Blog 36
So last month I talked about potentially catastrophic effects of sneezing that can cause multiple injuries including disc injuries. I must have put the sneeze of death into the good folks of north Bristol as I have seen nothing but disc injuries (not all sneezing related I should add!). New patient after new patient has blessed Cleve Chiropractic’s doors complaining of symptoms that turn out to be caused by disc problems. There are 3 regions where people get disc problems, the low back, the neck and more rarely, the thoracic region of the spine.
The discs are the bits that cushion the space between the back bones (vertebrae). They are made up of a jelly like middle that is kept in place by concentric cartilage like rings that provide stability. With repetitive stress and often rotational forces the inner jelly can break through one of the outer bands. This happens at some point to most people and it is not unusual to have no pain at all with it. However, if the forces are large enough and repetitive enough the jelly can break through more layers causing the outer layers to bulge. There are pain fibres in discs so this can cause some pain locally but if the bulge is big enough it can start to squash a nerve and this then will cause symptoms that are technically called “radicular” symptoms like numbness and tingling or even a burning pain somewhere else.
A classic example is a low back disc bulge causing sciatica down the leg into the foot and a part of the foot goes numb. These are called disc bulges but if the jelly breaks through the outermost ring and ends up in the spinal canal, then this is called a disc herniation (or a very poor term would be a slipped disc. Discs are not cartoon characters that slip about on the ice!). If the disc herniation breaks off and floats about then this is called a Disc Sequestration.
Strangely, if this happens it can cause some very varied symptoms but if they are not too bad the body will just reabsorb the jelly and the patient will hopefully heal by themselves. Indeed, a good number of disc patients will heal with no help at all between about 6 months and 2 years.
In the clinic when a patient presents with a disc like history we firstly ascertain if the patient has had any bowel or bladder disturbances associated with the problems. This is just to rule out more serious spinal issues and are very rare. Then we will do an examination that stretches the nerve to test if it has been trapped anywhere along its length, we test the patients skin sensation for numb patches and test the deep reflexes (like the knee jerk reflex that everybody has had done by the GP). The really sensitive tests are muscle tests. If you begin to trap a nerve sometimes the only symptom is a weakness in a limb.
This week I had a patient whose main symptom was a weak tricep (the press-up muscle) and sure enough he had 2 disc bulges in his neck after a rugby injury that affected the nerves that supply the tricep. If we suspect a disc we may well offer the patient a chance to shortcut the NHS que and refer patients to a private MRI that costs £235 within the week. Chiropractors are qualified to read the MRIs and can show you the problems on the MRI picture itself.
When a disc is confirmed there are many options from referring back to the GP or consultant or to, most frequently, treat the injury itself with gentle specific traction, soft tissue work and exercise. From research we know that in 4 out of 5 cases we can dramatically speed up the healing rate of discs. In 1 out of 5 cases the patient either needs more time or inevitably ends up in surgery.
And on that Happy Christmas bombshell all that’s left it to say that we reached the massive milestone of 9000 patients that attended Cleve Chiropractic and Next Step this month. Keith, Sarah and I went on the Bristol Rovers Christmas night out after the Bury game…don’t ask…I don’t remember! The Cleve Chiro/Next Step Christmas night is this weekend and with that in mind I look forward to telling you all about it next month…hopefully! I hope that everybody had a Merry Christmas and the team and I wish you all a happy and healthy 2017.
