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It is almost inevitable. At some point in our lives, nearly all of us experience back problems of one kind or another. For some it is a mild annoyance, but for as many as two million Americans, the pain can be completely debilitating. By some estimates, four out of five adults will endure back pain. Along with headaches, aching backs consistently top the list of physical aliments. In the U.S., lower back pain may account for 93 million lost workdays and a cost to society of between $20 to $50 billion a year.


What is the structure of a disc?
What is the disc's function?
Will anti-inflammatory medication help low back pain?
What's the body's response to a herniation and how does the body heal a herniation?
How does the body heal a herniation?
Can you play golf after a herniation?
What advice do you give golfers with an injured back?
What would the doctor recommend to prevent back problems?
How is the annulus of the disc injured?
What is a disc bulge?
What is a herniation?
I lifted a suitcase incorrectly and hurt my back. If feels like a pulled muscle. What happened?
So a spine joint is similar to an ankle or knee joint?
I twisted my back and heard a loud pop. Severe pain and stiffness that won't go away followed it. What was that pop?
I have back spasms. What caused it?


Question: "What is the structure of a disc?"
Answer: The disc is a round, multi-layered ligament that connects two vertebral bodies together. The fibers of each of the layers are crossed like a basket weave and are at different angles to provide strength and support. Additionally, it has a type of hydraulic center that serves as a shock absorber.

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Question: "What is the disc's function?"
Answer: The main function is that this is a ligament, just like in the knee or rotator cuff in the shoulder, and it's a key part of one of the joints in your back. Each level in the back is a different joint, just like your knee or your shoulder. So herniated discs are joint injuries.

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Question: "Will anti-inflammatory medication help low back pain?"
Answer: Usually. The anti-inflammatory medications decrease the inflammatory in the annulus, nerve and the other injured structures there.

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Question: "What's the body's response to a herniation and how does the body heal a herniation?"
Answer: Many patients have been told that they need surgery because they have a herniation. And we exam them and the findings are not as severe. Their straight leg raising is not bad. We know that there is a chance that we can help them nonoperatively. And so we help the body by decreasing inflammation and starting a back-strengthening program.

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Question: "How does the body heal a herniation?"
Answer: The body will put a glistering membrane over the herniation. The nerve has visco-elasticity, instead of being stretched over the herniation. But with time the nerve can change shape and it is now just running around the lump and not stretched over it. Inflammation decreases so the nerve adapts. The hole in the annulus heals. It takes 18 months to significantly decrease the size of a herniation on MRI. So a certain number of herniations found on MRI will be 50% less at 18 months.

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Question: "Can you play golf after a herniation?"
Answer: Yes. As soon as you can do a level 3 stabilization program, you can start playing golf. We know if you're doing a level 3 program, then when you swing the golf club those muscles are going to fire up to protect the spine.

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Question: "What advice do you give golfers with an injured back?"
Answer: To the amateur golfers we see, we advise most to cut down the back swing and the follow through because that's where the muscles are more likely to lose control of the spine.

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Question: "What would the doctor recommend to prevent back problems?"
Answer: The first thing to do is trunk strengthening exercises. Next,
preventive stretching exercises. Number 3 is proper instruction.

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Question: "How is the annulus of the disc injured?"
Answer: The annulus is the supporting structure of the disc, a multi-layer woven basket that connects the vertebrae together. If you repeatedly or with one sudden twist tear the annulus of the disc, it will initially consist of a circumferential tear, meaning the layers separate. If you get tears between the layers then it is going to loosen its overall structure and make it not as tight.

The next thing that happens after you get circumferential tears is that you get radial tears, which like a cut of a piece of pie. They go from the center out to the periphery. So if you have 100 layers to a disc then you may tear 75 of those layers from the center out which totally negates the mechanical advantage in that one area.

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Question: "What is a disc bulge?"
Answer: It's just like having a radial tear from the center going out. If you have 360 degrees with just one area that is torn, like you put a single slice in a piece of pie, it ends on the weak spot. The weakened area bulges out.

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Question: "What is a herniation?"
Answer: A herniation is when the bulging occurs toward the inside of the spinal canal. The disc is not entirely round, so it will produce stress more likely to occur in the posterior lateral corners. That makes each of these back corners more vulnerable to injury mechanically. This is where a herniation occurs- in the back of the disc, which is the floor of the spinal canal, right beside the spinal nerve. You can also get anterior herniations, but it is unusual.

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Question: "I lifted a suitcase incorrectly and hurt my back. If feels like a pulled muscle. What happened?"
Answer: You can injure muscles, tendons or joints in your back in much the same way you can injure them in your arm or leg. The basic components of the arm, leg or back are all essentially the same and therefore are prone to similar types of strains, tears and pulls. In the back, muscles attach to the spine with tendons and joints in the spine have ligaments. The most serious injuries are injuries to the joints, tendons or ligaments.

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Question: "So a spine joint is similar to an ankle or knee joint?"
Answer: Yes, the back is made up of a series of joints similar to the knee of ankle joint. Each joint is made up of an intevertebral disc and two facet joints, as well as the ligaments, tendons, nerves, and veins that supply that joint.

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Question: "I twisted my back and heard a loud pop. Severe pain and stiffness that won't go away followed it. What was that pop?"
Answer: For many severely painful back injuries, the pop is usually a tear in the intervertebral disc. The disc is a round ligament that allows motion between two vertebrae. The structure of the disc is that of a multi-layer woven basket. Rotation produces tears between the layers of the basket, as well as radial tears through multiple layers of tissue ringing the outer edge of an intervertebral disk. This produces intense inflammation, pain, and persistent back spasms.

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Question: "I have back spasms. What caused it?"
Answer: Back spasms should probably be thought of more at the result of back injury rather than the cause. It is the same idea as a fever being the result of an infection and not the cause of the illness. Even though fevers and back spasms are not the cause of the problem, they still require treatment. An injury to one of the intervertebral joints produces a reflex spasm. The spasm is caused by irritation of the nerves that supply the intervertebral discs and the joints of the spine, which happen to be the very same nerves that control muscle contraction in the back. If these nerves are stimulated through an injury to the joint, they produce pain and reflex spasm. Also a spasm can be though of as the body's misguided way of stopping motion in the injured joint.

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