The predisposing factors for the development of this condition began with a misalignment dysfunction at the spinal segment, which overtime causes the soft tissue ligamentous and muscle support to become overloaded and compromised allowing the biomechanical stress to reach the level of the disc and initiating the degenerative joint disease.
Disc injury is classified as per the level of the disc integrity and degeneration.
Disc Integrity
Protrusion injury is characterized by a bulge of the nucleus pulposus pushing back on the annular fibres surrounding the disc.
Extrusion injury is characterized by a complete tear of the surrounding annular fibres allowing the disc material to move out from its boundaries and irritate the adjoining neurological structures.
Disc Degeneration
There are five levels of disc degeneration (D1 to D5) the X-ray analysis provides an important window to visualize and classify the level of deterioration.
D1 – Acute injury showing increase disc space due to the build of inflammation
D2 – Decrease disc space at the posterior part of the disc
D3 – Significant decrease disc space at the posterior part of the disc
D4 – Reduce total disc space
D5 – Extremely reduce total disc space
The neck and lower back are common areas for the development of disc injuries. Usually there is a bilateral neck or lower back pain associated with this injury to start which eventually evolve into a full blown radiculopathy causing radiating shooting pain towards the upper or lower extremities as seen is cases such as sciatic and brachial neuritis. Depending on the level of never irritation, peripheral sensation abnormalities (numbness and tingling) and muscles weakness are also seen.
Is important to note that for the disc to become injured, the previous defence mechanisms have to have failed to allow the biomechanical stress to damage the disc, therefore, the treatment care must aim to restore the health of the entire spinal protective structures.
Assessment Protocol
Clinical assessment to identify the key joint dysfunctions of the spine that have contributed to this condition. Soft tissue analysis to pinpoint the level of irritation in the soft tissue support.
X-ray analysis
Anterior – Posterior (AP) and Lateral spinal views are essential to analyse the level and direction of the different patterns of misalignments and the degree of the degenerative disease.
MRI
Spine MRI is essential for visualizing the extent of injury on the muscle/tendon and ligamentous and meniscus layers and nerve compromised.
Locate the exact injury point; Allows the treatment to be more specific during the application of the treatment modalities
Identify the extent of tissue damage and the presence of scar tissue; Provides valuable information regarding prognosis and the application of friction soft tissue modalities to aid on scar tissue removal.
Rule out fractures not picked up by the x-ray and rule severe extrusion disc injuries and cauda equina compromised.
Rule out any other condition; There are rare disorders that may create similar patterns of dysfunction, is advisable to rule out these conditions prior to the start of the treatment.
Treatment protocol
The treatment care should aim to restore the Spinal alignment, the soft tissue muscles/tendon and ligamentous health as well as stimulating and remodelling the cartilage and disc repair.
Specific adjustments of the spinal segments followed by a rehabilitation regime to strengthen the entire soft tissue support of the spine.
Soft tissue and disc healing protocol
Application of Low-level Laser and PEMF directly over the injured tissues to aid on the cellular level of healing as well as improving the microcirculation for the area. Due to the natural poor blood supply properties of the disc, this treatment modality is essential to enhance disc healing
Friction soft tissue therapy helps to reduce dysfunctional scar tissue
Specific stretches and strengthening to improve the resilient of the soft tissue support
Specific selected essential oil application to enhance healing
Dry Needling to promotes blood flow and enhance the soft tissue and disc healing.
Depending on the level injury and chronicity, a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this condition.
