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May/June 2015
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Willsmere Health Newsletter

Slipped discs, Biopsychosocial Treatment and PracTx Software

 I Slipped a Disc! (Or maybe not)

The picture below paints a grim picture, this is what people think is happening, but its not as bad as you might think!

               

We see people everyday saying they are worried they have "done a disc", we thought it was time to talk about whats really happening. There are a number of terms used to describe spinal disc pathology, including "slipped disc", "bulging disc", "disc herniation" or "pinched nerve". But what actually happens?

Discs don't hurt!
-Many herniated discs do not cause pain. In fact current figures show if we scanned 3 people who have no low back pain , one of the three will have a disc bulge. So there is a 33% chance you are sitting there with a disc bulge as you read this and have no pain. Discs are very strong and firmly adhered to your spine above and below, with multiple ligaments anchoring them as well. They are meant to "squish"and "bulge"a bit. There is actually no such thing as "disc pain", but rather the disc contribution to the pain experience.

- Vertebral discs are much stronger than people may think. Given their primary role is in shock absorption, they are able to withstand a great deal of forces placed on the spine during everyday activity. In the case of a disc herniation, material from the centre of the disc bulges out through a tear in the outer surface, occasionally compressing the adjacent nerve root where it emerges from the spinal cord. This is actually quite rare, in our 24 years combined practice we have seen less than "4" patients who had a true "pinched"nerve who required surgery.In fact the spinal nerve only takes up about one third of the space where it comes out of the spine, so there is a lot of room around the nerve.

- Whats a Dorsal Root Ganglion? (DRG). In simple terms it is a cluster of neurons at the back of the spinal nerve. It relays information from your periphery to the spinal cord and brain.  Its an enlarged area and 2 important factors make it a little vulnerable to getting sensitized. First , as you can see in the picture below it is very close to the disc. Secondly and unusually for a nerve, it is poorly myelinated (i.e poorly insulated). When a disc has excessive strain a local inflammatory process occurs. The inflammation in the region can affect the DRG quickly because its close by and poorly insulated. Signals are sent to the brain and the brain can output quite a dramatic pain sensation.

 

-Tissue damage causes a local inflammatory response, where inflammatory cells produce chemicals responsible for mediating the healing process and tissue regeneration. However,these agents also act as irritants,changing the properties of neural tissue surrounding the area of trauma. Changes occur in the brain in response to this repeated nerve stimulation, known as central sensitisation. The brain develops a memory, meaning a more rapid response occurs when the same stimulation occurs in the future. This resulting hypersensitivity means that at times, even though no tissue is being damaged, pain may still be perceived by the individual.

-The level of pain experienced does not always represent the amount of actual tissue damage.

-Where do we come in? Early intervention is the key. Get your Osteopath to make an accurate diagnosis and get the right treatment and advice early on for a quicker recovery. The sooner we settle the local irritation the less likely we are to progress to more central sensitisation as described above.
What is a Biopsychosocial model of treatment?

The biopsychosocial model for treating pain is now universally seen as the most effective way to approach pain and painful conditions in humans. But what does it mean?

1.Bio, stands for the body, all the physical components that make up the body.

2.Psycho, considers the persons psyche, their thoughts, beliefs, emotions, past history and many other aspects that go into their opinion of what their problem is or could be.

3.Social. This part considers the enviroment the person lives in and the people around them.What support do they have, what are others saying about their problem etc.

All these factors play a considerable part in a person's pain output. Especially with chronic pain, we know if people only address the bio part (the body and tissues) the outcomes are normally poor.So sometimes we may ask questions or explore other ideas which seem unrelated to your painful area but there is a good reason for it.



The picture above provides an insight into the complexity of pain. Sure, sometimes someone has a simple muscle strain from overdoing it and it resolves quickly and the treatment will have a heavy bio slant. But a lot of the issues we see are long standing and require a bit more in depth look. For example under the social context, studies have shown having an over sympathetic partner (eg husband,wife,mum,dad) can make chronic pain worse! 
It highlights that a person's pain output is way more than just muscles,joints bones etc.
PracTx Exercise Software

Thankfully the days of photocopies or hastily drawn stick figures of exercises are gone. We have been using software called PracTx the last couple of years to deliver people their exercises. Patients are emailed their exercises that are tailored to them and also have a HD video demonstration of what to do. We also provide specific notes with it to follow in regards to repititions or special instructions. And, dont worry if you are one of the very few people without an email address (but, hey, you wouldnt be reading this anyway if you didnt), we can print it out for you.
People wonder why exercises are important at times.There are several reasons, such as;
  • They promote safe, pain free movement
  • They build strength in areas that may need it
  • They promote an active involvement in the treatment and recovery. Better treatment outcomes come when the patient has an active involvement in the therapy.
 Below is a screen shot of some sample exercises from practx. You can view your exercises not only on your computer but any portable device as well such as a phone or tablet.
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