Being at the elite level of sprinting (foot and bike) for most of a lifetime, I've learned many important factors about the lumbar spine and how to protect it. Even heal it. It was always assumed that just being physically strong and in great shape was protection enough from injury. But there's much more to it than just fitness and strength. I learned this lesson the hard way.
The spine is an amazing design. Its basic structure is really just bones separated by tough collagen, gelatin-filled discs, all held together and encased by ligaments. The discs can actually take a lot of abuse and load cycles before actually failing; the vertebrae are simply bone and hardly ever pose any problems when a healthy disc is in place. Damage to either part is really a "broken back" -- whether disc or bone, it's a very serious, bodily injury.
Disc condition is what usually determines spinal health, and injury prevention is focused here. At the basic level, spinal disc health depends a lot on your level of physical fitness and how much hydration it retains over time. There are, however, body movements and types of loading that over a long period of time greatly contribute to a lumbar disc breakdown and eventual injury. So working out the wrong way -- or even the "right" way -- can cause a problem, despite having great fitness from the regular working out. Keeping the discs hydrated is crucial, no matter what.
Typically, it's the discs of the lumbar region that's vulnerable to problems. Being at the center, or core of the body, there's maximal axial and rotational loads and forces here. A lot of leverage is placed on the discs from above by the torso and its weight, and from below by leg movement. There's also the most force from twisting put into the lumbar region. And... it's also got to be the foundation and support for the legs and torso. That's a lot of duty! And that's just assuming there's optimal physical fitness, strength balances and good posture. So as you can probably imagine, having even a slight flaw in posture, for example, can cause a problem over a long enough period.
It's amazing that disc injuries aren't more common. But in fact, minor issues are common but silent or unrecognized. They're not felt until the thecal sac is indented from a herniation. Disc bulges are most common and "silent", but typically cause referred pains, if there's any symptom at all. It's herniated discs that easily get the attention because the pain is sudden and very acute, and it's easy to diagnose. Identifying and correcting the "flaw" that caused the injury is most important for recovery and staying recovered.
A disc bulge is very common, and can even come and go over a lifetime. They do heal on their own -- usually, if the cause is not from continued overloading. Personally, I had a disc bulge that took about three years to form and progress to the level of producing acute symptoms throughout the final year before it finally herniated. It was like a ticking time bomb, just waiting to blow (herniate). At the later stages, the symptoms were not in the back at all. Had the symptoms been recognized as a disc bulge, even by healthcare professionals that saw me, the cause -- overloading, strength imbalances, and decimation -- could have been addressed and the eventual disc herniation avoided altogether. Learning to recognize the signs of a disc bulge are especially crucial for an athlete, but learning how to avoid a disc bulge is even more important for everyone.
But what is a "disc bulge" and "disc herniation"? What's really the difference? Seen from the outside, the disc is still bulging just the same. Primarily, the difference is the location of the nucleus of the disc and the integrity of the annulus layers and fibers. A herniation is particularly serious because the annulus has torn, from the inside toward the outside.
With a bulge, the nucleus is still basically centered within the annulus layers, while the annulus has just become weakened and allows the nucleus the push the annulus out -- usually no more than about 1-2mm. The annulus has not torn, it has just started to breakdown. This can later lead to an annular tear.
With a herniation, the nucleus has come off center within the disc because the annulus has torn to some extent, while allowing a bulge of at least 3mm and up. The size of the central canal "chamber" will determine the maximum allowable size of a bulge before the thecal sac is contacted and severe pain results -- so a 5mm bulge is more severe an injury for a smaller canal than for a larger canal.
The most important thing I learned from experience with my disc problem is simply that prevention is crucial. Period. Problems with the discs can almost always be avoided, particularly if their health is monitored. It's always stated that prostate and breast exams are so important for early detection of cancer, but when it comes to the spine... well, it gets ignored, despite the fact that disc decimation is so common, with the results usually being life-long pain, loss of activity or expensive, unnecessary surgeries. Sure, it may not kill you, but who wants to live in chronic pain and be partially disabled for life? By comparison, the cost of an MRI is a bargain -- prevention is crucial.
Disc decimation (loss of hydration) is typically the beginning of a disc problem -- it's almost always the precursor to a bulge or herniation. Once the disc starts drying out it gets brittle and prone to cracking and tearing -- think of the flexibility of a piece of green wood versus a dried piece of wood. Getting an annual MRI of your lumbar spine will allow you to monitor the situation - especially at age 40 and over, when decimation typically starts to show. You're watching out for decimation first, a bulge a distant second. There are many things you can do to prevent disc decimation -- that is, prevent "disc disease" -- over your lifetime, starting at a young age. The name of the game is to stop or prevent disc decimation.
The first thing to realize and understand is that you can greatly control the health and longevity of the discs. Keeping them hydrated is paramount. When you unload the discs by lying down, the disc can suck in fluid and attempt to rehydrate; putting load on the disc pushes fluid out. Simple principle to remember. When the disc loses hydration it gets temporarily thinner; if it can't rehydrate completely "disc disease" begins and it stays thinner, and gets thinner and still thinner... That's why you're taller after just getting up in the morning and shorter at bedtime; it's also why people typically keep getting shorter much later in life. Keeping it hydrated is very important. Can't stress it enough.
There are currently three basic "tools" to deal with disc hydration:
- A very simple body movement that unloads the spine and pumps fluid in and out of the disc, centers the nucleus, yet doesn't harm the annulus if done correctly. This should be done at least once per day, daily, and takes less than a minute. This is simply for disc "hydration maintenance". However, it can also be used as a part of a disc injury recovery program.
- If loss of hydration is detected -- if decimation has begun -- then a course of therapy that uses the DRX-9000 is ideal for getting total load off the disc and pumping it up with new fluid.
- In the event of a herniation, getting a maximum healing "matrix" is always the goal. Currently, Fibrin Glue injection is the best solution. (In the future, stem cell therapies may very well be found to work just great.)
Sitting is very hard on the lumbar discs. If you sit all day you are just pushing fluid out of the discs for that amount of time and bringing in none. Plus, your support muscles are getting weakened or not developed very well at all. And if you're sitting-posture is bad it's even that much harder on the discs. Sleep time -- the time when the discs can really rehydrate -- is now typically lacking, too. Factor in many years of just this and it's easy to understand how a disc dehydrates, how "disease" starts. Too much sitting, bad posture and too little sleep is the first major cause of "disc disease".
Personally, I never had any disc problems until I started sitting for fourteen hours a day at a computer, for about a year. The process can start with just one major change of lifestyle. Until then, my life was one of daily constant motion and never sitting for any long periods of time or otherwise being sedentary. Sleep was still between 7 and 8 hours, with daily workouts and great nutrition. But when "the bulge" started it was "silent" -- it almost always is silent -- and I didn't have an MRI to show me there was decimation starting in two discs as a result of the long sits. That one change in routine was the root cause of the disc decimation. Although it was routine for me, at the same time I was also doing extremely heavy speed pressing on an inverted leg-press machine -- up to 1300lbs., slammed out at fast reps of 10-13, with a body weight of 160lbs; "warm-up weight" was 800lbs. -- and that was not the thing to do in the given circumstances of sitting for so long, all day prior. Bad, very bad combination. That, added to the disc decimation, kicked off the beginning of a disc bulge, and three years later, even after having stopped the extreme leg pressing and not being chained to a computer all day, it finally herniated. You see, I hadn't acted to reverse the problem; didn't realize there even was a problem -- couldn't read the signs. But funny enough, the third year I was doing "therapies" to treat the symptoms, and that unwittingly caused the disc to get worse and lead it to herniation! Even the later-stage symptoms of the bulge were totally misdiagnosed by a doctor, and an MRI was not even recommended! So learn the simple causes of disc problems and be aware of it if symptoms are beginning. Learn to read the signs. Don't just rely on the "experts".
Copyright, 2012, by Don Huxley
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