Dr. Susan, I would like to add that ligamentous microtrauma is not the only mechanism of the acquisition of degenerative disc disease. More commonly is the loss of imbibition of the intervertebral disc, causing a loss in disc height. A short background on the intervertebral disc:
The intervertebral disc is a structure located between each spinal segment which helps with the absorption of forces from motion of the body (both gravitational and torsional). The structure itself is avascular; it relies on the blood vessels located in each vertebrae for nutrition. Water and other nutrients pass through the bottom layer (endplate) of the vertebrae to supply the disc. Water is indeed an important aspect of disc health; it provides height and structural integrity to the disc in order to resist the forces placed upon the spine. Proteoglycans are the molecules responsible for attracting and holding water in the intervertebral disc. As we age, we lose a concentration of proteoglycans. This process is aided by a calcification of the endplates of each vertebrae. More on this topic to come.
With the proteoglycans affected, the mechanics of the spine are altered. The disc attempts to lay down type 2 collagen fibers in an attempt to repair the now-vulnerable disc. Any damage within the structures will cause an inflammatory cascade. This anaerobic environment will decrease the amount of proteoglycans produced, leading to further degeneration.
Calcification of the endplates is another problem. If the nutrient channels on the endplates are occluded, nutrients such as water cannot pass through to give the disc the structural components that it needs. This feeds into the cycle of degeneration. It follows that metabolic waste cannot exit the disc if the endplates are calcified. This serves to further the process of inflammation and apoptosis (programmed death of a cell).
With so many degenerative processes occurring, pain is sometimes a manifestation of degenerative disc disease. With the release of inflammatory chemicals comes signals for neurogenesis, or the growth of nerves into the area of injury. This means that the injured area becomes hypersensitive because there are more nerves supplying it.
Interestingly, one of the only proven ways to increase flow into and out of the disc is through physical motion of the joint. This is precisely what chiropractors are trained to do. We find, using our hands, joints in the body which are not moving as they should and create motion in the joints by physically breaking adhesions. In as little as a few days with a joint that is not moving properly, microscopic degeneration is noted. In a person who has already acquired signs and symptoms of degenerative disc disease, chiropractic manipulation will aid in slowing the progression of the disease for the reasons stated above.
Chiropractors value a non-invasive approach to treatment. We do not utilize injections or other invasive forms of treatment that some other practitioners may use. In addition to adjusting the joints of the body, we may prescribe exercises as necessary. Dr. Susan, chiropractic adjustments and exercises would be a great alternative for those who do not wish to receive injections. Please reply if you have any questions and I would be happy to provide answers or references for the statements made here.
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Dr. Susan, I would like to add that ligamentous microtrauma is not the only mechanism of the acquisition of degenerative disc disease. More commonly is the loss of imbibition of the intervertebral disc, causing a loss in disc height. A short background on the intervertebral disc:
The intervertebral disc is a structure located between each spinal segment which helps with the absorption of forces from motion of the body (both gravitational and torsional). The structure itself is avascular; it relies on the blood vessels located in each vertebrae for nutrition. Water and other nutrients pass through the bottom layer (endplate) of the vertebrae to supply the disc. Water is indeed an important aspect of disc health; it provides height and structural integrity to the disc in order to resist the forces placed upon the spine. Proteoglycans are the molecules responsible for attracting and holding water in the intervertebral disc. As we age, we lose a concentration of proteoglycans. This process is aided by a calcification of the endplates of each vertebrae. More on this topic to come.
With the proteoglycans affected, the mechanics of the spine are altered. The disc attempts to lay down type 2 collagen fibers in an attempt to repair the now-vulnerable disc. Any damage within the structures will cause an inflammatory cascade. This anaerobic environment will decrease the amount of proteoglycans produced, leading to further degeneration.
Calcification of the endplates is another problem. If the nutrient channels on the endplates are occluded, nutrients such as water cannot pass through to give the disc the structural components that it needs. This feeds into the cycle of degeneration. It follows that metabolic waste cannot exit the disc if the endplates are calcified. This serves to further the process of inflammation and apoptosis (programmed death of a cell).
With so many degenerative processes occurring, pain is sometimes a manifestation of degenerative disc disease. With the release of inflammatory chemicals comes signals for neurogenesis, or the growth of nerves into the area of injury. This means that the injured area becomes hypersensitive because there are more nerves supplying it.
Interestingly, one of the only proven ways to increase flow into and out of the disc is through physical motion of the joint. This is precisely what chiropractors are trained to do. We find, using our hands, joints in the body which are not moving as they should and create motion in the joints by physically breaking adhesions. In as little as a few days with a joint that is not moving properly, microscopic degeneration is noted. In a person who has already acquired signs and symptoms of degenerative disc disease, chiropractic manipulation will aid in slowing the progression of the disease for the reasons stated above.
Chiropractors value a non-invasive approach to treatment. We do not utilize injections or other invasive forms of treatment that some other practitioners may use. In addition to adjusting the joints of the body, we may prescribe exercises as necessary. Dr. Susan, chiropractic adjustments and exercises would be a great alternative for those who do not wish to receive injections. Please reply if you have any questions and I would be happy to provide answers or references for the statements made here.
December 14, 2009 - 9:46amThis Comment
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