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Questions and Answers
What is one of the main causes of disc degeneration?
What is one of the main causes of disc degeneration?
Which activity is most likely to increase intradiscal pressure?
Which activity is most likely to increase intradiscal pressure?
What is a common sign or symptom associated with discogenic syndromes?
What is a common sign or symptom associated with discogenic syndromes?
When is the disc especially vulnerable to injury?
When is the disc especially vulnerable to injury?
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What mechanical condition leads to nuclear material 'oozing' in discogenic syndromes?
What mechanical condition leads to nuclear material 'oozing' in discogenic syndromes?
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What type of pain is characterized by being more distinct to one side and associated with the nerve root sleeve?
What type of pain is characterized by being more distinct to one side and associated with the nerve root sleeve?
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Which condition is associated with protective muscle spasms that may result in scoliosis, kyphosis, or a list?
Which condition is associated with protective muscle spasms that may result in scoliosis, kyphosis, or a list?
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What behavior typically aggravates symptoms associated with increased intradiscal pressure?
What behavior typically aggravates symptoms associated with increased intradiscal pressure?
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Which treatment technique is recommended unless extension is the worst symptom?
Which treatment technique is recommended unless extension is the worst symptom?
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Which factor is NOT considered a structural perpetuating factor for chronic pain?
Which factor is NOT considered a structural perpetuating factor for chronic pain?
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Severe inflammation is described as causing what type of effects for the patient?
Severe inflammation is described as causing what type of effects for the patient?
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Which of the following activities are likely to ease symptoms of pain caused by increased pressure?
Which of the following activities are likely to ease symptoms of pain caused by increased pressure?
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What is a common neurological symptom associated with nerve root involvement?
What is a common neurological symptom associated with nerve root involvement?
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What ergonomic issue could lead to chronic pain conditions?
What ergonomic issue could lead to chronic pain conditions?
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Which of the following conditions is NOT classified as a disease that may contribute to chronic pain?
Which of the following conditions is NOT classified as a disease that may contribute to chronic pain?
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Study Notes
Discogenic Syndromes
- Discogenic syndromes are caused by disc irritation, bulge or prolapse.
- Degeneration of the intervertebral disc is linked to accumulated micro trauma and possibly an autoimmune reaction.
- Annulus fibrosis tears and fissures do not heal well.
- Increased intradiscal pressure can cause nuclear material to “ooze” in a particular direction.
- This can inflame the disc, creating a bulge and potentially leading to nerve root irritation or compression.
- Degeneration itself may be asymptomatic, however a degenerated disc is a “weak link” prone to further deterioration under repeated or prolonged load.
History
- Discogenic syndromes can have rapid or slow onset, sometimes with prior episodes.
- Precipitating activities include flexion, flexion-rotation, lifting objects, prolonged sitting, jarring activities, falls, and weakened immune systems.
- The disc is often most vulnerable in the early morning.
Signs & Symptoms
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Area
- The area affected depends on the structures involved.
- Dura involvement presents with pain around the affected area, centrally and paravertebrally.
- Posterior longitudinal ligament (PLL) involvement leads to central or referred pain, not clearly defined, and proximal pain is more intense than distal pain.
- Nerve root sleeve involvement presents with more defined central pain on one side.
- Nerve root involvement presents with distal, defined, dermatomal pain.
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Character
- Pain can be deep (non-nerve root) or superficial (nerve root).
- Severe inflammation causes unbearable pain, distressing and sickening.
- Nerve root involvement leads to neurological symptoms.
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Behavior
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Aggravated by:
- Postures and activities that increase intradiscal pressure.
- Sneezing, coughing and the Valsalva maneuver.
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Eased by:
- Lying down, reducing pressure.
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Aggravated by:
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Protective Deformities:
- Protective muscle spasm can lead to scoliosis, kyphosis and listing.
Perpetuating Factors
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Structural:
- Weak core muscles (abdominal stabilisers), impacting intra-abdominal pressure.
- Kyphosis, lordosis and scoliosis.
- Abnormal gait, including leg length discrepancies.
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Ergonomic:
- Poor chair and table design.
- Inadequate workspace with flexion and rotation activities, such as packing shelves.
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Activities:
- Activities that increase intra-abdominal pressure.
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Stress:
- Fatigue and decreased immunity.
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Disease:
- Viral infections.
- Scheuermann's disease.
- Autoimmune diseases.
- Endplate fractures.
Treatment
- Spinal mobilisation techniques, excluding PA mobilisation when extension is the worst sign.
- Lumbar stabilisation exercises (local and global).
- Treating associated trigger points, searching widely.
- Neural tissue mobilisation.
- Education:
- Understanding the pathology.
- Avoiding postures and activities that increase intradiscal pressure.
- Kinetic handling.
- Ergonomics.
Special Discogenic Cases
- Severe pain requiring bed rest is indicative of an irritable condition. Evaluation and treatment should be performed accordingly.
"Flat Tyre" Syndrome
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Cause:
- Disc space narrowing due to degeneration and disc prolapse.
- Ligaments and capsules have not yet adapted to the change in intervertebral segment height.
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History:
- Slow or rapid onset following a precipitating jerky accident.
- Previous episodes contributing to disc degeneration.
- Acceleration of wear and tear due to occupational or hobby demands.
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Signs & Symptoms:
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Area:
- Local or referred pain depending on the involved structures and severity of instability.
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Character:
- Catching, twingy, stabbing, unexpected pain.
- Feeling of weakness in the back.
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Behaviour:
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Aggravated by:
- Prolonged standing, walking, lying down, extension exercises.
- Painful arc of movement, especially with flexion.
- Extension from flexion is difficult and painful, requiring hand assistance.
- Palpation provokes pain, palpation of a step indicates a lysthesis.
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Eased by:
- Stable positions. Sitting may aggravate symptoms if there is a disc lesion.
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Aggravated by:
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Protective Deformities:
- Depend on the structures involved.
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Area:
-
Perpetuating Factors:
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Structural:
- Multiple levels involved: trunk stability and general degeneration.
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Activities & Posture:
- Activities requiring quick movements, large range of motion and jarring, particularly into extension.
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Stress:
- Unconscious use of the body.
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Structural:
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Treatment:
- Spinal mobilisation techniques.
- Spinal stability exercises.
- Neural mobility.
- Education:
- Understanding the pathology.
- Avoiding jerky, twisting, jarring activities.
- Avoiding extension postures and activities (if antero displacement).
- Central stability.
- Educating about cord and cauda equina signs and symptoms.
Juvenile Disc Syndrome
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More young men than women are affected.
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Symptoms include mild spinal stiffness, muscle spasm, and joint signs disproportionate to pain.
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In the lumbar area, there is commonly a flexion deformity that persists in prone lying.
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Manual palpation reveals minimal findings unless strong grade IV/V pressure is applied, generating intense pain.
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Marked limitation with flexion and SLR.
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Treatment Aim:
- To reduce pain rather than increase ROM.
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Description
This quiz covers the essential aspects of discogenic syndromes, including their causes, history, and related signs and symptoms. It highlights the role of intervertebral disc degeneration and the impact of various activities on disc health. Test your knowledge on how these syndromes develop and their potential effects on the body.
