Internal disc disruption
Internal disc disruption is a frustrating spinal condition. Normal MRI scan will not show internal disc tears. Therefore, it is possible that patients be in considerable pain but told their MRI results are normal. Patients are usually left wondering why they are in so much pain. On MRI, our discs can look perfectly normal (with dehydration) put still have little painful tears within them called annular or concentric tears (show black – high intensity zones – HIZ on MRI).
Now, in saying all of this, some tears within the disc are symptomatic and others are not, we are still not quite sure why. It is thought that these tears in the disc are caused by ongoing laborious occupational, sporting activities or trauma and injury to the spine as we age. This process is called degenerative disc disease. There may also be a genetic predisposition for tearing. Tears can be graded from I to III with Grade I being a little one in the centre of the disc and grade III being a tear that extends all the way through the disc (full thickness). Grade I tears are usually not painful as we only have pain receptors in the outer third of our intervertebral discs. Tears usually start in the middle of the disc and extend out but full thickness tears can also start on the outer edge and go all the way in. In any cause, if the tear isn’t in the outer third we will not feel it.
Generally speaking there are two types of tears that a disc can have, one is a radial tear that extends straight through a disc and the other is concentric (circumferential) tear that goes around the disc and spits its layers (imagine peeling/ separating an onion skin layer). Both can be extremely painful. Radial tears are usually thought to be from flexion and extension type overload such as bending or chronic lifting and concentric are thought to be from twisting movements such as golf swings.
Symptoms of internal disc disruption
Back and neck pain is the hallmark of internal disc disruption and is usually located around the level of the tear in the back, however there is some suggestion that pain can project from a disc without nerve involvement and this is why some patients may experience radiating pain from a tear in the disc. Pain is usually worse with postures that increase the pressure in the disc such as slouching or tilting the neck forward. In cases of neck pain that goes down the arm, an important job for a chiropractor or physiotherapist is to differentiate between discogenic pain with referred pain down the arm or discogenic radiculopathy (pinched nerve). Going to an experienced chiropractor or physiotherapist in spinal and particularly neck pain is very important.
Treatment of internal disc disruption
In the vastly majority of patients, chiropractic and physiotherapy, along with Mother Nature will allow for a full recovery from neck pain. This unfortunately can take some time with data suggesting up to 18-24 months. At Sydney Spine & Sports Centre (S3C) we typically see results far quicker. Treatments are centred on improving function and reducing the pain associated with the disc tear(s). It is important to remember that we feed discs and remove waste products within disc through pressure gradients and thus it is very important that patients do not rely on bed rest and get plenty of movement each day and enough sleep as the diurnal cycle of disc hydration is very important to deliver nutrients and remove waste from a disc. Our chiropractors and physiotherapists will give you all the advice; reassurance, exercises and treatments to ensure the most favorable outcomes are achieved.