Disc herniation versus Disc Bulge

What is the difference between a disc herniation and disc bulge

You just received your MRI results and it says that you have a disc herniation or disc bulge. I’m sure this might be worrisome to you. So what does this mean? 

First of all, these terms are often used interchangeably but, in reality, there is a difference between the two.

Anatomy of the disc

https://youtu.be/pDGXX5OwQ2Y

The discs are spacers found between two vertebrae.  They are responsible for movement between the vertebrae; flexion, extension, rotations and lateral bending. 

They are made up of the following parts

  1. Annulus fibrosus – It consists of strong fibrous layers of criss-crossing fibers that firmly attach to the vertebrae above and below.  It is responsible for holding the two vertebrae together and pressurizing the inside of the disc.
  2. Nucleus pulposus.  This is found in the inner core of the disc. It is of jelly-like consistency.  The nucleus really likes water.  It absorbs water when we lay down. This is why we are taller in the morning. That excess water is squished out when we stand up and move around. 

Disc herniation

As you bend forward the pressure on the front of the disc causes the jelly like nucleus pulposus to creep backwards.  With repetitive flexion or flexion and rotation activities fissures can form  and the layers of connective tissue can separate in the annulus fibrosus (known as delamination). The nucleus can then work it’s way down these fissures.  Over time these cracks and fissures can extend out to the periphery of the disc which causes the nucleus to herniate out into the space where the nerves/spinal cord are located.  This is a disc herniation.

Think of it like a jelly filled donut.  Take a bite on one side of the donut and the pressure squirts the jelly out the hold.  If the hole for the jelly wasn’t there the jelly would be contained and not squirt out. 

Interestingly though, when it comes to an intervertebral disc, vertical pressure down on the disc won’t cause the jelly to herniate out but bending forward can.

Disc bulge 

Disc bulges are typically age related.  As we age, the discs have less ability to hold onto water. Less water causes the disc to decrease in height and bulge outwards. 

Think of this like a deflated tire. When a tire’s pressure is less than optimal the  car will sit lower and sides of the tire will bulge out.  If the bulge projects backwards towards the spinal cord. 

Both of these situations may cause back pain when there is nerve irritation (due to chemical irritation or physical compression).  But at the same time, there are numerous people walking around right now with disc herniations or bulges who experience no pain at all.  Their herniations or bulges may be of similar size and shape as yours. So what this means is your disc herniations or bulges may just be incidental findings. 

Be aware that most disc issues get better. Even the worst disc herniations resolve; as a matter of fact they are the most likely to resolve. 

So what can you do? 

Be assessed by a chiropractor, athletic therapist or other professional who can determine what factors aggravate or relieve you.  Seek someone who gets you active, guides you towards self care and makes lifestyle modifications  to manage pain and return you to an active healthy life.

Weather and Pain

Often I have patients who claim they can predict the weather or that their pain is influenced by the weather. I often assumed that the patient was seeing a correlation that didn’t really exist possibly because they have been told by others that weather influences joint pain. This subject, even in the area of research is controversial. Results of studies have shown connections while others show no effect. I decided to see what some of the research says.

From what I have learned from some of my research is as follows:

1. Low temperature, more often than not, has some effect on pain (osteoarthritis, rheumatoid arthritis)
2. Low temperature makes those 50 – 65 year old 15% more likely to experience rheumatoid arthritis pain
3. Relative humidity has a significant association with hand osteoarthritis pain
4. Absolute change in atmospheric pressure is associated with pain.
5. Limited evidence between fibromyalgia and weather conditions

I admit this isn’t not an exhaustive study of the subject but it is food for thought. Feel free and read the abstracts found below

Dr Notley

Influence of weather on osteoarthritis of the hands

Background: The aim of this work was to investigate the association between meteorological variables and pain, stiffness, and function of the hand in patients with osteoarthritis.

Methods: The survey was carried out over 2 months in 2009, covering July and November. The patients filled out a questionnaire, consisting of visual analogue scales covering the three categories of symptoms that primarily determine the situation with rheumatism of the hands: function, joint stiffness, and pain. The questionnaire was completed on Monday, Wednesday, and Friday for every week in July and every week in November. The meteorological variables recorded included atmospheric pressure, air temperature, relative humidity of the air, and precipitation. The climate records were checked against the variables of functional evaluation of the hands from each patient using bivariate analysis and multiple regression analysis.

Results: In general, air temperature and relative humidity were the variables that displayed statistically significant higher association in all evaluated aspects of the hands, being explained by the influence of temperature in 40-88% (r) and relative humidity in 39-85% (r). In the multivariate analysis, there was a reduction in the number of weather variables that influenced pain. The variation of pain was explained by the average atmospheric pressure of the day of the questionnaire and the temperature the day before and the day after the questionnaire (52-88% [R2]).

Conclusions: The results implied individual variation in perception and quantification of function, stiffness, and pain. The lowest temperature associated with worsening of symptoms of pain and function in osteoarthritis of hands was the variable weather most frequently observed.

Weather conditions may worsen symptoms in rheumatoid arthritis patients:
The possible effect of temperature

Lydia Abasolo, Aurelio Tobías , Leticia Leon, Loreto Carmona, Jose Luis Fernandez-Rueda, Ana Belen Rodriguez, Benjamin Fernandez-Gutierrez, Juan Angel Jover

Objective: Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and determined possible seasonal fluctuations.

Methods: We conducted a case-cross over study in Madrid, Spain. Daily cases of RA flares were collected
from the emergency room of a tertiary level hospital between 2004 and 2007.

Results:245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures.

Conclusions: Our results support the belief that weather influences rheumatic pain in middle aged patients.

Influence of weather variables on pain severity in end-stage osteoarthritis

Stephen A. Brennan, Thomas Harney, Joseph M. Queally, Jade O’Connor McGoona, Isobel C. Gormley, Fintan J. Shannon

Purpose

Patients often attribute increasing pain in an arthritic joint to changing weather patterns. Studies examining the impact of weather on pain severity have yielded equivocal and sometimes contradictory results. The relationship between subchondral pseudocysts and the role they play in this phenomenon has not been explored.

Methods

Fifty-three patients with end-stage osteoarthritis of the hip completed daily pain severity visual analogue scale (VAS) scores over a one month period. Radiographs were reviewed to determine the presence of pseudocysts. Data pertaining to precipitation, atmospheric pressure and temperature were collected from the nearest weather station. A generalised linear mixed model was used to explore the relationship between weather variables, cysts and pain severity.

Results

Pain levels increased as a function of absolute change in atmospheric pressure from one day to the next
. Precipitation, temperature and the presence of subchondral pseudocysts were not shown to influence pain severity.

Conclusions

This data supports the belief held by many osteoarthritic patients that changing weather patterns influence their pain severity.

Influence of Weather on Daily Symptoms of Pain and Fatigue in Female Patients With Fibromyalgia: A Multilevel Regression Analysis

Ercolie R. Bossema, Henriët van Middendorp, Johannes W. G. Jacobs, Johannes W. J. Bijlsma, Rinie Geenen

Objective

Although patients with fibromyalgia often report that specific weather conditions aggravate their symptoms, empirical studies have not conclusively demonstrated such a relationship. Our aim was to examine the association between weather conditions and daily symptoms of pain and fatigue in fibromyalgia, and to identify patient characteristics explaining individual differences in weather sensitivity.

Methods

Female patients with fibromyalgia (n = 333, mean age 47.0 years, mean time since diagnosis 3.5 years) completed questions on pain and fatigue on 28 consecutive days. Daily weather conditions, including air temperature, sunshine duration, precipitation, atmospheric pressure, and relative humidity, were obtained from the Royal Netherlands Meteorological Institute. Multilevel regression analysis was applied.
Results

In 5 (10%) of 50 analyses, weather variables showed a significant but small effect on either pain or fatigue. In 10 analyses (20%), significant, small differences between patients were observed in the random effects of the weather variables, suggesting that symptoms of patients were, to a small extent, differentially affected by some weather conditions, for example, high pain with either low or high atmospheric pressure. These individual differences were explained neither by demographic, functional, or mental patient characteristics, nor by season or weather variation during the assessment period.

Conclusion

There is more evidence against than in support of a uniform influence of weather on daily pain and fatigue in female patients with fibromyalgia. Although individuals appear to be differentially sensitive to certain weather conditions, there is no indication that specific patient characteristics play a role in weather sensitivity.

On the belief that arthritis pain is related to the weather (1996)

D A Redelmeier and A Tversky

Abstract

There is a widespread and strongly held belief that arthritis pain is influenced by the weather; however, scientific studies have found no consistent association. We hypothesize that this belief results, in part at least, from people’s tendency to perceive patterns where none exist. We studied patients (n = 18) for more than I year and found no statistically significant associations between their arthritis pain and the weather conditions implicated by each individual. We also found that college students (n = 97) tend to perceive correlations between uncorrelated random sequences. This departure of people’s intuitive notion of association from the statistical concept of association, we suggest, contributes to the belief that arthritis pain is influenced by the weather.

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Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis.
Smedslund G, Hagen KB.

OBJECTIVE:

To examine the association between weather and pain in rheumatoid arthritis (RA).

METHODS:

Systematic review of longitudinal observational studies (up to September 2009) with data on the association between weather variables and severity of pain in RA. The methodological quality was rated independently by the two authors according to an adapted Newcastle-Ottawa Scale. We analyzed the data on an aggregated (group) level with a meta-analysis of correlations between pain and weather, and at an individual level as the proportion of patients for whom pain was significantly affected by the weather.

RESULTS:

Nine studies were included. Many different weather variables have been studied, but only three (temperature, relative humidity and atmospheric pressure) have been studied extensively. Overall group level analyses show that associations between pain and these three variables are close to zero. Individual analyses from two studies indicate that pain reporting in a minority (<25%) of RA patients is influenced by temperature, relative humidity or atmospheric pressure. We were not able to relate the findings to methodological quality or other aspects of the studies.

CONCLUSION:

The studies to date do not show any consistent group effect of weather conditions on pain in people with RA. There is, however, evidence suggesting that pain in some individuals is more affected by the weather than in others, and that patients react in different ways to the weather. Thus, the hypothesis that weather changes might significantly influence pain reporting in clinical care and research in some patients with RA cannot be rejected.

Previously published August 1 2013

Self Myofascial Release of the Pecs

The pec major muscle is the large muscle that makes up the musculature of  chest. It has multiple sites of attachment; the collar bone, the sternum and the cartilage of the ribs. Interestingly enough the pect major also blends into the external oblique and sometimes the rectus abdominus. From these sites of attachments the muscle fibers cross the shoulder joint and attach onto the humerus (upper arm).

Due to the pec major having multiple sites of attachment there are several directions of movement that the pec major is involved in. It can have an effect on several joints but mostly the shoulder joint.  Pec major helps to depress the shoulder girdle, aids in flexing the shoulder, adducting the shoulder and internally rotating the shoulder. The muscle is involved in pressing exercises, push ups, cable cross overs, pull downs, and stabilizing the shoulder girdle during gymnastic ring work. 

When this muscle is a problem we often see a rounded forward posture and as a result the muscles between the shoulders blades become over worked.

When pec major is a problem you may experience chest/breast pain, shoulder pain and even pain down the medial arm.  When pain occurs on the left side it may be confused with angina pain.

So how can you help yourself?

Method of releasing the pec major

Upper portion

To stretch the upper portion of the pec major you will be extending the shoulder backwards. Place a ball over the upper portion, near the collar bone, and then extend your arm backwards behind you. Feel the stretch and hold for your desired amount of time

Middle portion

Place the ball over a tender spot in the middle portion of the pec major. With your arm out in front of you at around shoulder height move your arm out to the side.

Another way you can hit the middle portion of pec major is by placing your hand on the wall in a one handed wall push up position. Then, as you you press the ball into your chest, turn your body away from the wall.

Bottom/lateral portion

The lateral portion of pec major is the outer edge of the pec major. After placing the ball over this region reach up over head and seek out the stretch you need.

Dr Notley

Winnipeg chiropractor and athletic therapist

Self Myofascial Release of the Shoulder: Deltoid

The deltoid muscle, capping the shoulder joint, is made up of three parts.  There is an anterior (front) part, lateral (middle) part and posterior (back) part.  It is used in all forms of movement of the shoulder

Action of the deltoid

The anterior deltoid flexes the shoulder forward while the posterior deltoid extends the shoulder.  The middle portion abducts the arm out to the side; assisted by the other two portions.

At least one part of the deltoid muscle is involved when performing shoulder press, pushups, bench press, chin ups and rowing activities.

Causes of pain in the deltoid

The deltoid can be a source of pain as a result of trauma or from over exertion. When experiencing pain into the shoulder the deltoid muscle is not the only possible cause of pain.  Possible causes include rotator cuff tears,biceps tendonitis, subdeltoid bursitis, shoulder impingement syndrome, and C5 radiculopathy.

How to release the deltoid

If all other possible causes of pain in the shoulder have been ruled out by a professional you may gain a benefit by just finding the tender point and holding pressure on it but I like to add a stretch to it. 

Anterior portion

The anterior deltoid is found on the front side of the shoulder.  Its main action is to aid in flexing the shoulder forwards. It originates on the collar bone and attaches onto the outer portion of the upper arm along with the other parts of the deltoid.  Underneath the anterior deltoid is the long head of the biceps tendon. When treating this muscle you might end up aggravating the tendon.

Standing facing a wall. Place the ball on the anterior deltoid.  Have your arm out to the side. Rotate your shoulder inwards so your palm faces outwards and then bend the elbow. Pin the muscle down and then rotate your body away from the shoulder. This helps take the stretch off the biceps muscle. 

Middle portion

The middle portion originates on the shoulder blade. It is active when lifting the arm out to the side (abduction). To stretch it you will want to adduct the arm. Place the ball on the wall and press the middle deltoid into the ball.  Take your arm and reach behind your back. Use your other hand to pull the hand further across the body and down towards your back pocket.

Posterior Portion

The posterior portion also originates on the shoulder blade. It is active in extending the arm backwards. To stretch you’ll have to flex the shoulder forwards. In this case you’ll be horizontally flexing or horizontally adducting the shoulder across the body

Facing away from the wall,  with your arm at shoulder height, place the ball between the wall and the muscle.  Rotate your body away from the wall. Use your other hand to help pull the elbow away from the wall.

Dr Notley

Winnipeg chiropractor and athletic therapist

Make sure to take a look at these related articles

https://drnotley.com/self-myofascial-release-of-the-shoulder-teres-major/

Review of a stand up desk converter

Movement is an important part of a healthy lifestyle.  Sadly, many of my low back pain patients are suffering with adisc injury because they sit for long periods of time. For these patients I often recommend they move more, get out of their seat more, going for walks, performing back bends, etc.  To keep them productive at work, I may suggest a stand up desk.

For most companies and patients, the cost of purchasing an adjustable desk is too costly.  An alternative to an adjustable desk is having a high desk and then using a stool to quickly go from sitting to standing. But again this can be costly too.  Another alternative is to use a regular desk and have a standing desk converter placed on the desk.

I was recently asked by AnthroDesk to review one of their products; the AnthroDesk: Sliding Standing Desk Converter (Black.

** Please note that this is not an affiliate link. The product was given to me so I could do a review.  I told them that despite receiving the product for free my comments on their product would not be biased. *

Anthrodesk Standing Desk Converter Review

I would like to note that I have only had the converter for approximately 3 weeks but here are my thoughts:

Pro:

  1. It was quick and easy to assemble the converter. An Allen key is provided and no added tools are necessary. It took me 10 minutes to assemble it.  The website said it could take up to 15 minutes.
  2. Once assembled, the converter feels sturdy.  In my video you can see the monitor shake but the converter felt solid.
  3. The latches have a safety mechanism to prevent accidental unlatching.  Though this might be difficult to unlatch when needed i’d rather have difficulty unlatching than having my monitor fall.
  4. With the monitor as far back as it can and the front end of the bottom shelf right at the edge of the desk the monitor is an arms length from the user.  A general rule of thumb for monitor distance is one arm’s length from the screen
  5. At the current price (February 3, 2019), the converter is $99.99 CAD.  This is a lot cheaper than an adjustable table.

Cons:

  1. It is loud when changing the heights of the shelves. In an open office setting this might not be desirable but in an home office room this might not bother you.  
  2. At the lowest position of the lower shelf it can be difficult to get the shelf up.
  3. When moving the shelves there are moments of sticking.
  4. The support post height is limited to the heights that it can support.  For shorter individuals this will be of no use.

Other Thoughts

At its lowest position the bottom shelf will stand 1.25 inches off the desk.  If your desk is currently at the right height for your keyboard this may alter your ergonomics.

It takes approximately 15 to 20 seconds, for me, to adjust the converter up or down. This may be considered long when comparing to a fixed height desk with a tall stool which takes seconds to adjust. I also don’t know how long it takes for an adjustable desk to change heights.  I would think that if it feels even remotely inconvenient you may end up not using it at all.

I’m curious to see if the noise from my converter is just a flaw in the converter given to me or if it is experienced on others. If this is what happens on all of the devices this might not be a product that would be desirable in an open office setting or a reception area.

Conclusion

 For the price, this product is a cheap alternative, and if you don’t mind the time it takes to change the heights of the shelves or the sound then this could be a good option for a stand up desk.

Effects of Long Standing

Remember movement is the most important part.  If you think that just switching to standing all day is going to fix all your problems, long standing can have its own negative effects.

  1. Lower back fatigue and discomfort.
  2. Carotid arteriosclerosis, leg edema, orthostatic symptoms (light headedness or dizziness), heart rate, blood pressure, and venous diseases (varicose veins, chronic venous disease and chronic venous insufficiency).
  3. A number of studies have shown that exposure to prolonged standing tasks can increase the physical fatigue and discomfort reported by workers.