morning, and better after moving around.

Diseases of the spine cause low back pain that tends to be worse in the affected area. The pain might be accompanied by fever and sensitivity of the spine to touch.

Low Back Pain Diagnosis:
It is necessary to determine the particular cause of the low back pain in order to decide upon the correct course of treatment.

Your doctor will ask for your medical history, including any previous back problems. You will be asked about your current symptoms; what makes the pain better or worse; the type of pain you are experiencing, and the site of the pain and whether it radiates to any other part of the body. You will probably be asked about any remedies that you have already tried.

You will have a physical assessment, including your posture, spinal alignment, reflexes, muscle strength and range of motion. You may be asked to sit or lie down and raise one straight leg into the air, to see if you might have a herniated disc.

Other diagnostic tests, depending on what the doctor thinks might be the problem, might include X-ray, CT (computed tomography) or MRI (magnetic resonance imaging) scans. Occasionally a bone scan might be ordered, as might a discogram or myelogram.

Low Back Pain Treatment:
Time usually solves most low back pain.

Self-help options:

Sacroiliac Joint Injury | SI Joint Injury

The sacroiliac joints are found where the sacrum meets the left and right iliac bones, below the lumbar (lower) spine and above the coccyx (tailbone). The sacrum is made from five bones fused together into a triangular shape. The iliac bones are the two large bones that form the pelvis. Between these bones are small, strong joints that act as shock absorbers and carry the entire weight of a standing person. Strong ligaments connect the bones and keep the joints in the correct position. The range of motion in the sacroiliac joints is very small, about 2-4 mm for men, and only slightly greater for women.

A sacroiliac (SI) joint injury can be called SI joint dysfunction, SI joint syndrome, SI joint strain, SI joint inflammation, or sometimes facet syndrome. They all mean that the joint has suffered some damage that is causing sacroiliac joint pain.

Sacroiliac Joint Injury Causes:
It is generally believed that an injury to this joint, and the resultant si joint pain, is caused by either too much motion in the joint, or too little.

The most common cause of injury is normal wear and tear due to aging. The ends of the bones that form the joint are covered with cartilage, a smooth and slippery connective tissue that allows the bones to slide over each other with minimal friction. As we age, the cartilage thins through usage, or becomes damaged, which results in the bones starting to rub against each other. This can lead to osteoarthritis, otherwise known as degenerative arthritis.

During pregnancy, in order to ready the body for childbirth, hormones are released that relax ligaments. Loose ligaments do not hold bones together tightly enough and can cause problems with the sacroiliac joint. After childbirth, the ligaments tighten up again, and in some cases tighten too much, again leading to pain in the joint. Also, the extra weight being carried by a pregnant woman, and the different way of walking involved, add stress to the joints and might cause difficulties.

In fact, any altered manner of walking, perhaps as a result of having a bad knee, or hip, increases stress on the SI joints. Poor posture can also be responsible for abnormal wear on the joints, as can lots of bending and twisting while playing sports, or lifting and twisting while holding a heavy weight.

Some disorders such as ankylosing spondylitis or rheumatoid arthritis are known to produce pain in the SI joints.

Sacroiliac Joint Injury Symptoms:
It can sometimes be difficult to pinpoint the exact location of the pain, but generally it is felt in the lower back or back of the hips, sometimes radiating out into the groin or down into the legs.

It is thought that if there is too much movement in the joint, the pain will be felt mostly in the lower back, hip and the groin.

If the problem is not enough movement in the joint, the pain will still be felt in the lower back, but also on one side of the buttocks, and down into the leg with a sensation similar to that of sciatica. There may also be a feeling of wanting to stretch the back at that point.

If the cause is inflammation or arthritis in the sacroiliac joint, stiffness or a cold, burning sensation in the pelvis might be felt.

Coughing, sneezing or bending may make the SI joint pain worse. Standing up and walking may also make it worse, while lying down will generally make it better.

If any nerves have been pinched or otherwise impaired, weakness in the legs might be experienced.

A fracture of any of the bones may produce a grinding feeling in the joint and the inability to bear any weight on the leg.

Sacroiliac Joint Injury Diagnosis:
One reliable and simple way of determining that your pain is caused by an injury to the sacroiliac joint is by pressing on the site of the pain. If that corresponds with the position of the joint, it is the source of your discomfort. Of course, any of a number of conditions might be responsible, and your health care provider will try to determine which it might be.

A medical history will be taken, and you will have a physical examination as well. Your doctor is likely to place your hips and legs in certain positions and then apply some pressure, in an attempt to reproduce the conditions that cause you pain.

An x-ray might be taken, and possibly a CT or MRI scan. CT and MRI scans are more detailed and show the soft tissues of muscles and ligaments as well as bones. It is also possible that a bone scan might be needed.

The only non-invasive test that will definitively confirm that the SI joint is the source of your pain is an injection of a numbing agent, such as lidocaine, into the area. If the SI joint is numbed, and your pain disappears, then the joint is responsible.

Sacroiliac Joint Injury Treatment:
Non-surgical options are usually successful.

Self-help options:

Sciatica: What is Sciatica? What is Sciatic Nerve Pain?

Sciatica Definition:
Sciatica is not an injury or a disorder, but a symptom of an underlying problem involving the sciatic nerve. It is the term used to describe the pain that is felt as a result of damage to, or compression of, the sciatic nerve.

The sciatic nerve is the longest nerve in the body and is actually two nerves, the tibial and common peroneal, held together in a sheath of connective tissue. Nerve roots leave the side of the lumbar (lower) spine at intervals, eventually joining to form one large nerve that travels through the buttock and down the back of the thigh, dividing back into the tibial and common peroneal nerves at about knee level.

Causes:

Spondylolysis and Spondylolisthesis: Definition, Symptoms & Treatment

Spondylolysis Definition:
Spondylolysis is the diagnostic term describing tiny fractures in the pars interarticularis bones of the spine. Spondylolysis is the most common cause of spondylolisthesis, the slippage of one vertebral bone over the one beneath. Although either of these disorders can be found anywhere in the spine, the lower back is predominantly affected, probably due to the increased weight that this area has to bear.

The vertebrae, or bones of the spine, are separated by discs which act as shock absorbers and allow movement of the spine in several directions. Part of the vertebrae include facet joints at the back of the spine and, attaching the joints, are small arched bones called the pars interarticularis.

If the pars become sufficiently damaged, they may no longer be able to hold the vertebrae in place, which can cause spondylolisthesis. Such damage also increases the stresses and forces that the intervertebral discs have to withstand, which may lead to conditions such as sciatica.

Spondylolysis is commonly found in young athletes whose particular sport necessitates regular hyperextension of the lumbar spine (lower back). Gymnasts are a good example, although the condition is found amongst athletes participating in many other sports. Spondylolysis can be diagnosed as active or inactive. The condition is not always dangerous, and does not necessarily lead to spondylolisthesis, but, if active, it does require careful treatment to avoid incorrect healing, which might lead to chronic or recurrent back problems.

Spondylolisthesis damage can occur on one or both sides of the spine. It is usually found between the fifth lumbar and the first sacral vertebrae, although it can also be found between the fourth and fifth lumbar vertebrae. It is rarely found higher in the spine. It is graded accordingly to severity, with 1 being the mildest, and 5 the most severe, in which instance the vertebra has completely slipped off the one below.

Spondylolysis and Spondylolisthesis Causes:
Spondylolysis:
It is believed that 3-7% of the population has this condition, but it is not understood what will cause it in one person rather than another. Common causes are:

Sternoclavicular joint

The sternoclavicular joint (SCJ) is the joint between the clavicle (collarbone), and the sternum (chest bone). You might be able to feel the end of the clavicle as a bump to the side of the dip at the base of your throat. The actual joint is just below this bump. The end of each bone is covered with smooth, slippery, cartilage, which allows them to move against each other with minimal friction.

The SCJ supports the shoulder and is the only joint that connects the arm and shoulder to the main skeleton. It is an inherently unstable joint, but there are four different types of very strong ligaments, attaching bone to bone, which help to reinforce it and to keep the bones in their correct positions.

Types of sternoclavicular joint injury:
Sternoclavicular joint injuries are uncommon but not unknown, and are usually caused by a strong blow to the clavicle that tears or ruptures one or more ligaments, thereby damaging the joint to a greater or lesser degree.

Tailbone Injuries | Coccyx Bone Injury

Tailbone / Coccyx Bone Injury Definition:
The coccyx, or tailbone, is found at the very end of your spine. It is not, in fact, one bone as the name would suggest, but 3-5 small, not fully-formed, vertebral bones, held together by joints and ligaments to form a triangular shape which has a limited range of motion. Because of these attachments, and the number of nerves in the area, damage to the coccyx can cause problems in the rest of the spine, the pelvic floor and perhaps even the intestines.

The coccyx is normally well protected as it curves inward toward the front of the body. However, in women, it curves less and is therefore more vulnerable to injury. A fall or some other trauma to the tailbone can be extremely painful. It even has its own name - coccydynia. There can be extensive bruising, ligaments can be stretched or torn, and the bones can be dislocated or perhaps even fractured.

Tailbone / Coccyx Bone Injury Causes:
The most common cause of an injury to the coccyx is a fall onto a hard surface. Slipping on ice and landing hard on your backside frequently results in a fractured or broken tailbone.
Other causes might be: