Both my inner osteopath and the lover of dance was awestruck, as usual, by the beautiful grace and movement of the Bangarra dancers, watching their 20 year gala performance on Saturday night. It was a trip down memory lane watching some of those magical pieces from the last 20 years being performed. Congratulations to Stephen Page and all the creative team at Bangarra for their inspiration and stories to us.
One of the common causes of low back pain is due to minor damage to the disc known as Internal Disc Disruption (IDD). It is believed that around 40% of low back pain is caused by IDD.
Damage to the disc can be caused by a number of factors from overload and injury to long term poor postural habits and the degenerative nature of the disc itself.
Any factor that creates undue load on the spine can lead to injury and back pain. Too much mechanical stress or dysfunction may occur due to repetitive strain of the spine leading to fatigue, one very large strain, or unexpected strain. Poor technique in physical activities or poor body mechanics may lead to disc
injury. Unexpected loading can result from falls, collisions or poor technique.
You will remember from the last blog that the discs are mainly avascular and the nucleus and inner 2/3 of the annulus have no nerves. The outer third of the disc does, however, contain tiny pain-carrying nerve fibres (nocioceptive C-fibres) that, when irritated, have the capacity to cause pain and disability.
When a tear of the annulus spreads to the outer third of the disc, these nerve endings (known as sino-vertebral nerve endings) are exposed to material leaking out from the nucleus of the disc which will lead to pain from the chemical irritation of these pain-carrying fibres.
Mechanical pain can occur when the functional abilities of the annulus are compromised. When the nuclear material invades the annulus, it will destroy annular collagen fibres. The mechanical forces spread across the remaining fibers and overwhelm the disc’s normal ability to support the weight of the body and the strong compression and rotation forces placed on the spine. The excessive strain transmitted to the highly nerve sensitive outer third of the disc results in mechanical pain signals on normal movements.
Tears can occur from the inner part of the disc outwards but also from the outer part in. there is also a relationship between a disc that has lost some of its water content and become increasingly brittle (part of the degenerative disc process) and disc tears
In a degenerative disc you can also get radial tears running circumferentially around the brittle annulus itself. These are known as concentric annular tears, or radial tears, and will weaken the disc and create an irritation of the nerve fibers within the annulus of the disc.
The symptoms of back pain due to disc disruption are of chronic duration and typically worse with any loading of the disc or activities that increase the intradiscal pressure. Such activities often include bending, lifting, sitting and, sometimes changes in posture.
This pain is not a result of disc compression upon the nerve root, which is the case in a disc herniation, but rather, it is due to the damage of the internal structure of the disc itself. The resulting changes to the nuclear material and internal radial fissures lead to a pain that does not usually radiate into either leg past the knee and there are not usually classic neurological findings. In other words, there is generally no weakness or sensory loss, no loss of deep tendon reflexes or root tension signs.
Most people who suffer back pain from IDD will obtain relief with time and conservative treatment. IDD can take up to 18 to 24 months to heal and patience is, obviously, an important factor here. The other important factor is to reclaim mobility as early in the healing process as possible, without exacerbating the pain. Conservative osteopathic approaches include gentle traction and mobilisation treatments and spinal stabilization training exercises.
Anti-inflammatory and analgesic medications will also aid in the early part of the healing process.
To get a visual sense of this process go across to http://www.bayareapainmedical.com/disruption.html and click on their animation
People often ask me how I got into osteopathy or for how long I have been in practice. I have been pondering these questions lately, as one does from time to time, though it does make me seem somewhat ‘older’ than I really want to be.
Recently I made a video with my colleagues from Sydney Osteopathic Medicine about how we all got into osteopathic practice. It was fun to sit and tape our stories. See my blog ‘Video killed the radio star’…..It made me think about starting up both of my clinics at Bondi Junction and in Sydney CBD; so here is a bit more of my story:
While working in the area of prenatal care and teaching anatomy and healthcare to trainee childbirth educators, I was introduced to a wonderful acupuncturist and practitioner of traditional medicine, Elyane Brightlight, who had moved from the Village Healing and Growth Centre, a large group practice in Paddington, to her own smaller clinic in Bondi Junction. I was, at this time practicing from a home based clinic in Kensington, from rooms in North Sydney and working out of the Sydney Dance Company studios at the Wharf in Hickson Road in The Rocks. The temptation to have one base in Bondi Junction, which I considered to be the heart of the east and the heartland of Osteopathy here in Sydney, was one that became a delightful reality very quickly.
So I moved into the Good Spring Centre at Bondi Junction with the colorful and talented Elyane and began a long and fruitful professional relationship with a wonderful colleague who continues to inspire me today, so many years down the track….. and my osteopathic practice at Bondi Junction was born.
We worked together for about six years at this clinic in Hollywood Avenue before I purchased my first clinic and together, we moved up to the eagles eyrie of Harley Place Health just along the road on the corner of Hollywood and Oxford…. I still today love giving out that descriptor…. overlooking the magic of the Junction, across to the city skyline and down through to Double Bay, our ever changing Slessorian harbour and beyond to the hills of the north shore. On a fine afternoon you can see the glistening dome of the Bahai temple at Mona Vale from our clinic. This is a view that, to this day, I do not tire of.
We have collaborated on many different aspects of clinical practice over the years and taught from our respective expertise in the area of prenatal care and childbirth along with other areas of clinical knowledge. Years later some of my work was published in a small book for consumers by Wellbeing magazine and Elyane went on to publish her first book in this area called ‘Natural Childcare’.
In addition to working in the very exciting and life-changing area of childbirth, I also developed my Bondi Junction practice in the area of dance and performance injuries. Working in the arts and being involved on the edges of the creative arena has been an inspiring experience and has presented me with some wonderful opportunities to make my small contribution to the creative process, both as an osteopath and then diversifying into other areas within the arts. This has provided me with many extremely fulfilling and enlivening experiences and people many of whom today I am fortunate to continue to have in my life. Twenty years down the track I am as inspired and in awe of the creative process of the human body-mind and its capabilities as I was all those years ago when I first was introduced to the osteopathic concept.