Spinal Degeneration

Spinal Degeneration
Natural aging causes the spine’s disc to dry out and shrink somewhat.  The facet joints are then closer together so that they may irritate each other.  Aging may also cause the muscles and ligaments – tough bands of connective tissue-that hold the facets in place to become lax, like worn rubber bands, losing their ability to support the joints.  To adapt to the laxity of the ligaments, the facet capsules either shorten or lengthen, so that the facets aren’t lined up properly.  The rub together roughly, not smoothly.  The cartilage coating each joint then becomes worn and rough.  Pain from worn facets can travel to the leg.  However it’s usually a deep aching that’s hard to pinpoint.

Other Irritants
* Twisting beyond the normal range of the spinal vertebrae can cause the capsule                 around the facet joint to get caught           and nipped or bruised.
* Curving your lower back inward                 (swayback) can irritate worn facet             joints by bringing them close                     together.
* Wearing high heels tends to                      exaggerate the curve in your back            and can cause pain and damage to          facets over time.

What You Can Do
You can slow the aging of your facet joints by being sure that your spine is in good alignment and your muscles are in balance.  The keys to keeping your back healthy and pain-free are:
* exercise for your back muscles
* good lifting techniques
* good posture
* stress management
See Dr. Clare if you experience sudden or ongoing back pain.

Spinal Degeneration, An aging Process
When you’re growing, your bones and tissues are being formed faster than they’re being depleted. After you’re grown, more tissue is being destroyed than produced this is degeneration, a normal part of the aging process.

Normal Spinal Degeneration
* Fibers of the annulus, a disc’s outer cartilage cushion, begin to wear out, like the                 tread on a tire.
* The disc nucleus – the soft center-begins to dry out.
* The body loses some ability to lubricate the facet joints linking your vertebrae, which           begin to show wear and tear.
* Spinal ligaments become lax, so that they don’t support facet joints as well.
Ligaments can’t be un-stretched, but you can make up for the stretching by making             the muscles of your back stronger.
* Spinal muscles can lose strength and go into spasm to protect the worn areas of the          spine.  You can prevent this by exercising your back muscles.
* Osteophytes, or arthritic bone spurs, begin to form above and below the disc
attachments to the vertebrae.

Degenerative Diseases
Degenerative diseases go beyond the normal aging process, sometimes causing severe pain.  Some of these diseases run in families.  If you have or are likely to get such a condition, it’s even more important to take good care of your back.
* Rheumatoid arthritis is a serious, body wide illness.  It’s an inflammation of the lining           of the joints, causing pain, stiffness swelling and often permanent damage to the                 joints.
* Osteoarthritis is the wearing away of the joint cartilage.  It causes pain, stiffness and           swelling.
* Spinal stenosis is a narrowing of         the spine so that the spinal cord         is compressed. It causes pain in         the buttocks, thighs or calves             that gets better with sitting or               bending forward.
* Osteoporosis occurs in about             one-third of people over 60,                 particularly women.  Bones become thin and porous and easily injured.

Degeneration – The Good Part
There’s a good side to the way your spine ages. By the time you’re in your 60’s and 70’s, the spine has become more fixed in place and less likely to be injured.  Back pain actually tends to lessen with age.  And by exercising the muscles of your back to make them strong, you can add another word to your vocabulary; “regeneration,” or healing.


Low Back Pain…A Modern Epidemic

Along with the blessings of modern life comes the downside: too much stress, too much sitting down and too little time to exercise.  The result is a near epidemic of back problems in recent times.

More Stress + Less Exercise = Back Trouble
You may not always find time for the daily exercise that keeps your back strong.  When you do exercise, you may ask too much from yourself and “break your back” playing weekend athlete or gardener or trying to keep up in an exercise class.

We expect a lot from our spines without giving them the daily attention they need to stay strong and flexible.  Combine this with constant muscle tension because of stress and sitting for long hours at a desk or behind the wheel and you’ve got back trouble.

Poor Posture and Alignment
If you find yourself with an aching back or neck after sitting or standing for long periods, check your posture.  Poor posture puts strain on the muscles and ligaments of your back and forces the joints of your vertebrae to carry more weight than they were meant to carry.  The results are pain and extra wear and tear on your spine.  Your spine should be held upright in a gentle S-curve that allows your head, shoulders and torso to balance above your lower back.

Intense weekend exercise, a session of furniture moving or a load lifter improperly may produce a few twinges or no pain at all.  Then, suddenly, the pain puts you flat on your back. Listen to your back’s signals that it’s had enough – but avoid overexertion even when your back seems okay.

Traumatic Back Injuries
Car, work and sports accidents cause most traumatic back injuries.  Regardless of the cause, a back strengthened by regular exercise is less likely to be injured.

Wear and Tear
Although the spine undergoes a natural aging process, poor posture and overexertion can speed it up.  Arthritis, osteophytes (bony growths around the vertebral bodies and facet joints), osteoporosis, disc aging and facet joint damage are some of the effects of aging that can cause back pain.

Bulging or Herniated Discs
Herniated or protruding discs actually cause only a small percentage of back pain.  Again, regular moderate back exercise can help prevent such injuries and speed recovery when they occur.  In some cases, surgery may be needed.

Stress and Muscular Tension
Stress and staying in one position too long cause muscles to contract.  Continually contracted muscles stop the circulation of blood and oxygen, resulting in pain and muscle weakening.  Take frequent breaks to relax and stretch your muscles.

Structural Problems
Occasionally, low back pain is caused by a predisposing condition such as scoliosis, spina-bifida or spondylolistheses.  These abnormalities may be diagnosed by an examination, x-ray or other test.

Sprains, Strains and Muscle Spasms
Most low back problems are caused by simple strains that can heal within six to eight weeks.  If you know what causes back problems, such as sprains, strains and muscles spasms, and how to prevent them, you can save yourself a lot of discomfort.

Sprain-Ligament Injury
You’re painting and you fall off your step stool.  You feel a wrenching pain in your back, but you can get up on your own and continue painting.  The real pain comes later.  This is a sprain.

In a sprain, a joint’s forced to go beyond its normal range of motion.  The ligament fibers overstretch and tear.  This often happens with sudden twisting in active sports.  The joint can still function, but ligament tears leak blood into the tissue surrounding the joint, causing swelling and discomfort.

Back sprains are usually severe.  Pain and motion in the lower back will often cause a muscle spasm.  See your doctor for a sprain.

Strain-Muscle or Tendon Injury
If a muscle or tendon was injured when you fell off the ladder, you have a strain.  Strains are not as serious as sprains.  They often happen when you neglect to warm up your muscles before using them or when you’ve overworked weak back muscles.  Years of tension or misuse can cause chronically strained muscles or tendons.

Spasm-Muscle Contraction
You’ve been driving for two hours.  You turn and reach for your hat in the back seat and wham – your lower back muscles on one side clamp into a spasm.

A spasm is a sudden, forceful and continuous muscle contraction.  It’s usually caused by direct trauma to the muscle, too much exercise or chronic strain.  You can tell when your muscle is in spasm.  It bulges and is hard to the touch.  The muscle’s painful and feels like it’s tied up in a knot.  When you have a muscle spasm, all the fibers contract.  With normal movement, only some of the fibers contract.

Muscles do two things: contract and relax.  Muscles help protect your spine.  If you overwork them, the message from the nervous system to the muscle is to contract and protect.  A muscle spasm acts like a splint, restricting motion in your joints.  If something’s wrong with the discs or facet joints, muscles may go into spasm to hold everything in place, preventing further damage to the spine.  Protective spasm can be chronic.

Treat your muscles with the care and respect they deserve.

  • Keep them flexible with daily slow stretching.
  • Warm up your muscles and joints before exercise.
  • Stretch out your muscles when you’re through exercising.

Back Problems

Who Gets Backaches?
More people visit the doctor for back pain than for any other ailment except colds and sore throats.  People who get backaches are people who:
*sit or bend a lot.
*lift or carry things incorrectly.back
*are overweight.
*are inactive
*are under stress
*have poor posture.
*play sports.
Causes of Back Pain
*Wear and Tear
*Poor posture, lack of exercise, excess weight
*Ruptured or herniated disc
*Back sprains
*Stress and fatigue
What you can do to Prevent Back Pain
*Practice proper body mechanics and posture
*Use chairs that offer lumbar support and adjustable height
*Learn the basics of safe lifting: bend your knees stay close to the load; avoid twisting;       get help with large or awkward loads.
*Maintain a healthy weight.
*Get regular exercise (at least 30 minutes every other day)
*Keep your three natural curves in balanced when sitting, standing, lifting or lying down.
*Stretch and warm up before exercising.
*Gradually add strength training exercises to your routine.
*Do only bent-leg sit-ups.
Back Alert
Although most back pain is caused by muscle strains or sprains, overuse or muscular tension brought on by stress, it can be a symptom of a more serious problem.  Call your healthcare professional if you experience:
*you have back pain that radiates down your leg.
*you have numbness, tingling or shooting pain in your arms, legs or buttocks.
*your legs feel weak so that you can’t raise up on your toes or heels.
*you urinate frequently or lose bowel or bladder control.
*you have pain in any part of your spine after an accident or other trauma.
*your backache is so sever it keeps you awake at night.
*you have chills or fever.

Getting With the Systems

Three body systems – the skeletal system, the soft tissue system and the nervous system – work together to support your body and allow you to move

Your Skeletal System
The bones and joints of your skeletal system give your body it’s structure.  Your spine is the part of your skeletal system that’s in your back.skeletal

Your Nervous System
Your central nervous system is made up of your brain, spinal cord and nerves.  Nerves connect your spinal cord to your muscles, joints and skin.  Messages travel to and from your brain and muscles in split seconds.

Your Soft Tissue System
The parts of your soft tissue system – muscles, ligaments and tendons – work together to stabilize bones and joints and control all or your movements.
* Ligaments connect bones.  They keep joints in place and allow movement.
* Tendons attach your muscles to you bones.
* Muscles contract (shorten) to move your bones.nervous

What These Tissues Do
Without your soft tissues, your skeletal system couldn’t support your body.  The deep muscles and ligaments of your back stabilize your spine, help hold your posture and maintain your three natural curves.  Your abdominal and back muscles are especially important in supporting your back.  Your abdominal muscles act like the stays on a sailboat that help the mast upright.  In your legs, the thigh and hamstring muscles help balance your torso when you’re standing or sitting.

Strong Muscles = Healthy Back
Strong flexible muscles keep your back in good working order.  That’s why exercise is so important to your back’s health.  Daily exercise, good posture and good bio-mechanics are the secrets to staying free of back strains and sprains.

Your Feet

Your Feet
Does your back bother you when you wear high-heeled shoes and dance the night away?  After jogging five miles in your favorite tennis shoes? If it does, you’re not alone.  To get to the root of your backache, start at your feet.

Your Amazing Feet
Your feet are complicated things.  Each foot has 26 bones – together they have nearly one-quarter of the bones in your entire body.  Your feet are specially designed to take you places while carrying the weight of your body.

When the Shoe Doesn’t Fit
In normal movement, your big toe maintains balance and your body weight is centered Shoesover your foot.  The wrong shoes can disrupt this balance and make your back ache.
* High-heeled shoes throw off your body’s natural         balance, forcing you into a swayback position             that puts stress on your lower back.
*  When you buy shoes that are too small, your             feet wind up adjusting to the shoe, resulting in             problems such as hammertoes, bunnions,                   calluses or ingrown toenails. Cush problems               can make you change the way you walk to take         pressure and weight off the sore foot.  Doing               this tends to pull an strain on your muscles and throw off your natural alignment.
* When you wear sandals or the wrong type of shoe for jogging, walking or other                   exercise, your feet don’t get enough support and protection.
* Wear protective shoes on the job if your feet are at risk of injury.

Put Your Best Foot Forward
Although proper foot care doesn’t prevent or solve everybody’s back pain, improper foot care often leads to serious back problems.  Wear the right shoes for each activity and make sure your shoes fit properly.

When Buying New Shoes
* Shop for shoes in the afternoon when your feet are at their largest.  Your feet tend to           swell late in the day.
* Choose shoes of leather or fabric so your feet can breathe.
* The end of your longest toe should be a thumb’s width away from the end of the shoe         when you’re standing.
* Measure both feet and buy shoes that fit the bigger foot comfortably.
* If shoes are uncomfortable in the store, don’t buy them with the idea you’ll “break                them in.”
* Make sure your new shoes are comfortable by walking on carpet for a while.  Most            stores will give you a refund if the soles have not been worn or soiled.

Your Neck

Your Neck
Your neck has a much wider range of motion than the rest of your spine and must also carry a big load: your skull.  Because of this, it’s easy to injure or overuse your neck.

Your Neck at It’s Best
A healthy neck has a slight forward curve that’s in balance with the other curves or your spine. This balance distributes your body weight evenly and protects your muscles and ligaments from pulls and strains.

Your neck can move forward and back, tilt from side to side and rotate in both directions, all while supporting your skull.

Strength and Flexibility
Your neck is made up of seven small bones called cervical vertebrae.  Flexible but strong, they support your skull and hold your head erect.  This column of vertebrae also forms a canal to protect your spinal cord.

Your neck muscles control the movements of your head and tongue.  For extra support, several deep muscles of the back and shoulders extend into the neck region.

Regularly exercising the muscles of your neck keeps them strong and flexible.  Good posture – your head balanced on top of your neck’s curve – protects the bones and discs from wear and tear.

Nothing’s Too Good for Your Neck
When it comes to back health, your neck is the top of the line.  To protect your neck:
1) Keep your posture in balance – whether you’re sitting, standing or lying down.
2) Do exercises for neck strength and flexibility.
3) Use a headrest in your car and wear proper head protection during sports.

Common Causes of Neck Problems
1) Cradling a telephone handset between your head and shoulder – this position is hard           on your neck joints and shoulder muscles. Newer telephones with smaller handsets           have made the problem worse.  Use an operator’s handset, a speakerphone or                   shoulder rest and switch sides every couple minutes.
2) Propping up your head with pillows to read in bed – bending your neck at an angle               causes wear and tear on your vertebrae.  Sit up straight with a pillow under your                 knees to relieve pressure on your lower back.
3) Sleeping with the wrong pillow – your pillow should support your neck without lifting             your head at a sharp angle.

Your Three Natural Curves

Your spine is truly a remarkable engineering feat – a column of small bones designed to be strong enough to support the weight of your head and body, yet flexible enough to allow you to walk, sit and dance.  The secret to your spine’s supple strength is in the balance of its curves.

Know Your Curves
The small bones of your spine-called vertebrae-are designed to fit together in an S-shaped column.  This column of curves is balanced so that the weight of your body is evenly distributed throughout your spine.  If these curves get out of balance, the vertebrae are pushed out of line, stressing muscles and discs and causing pain.  Starting from the top, the curves are:

  • The Cervical Curve, made up of seven small flexible vertebrae in your neck that spinesupport your skull, has a slight forward tilt.
  • The Thoracic Curve, the mainstay of the chest cavity, is made of larger more rigid vertebrae.  Twenty-four ribs extend from these long, slender bones.  The thoracic curve has a more prominent backward curvature.
  • The Lumbar Curve, often called the workhorse of the spine, is made of five massive, somewhat flexible vertebrae that carry most of the weight of your body.  The lumbar curve has a forward tilt.

Keep Your Curves
When you keep these curves in balance, you reduce the risk of stress on your vertebrae – stress that can lead to pain and back injury.

A straight back keeps your curves in balance.  Imagine a straight line running from your your ear, past your shoulder to your hip.

A hunched back can stress the lumbar region and put pressure on the discs.

A swayback – too much curve – can stress the muscles and ligaments of the lumbar region.

The two most important things you can do to keep your back in balance are to develop good posture and to do regular exercises to strengthen the muscles that support your spine.

Disc Facts

A quick look at how discs work and what they’re made of can help you understand why they’re sometimes blamed for back problems.

What’s a Disc?  Each vertebra in your spine is separated from it’s neighbor by a cushion of cartilage called a disc.  Discs, in fact, make up one-third of your spine’s height and serve as hydraulic shook absorbers.  The outer ring of the cartilage cushion, called the annulus fibrosa, is dense and layered with crisscrossed fibers, like the covering of a radial tire.  The interior cartilage, the nucleus pulposus, is soft and squishy, like thick jelly.disc

Healthy Discs – are like springs; they compress and release with you back’s movement. They’re flexible spacers between vertebrae, giving the bony parts and tissues of the vertebral joints room to breathe and move.  At night, when your discs are free from the pull of gravity, they soak up nutrients and water from your blood, so you’re usually at your tallest in the morning.

Aging Discs – as you age, your discs lose moisture.  They lose their ability to repair themselves after injury, disease or just plain wear and tear.  As the disc loses moisture, it also loses height, which can put pressure on nerves and affect the way the joints of your vertebrae line up.  The good news is that as the disc center loses moisture and shrinks, less pressure is put on the annulus, so that a disc injury is less likely.

Herniated Discs – a herniated disc is the most severe disc problem, often caused by a sudden injury.  When the disc covering weakens before it’s center has dried out,  the pressure from the center can cause the annulus to crack or rupture and the nucleus pulposa to ooze out.  This protrusion can be mild, or it can cause severe pain, depending on how much of the disc center escapes and whether it presses against a nerve.  Sometimes surgery is the only solution for a herniated disc.

Bulging Discs – rather than what are commonly called “slipped disc,” discs sometimes bulge out from between the vertebrae.  This is especially true in the lower back.  A bulging  disc can irritate a nerve root or ligament, causing pain that tends to come and go.  It can be brought on by bending forward.

Your Spine

Hardly none of us has escaped occasional back pain.  For some it’s the sharp pain of a sudden injury; for others it’s a dull nagging ache that seems to never go away.  Injury, misuse and the aging process can lead to spinal problems that cause pain, stiffness, tingling or numbness in your back.

Your Spine – It starts with an “S” to understand what causes spinal problems, you must understand how your spine works.  The bones of your spine, called vertebrae, are separated by small shock-absorbing discs.  Rather than forming a straight column, they form three curves balanced one above the other.  Muscles in your back, abdomen and legs help keep your spine in its natural S-shape.  This position distributes your body weight evenly to protect your vertebrae and discs from injury and wear.

Improper posture – such as slouching with your shoulders slumped and your head forward or standing in a swaybacked position puts stress on your spine and causes the vertebrae and discs to move out of the balanced position.  Too much forward bending and excessive backward bending can speed the aging process of your vertebrae and discs, leading to ruptured disc, arthritis and instability.

  • Your discs have a soft center called the nucleus, surrounded by a series of tough outer rings called the annulus.
  • Over time, your discs lose moisture and elasticity, so it’s harder for them to bounce back into place.
  • Discs can’t really “slip,” but swelling or years of poor posture can leave them sticking out from between the vertebrae.  The vertebrae squeeze the bulging disc and cause pain.
  • A bulging disc can become a ruptured or herniated disc.  As pressure on the disc builds, the nucleus can tear the annulus and squeeze out and put pressure on the spinal nerve.

Protect you back from premature wear and tear by using correct posture and learning how to prevent back injuries.

Break bad habits such as slouching and bending over your desk or workspace.

Avoid carrying loads that cause you to lean back into a swayback position.

What’s In Your Back?

Your back is an intricate network of muscles, ligaments, discs and nerves.  It’s a delicate system with a big job.  Your back carries most of your body’s weight and supports your spinal column, the main pathway of your nervous system.

The Parts of Your Back
Vertebrae – Small bones called vertebrae form your spine.  Your spine supports your head and trunk, makes your body flexible and protects your spinal cord.  There are five types of vertebrae:chart

  • Seven small, flexible cervical vertebrae support your skull and neck.
  • Your chest cavity is formed by 24 ribs extending from 12 thoracic vertebrae.
  • The five lumbar vertebrae are the largest and carry most of your body weight.
  • Five fused vertebrae below your lumbar vertebrae from the sacrum.
  • Fused vertebrae from the coccyx, or tailbone.

Discs – In between your vertebrae are shock absorbers called discs.  Discs have a strong outer casing with a pliable jelly-like substance inside.

Spinal Cord – Your spinal cord, with your brain, forms your central nervous system.  It’s about 18 inches long and a half inch thick.  It runs through a canal in your vertebrae.

Nerves – About 31 pairs of nerves branch out form your spinal  cord and travel throughout your body.  These nerves carry commands to your organs and muscles and relay messages about touch, temperature and pain.

Muscles – Some 400 muscles work together to keep your spine steady, maintain your posture and help you move.

Tendons – More than 1,000 tendons connect muscles to your bones

Ligaments – Bands of tissue between your bones support your back and keep it from moving more than it should.

Your Supporting Role
Your back supports you in everything you do.  Your role is to support your back by using good posture, exercise and body mechanics to keep it strong, flexible and balanced.