Sarah,
I agree with Sarah that the disc do heal despite a lack of blood supply, but
when the patient leaves the clinic, what is stopping the nucleus pulposis
from leaking?? Does this mean that the patients will need to do extension
exercises often to prevent the nucleus from flowing again?? I remember Gwen
Jull telling us that one can never injure a normal disc, one can only injure
a damaged disc - can anyone comment on this??
One interesting patient I had on Saturday morning that I'd like to share
with everyone. This person is an Ass. Professor of Chemistry and has had a
30 year history of back pain, and has been to the every type of therapy but
nothing helped in the long term. He went to 5 orthopaedic surgeons, 3 of
these said that there was nothing they could do for him, and 2 of them said
they wanted to operate (which he strongly refused).
He presented to me with isolated right sided back pain and pain down the
anterior leg. He stated that the pain had always been on the left side, but
somehow this time, it is on the right side. He also stated that he had
irritable bowel syndrome (which the doctors had put as a result of stress)
and suffered from severe migrains, which coincidently always occurs before
his back pain starts.
On examination, he had a ~35 degree list in the thoracolumbar spine to the
left, and could not bend forward or laterally flex to the right at all. He
had active trigger points in both his psoas and iliacus muscles, which were
the only muscles that I looked at yesterday.
>From his presentation, I knew that he had psoas problems. The right psoas
lies close to the ascending colon and hence can cause irritable bowel
sydrome, and I agree with the Doctor, stress will tighten muscles. As well,
the iliacus muscle can actually give severe migrains through a chain of
muscles up the back ending up in the sternocleidomastoid. During this
treatment, I basically used spray and stretch on the psoas muscle, and
showed him how to stretch this muscle out regularly. Amazingly, this person
stood up with a straight thoracolumbar spine, and even though he still had
pain on forward bending at the end of range, he could bend forward. It would
be very interesting to see in the next month, how the irritable bowel as
well as the migrains change as a result of simply treating the muscles.
This give everyone an idea of some of the reasoning behind my treatments. I
am not saying that all back pain patients are treated this way, because no 2
patients are the same. However, I was so blown away by this case that I just
wanted to share it with everyone.
Henry***
>From: Sarah Fern Striffler <[log in to unmask]>
>Reply-To: [log in to unmask]
>To: [log in to unmask]
>Subject: Re: cold spray (about the disc)
>Date: Fri, 06 Oct 2000 05:26:04 -0400
>
>Dear Stewart,
>
>Also no direct blood supply to synovium. In both cases, fluid movement
>is via passive flow. Surely you've heard of the phenomenon of incresed
>disc size in the a.m., "imbibition" of fluid & the subsequent loss of disc
>height during the day. These days, it's even known that articular cartilege
>has the possibility for self-repair. Of course, the healing time can vary &
>healing achieved can be variable, so all we can do to support healing is
>good sense.
>
>In terms of the exact mechanisms, an inflammatory reaction is known to
>occur in the disc material, according to some recent articles in Spine. I
>don't have the references hand, sorry. As in many parts of the body,
>unfortunately, the inflammation can become chronic & fail to resolve in
>the formation of scar tissue.
>
>Please, everyone, add whatever else you know about the healing
>mechanisms.
>
>Thanks.
>
>Sarah Fern Striffler, PT
>
>
>[log in to unmask] wrote:
>
> > Sarah, could you explain what mechanisms allow the disc material to
>heal. As
> > I understand it their is no blood supply to the disc material therefore
>no
> > known method of natural repair.
> >
> > Stewart Harrison
> > Physiotherapist
> > UK
>
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