Annular Tear
Published in the Times Standard
    In my last article on facet arthropathy I mentioned four common reasons for back or neck pain.  One of these has to do with the intervertebral disc and its surrounding ligament called the annulus.
    A majority (some say 90%) of back and neck pain thought of as a sprain-strain type injury are due to damage to the disc annulus.  With trauma to the spine from falls onto the back or buttocks, improper lifting or twisting with a heavy load, vehicular accidents, repetitive stress on misaligned vertebra and/or tilted sacrum or pelvis, discs are internally damaged or disrupted. 
    The discs serve as shock absorbers to the spine, connect the vertebrae and act as pivot points.  They have a central portion called a nucleus pulposus, the surrounding ligament, the annulus, and the vertebral end plate portion above and below.  All three portions are made up of the same type of materials but in different ratios.  The three basic ingredients are protein (proteoglycans), collagen (cartilage), and water.  Discs are under constant axial pressure, especially when sitting.  The annulus is made in a concentric and layered way to keep the semi-fluid nucleus in place.  The outer third of the disc annulus is highly innervated with pain sensors that connect with spinal nerves.  Tears in the annulus therefore can be extremely painful and even mimic disc herniations or bulges causing sciatica.  Tears can be rim lesions (on the outer layers), concentric (within the annular layers vertically) or radial (extending from the nucleus out).  Radial tears can allow the nuclear material to leak or bulge into the nerve root or spinal canal with severe pain, sciatica and spasms, even loss of bladder control.  Having little blood supply, these tears can take 6-18 months to heal.  Special MRI’s or CT discograms are used to reveal these tears.
    The goal of Chiropractic care is to remove any structural misalignments causing additional stress to the supporting structures and the discs. The sacrum and pelvis must be level to allow balance over the vertebrae and distribute the load evenly.  Specific decompressing techniques can be utilized to reduce the axial loading and decrease the inflammation.  Water intake is important to keep the discs and annulus hydrated since they are largely water.  Specific exercises may be helpful after time to increase circulation to the area, strengthen muscles and maintain joint flexibility.  Specific nutrition is often needed for cartilage and ligament health and repair.  Surgical intervention should be your last resort because of its risks, and results that have a 50-50 chance of improving or worsening the pain 
    Applying the proper technique and care, the body will heal itself the best way it knows how with the help of Chiropractic “naturally”.
Crosbie Chiropractic
Michael H. Crosbie, D.C.
1828 Main Street
Fortuna, CA 95540
(707) 725-5668