A non-contained disc is one that has either partially or completely broken open; a herniated or ruptured disc. To illustrate, imagine a tube (anulus fibrosus) of toothpaste (nucleus pulposus) placed under pressure. The pressure causes the toothpaste within the tube to move wherever it can. If any part of the tube is weak toothpaste may leak out. When a disc herniates the contents may spread out to the spinal cord and nerves. The disc material has little space to go --- into the area occupied by the spinal canal and nerve roots.

Why might a herniated disc cause pain?
Returning to the leaky tube of toothpaste, the disc's gel-like nucleus contains a chemical that irritates the nerves causing them to swell. After the chemical agent has done its job, the remnants of the chemical remain and continue to press on the irritated and swollen nerves. To complicate matters, sometimes fragments from the anulus (tire-like outer disc wall) break away from the parent disc and drift into the spinal canal. These free fragments may travel in the spinal canal. Depending on the type of injury and the condition of the discs, more than one disc may herniate, rupture, or bulge. Sometimes injury causes a combination of disc disorders.

This article is an excerpt from a book titled Save Your Aching Back and Neck, A Patient's Guide (Second Edition, May 2002, completely revised), and borrowed from the Spine Universe Web Site.

If you have chronic back or neck pain, you may have degenerative disc disease. This degenerative spinal condition is not really a disease—it’s the normal wear and tear process of aging on your spine. Unfortunately, as we age, our intervertebral discs (pillow-like pads between the bones in your spine) lose their flexibility, elasticity, and shock absorbing characteristics. When this happens, the discs change from a supple, flexible state that allows fluid movement, to a stiff and rigid state that restricts your movement.

People with degenerative disc disease generally have ongoing back or neck pain, with occasional flares of acute pain when their “back goes out.” DDD can affect any part of the spine. The pain usually occurs in the area where there is gradual deterioration of a disc.

Common symptoms include:

• More pain when sitting for a long time, bending, lifting, or twisting
• Less pain when walking or running
• Less pain if you change positions frequently
• Less pain when you lie down

It’s important to treat your back and neck pain properly. Seek medical attention if your pain persists—and seek immediate attention if you have any of the emergency signs listed below.

Warning Signs You Need Immediate Help

• Pain is getting worse
• Disabling pain
• Leg weakness, pain, numbness, or tingling
• Loss of bowel or bladder control

Back pain may not be just a sign of aging. To get the best treatment, you first need to know the origin of the problem. This article will help you understand your back pain and some of its causes. You will read about treatment options and discover prevention tips to help you make wise choices.

This article was borrowed from the Spine Universe Web Site.

Sprains and strains are similar disorders affecting different soft tissues in the spine. Sprains are limited to ligaments whereas strains affect muscles, tendons, or muscle-tendon combinations.

Ligaments are strong flexible bands of fibrous tissue. Although ligaments are resistant to being stretched, they do allow some freedom of movement. Muscle is made up of individual and segmental strands of tissue. When back muscles encounter excessive external force, individual strands can stretch or tear while the rest of the muscle is spared injury.

To illustrate a sprain or strain, consider what happens when lifting something heavy. Initially muscles are recruited to manage the load. When the load or force exceeds the muscles' ability to cope, the force is shared with the ligaments. When a ligament is stressed beyond its strength, it can tear.

Local tissues swell when ligaments, muscles, tendons, or combinations become overstretched, overused, or torn. Swelling causes pain, tenderness, and stiffness; swelling serves to protect the injured back by restricting movement - similar to a splint on a broken leg.

Sciatic nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum. The nerve passes through the sciatic foramen just below the Piriformis muscle (rotates the thigh laterally), to the back of the extension of the hip and to the lower part of the Gluteus Maximus (muscle in the buttock, thigh extension). The sciatic nerve then runs vertically downward into the back of the thigh, behind the knee branching into the hamstring muscles (calf) and further downward to the feet.

Sciatica Fig 2

Sciatica Symptoms

Usually sciatica affects one side of the body. The pain may be dull, sharp, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg. Sciatica then extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain.

The Cause: Nerve Compression
Compression of the sciatic nerve can cause any of the above-cited symptoms. Rarely is nerve damage permanent and paralysis is seldom a danger as the spinal cord ends before the first lumbar vertebra. However, increasing trunk or leg weakness, or bladder and/or bowel incontinence is an indication of Cauda Equina Syndrome, a serious disorder requiring emergency treatment.

Lumbar spine disorders known to cause sciatic nerve compression include the following:

• Herniated discs are the most common cause of sciatica in the lumbar spine.
• Degenerative Disc Disease, a natural biological process associated with aging, is known to cause disc weakness that can be a precursor to a disc herniation.
• Lumbar Spinal Stenosis is a narrowing of one or more neural passageways due to disc degeneration and/or facet arthritis. The sciatic nerve may become impinged as a result of these changes.
• Isthmic Spondylolisthesis results from a stress fracture often at the 5th lumbar vertebra (L5). The fracture combined with disc space collapse may allow the vertebra to slip forward on the first sacral segment (S1). The slippage may cause the L5 nerve root to become pinched as it leaves the spine.

Spinal Tumors and Infections are other disorders that may compress the sciatic nerve, but this is rare. There are other conditions, which may occur, and may mimic true sciatica but these are difficult to diagnose.

Diagnosis of Sciatica

The physician's examination includes the patient's medical history, a review of current medications, a physical and neurologic examination and, if warranted, x-rays, CT scan and/or MRI. A proper diagnosis requires an analysis of the patient's pain. The patient is often provided a Pain Diagram to illustrate pain distribution and sensation (eg, tingling and burning).

The physician's questions may include:

• "How did the pain develop?"
• "On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain."
• "Is the pain worsened by walking uphill or downhill?"
• "How does the pain affect activities of daily living?"
• "What type of treatment has been tried and what was effective?"

The patient's range of motion is observed. Reflexes and muscle strength are tested. The physician may use one or more movement tests to determine the source or cause of the pain.

This article was borrowed from the Spine Universe Web Site.