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Disc Herniation...That Sounds Bad

Updated: Jan 8, 2019

I am moving from north Dallas into the downtown in a few short weeks and had to inform my current gym owner I was leaving. I was not excited to do this because the gym I am at (North Frisco Crossfit) is kickass. Ryan, the owner is super cool guy and the gym has AC. In Dallas, Texas that might seem like a necessity but you would be surprised. There is more I could say about this box but I should not digress to far, otherwise we will end up in all things Frisco like how you absolutely have to go to Mash'd and get their buffalo wings or it's a damn shame that Three Stacks BBQ closed and now I'll never get the greatest brisket taco ever made again.


In saying my goodbyes the topic of disc issues came up and it reminded me of something that I know and understand to be true, but I believe many patients do not. And that is that discs heal. I believe the confusion arises from imaging that shows normal degenerative changes, like disc bulges and disc narrowing, combined with the knowledge that "the brain and spine don't heal". These two notions lead people to believe that surgical interventions or sucking it up and dealing with it via pain management are the only options available. Next is not a pitch for get into your nearest PT. Instead, I would like to clarify a few misconceptions about back health.

First of all, discs do heal. For a visual, imagine a small circular cut-out of jello wrapped in bacon. I know that sounds odd, but if you haven't tried it you can't bash it. The bacon on the outside is analogous to your annulus fibrosis or outer layer. It's tough, somewhat thick and has close proximity to the rest of the soft tissues in your back. The jello is the annulus pulposus and is softer, but is designed to absorb force. The soft tissues lining the outer layer include muscles, nerves, fascia and blood vessels. Blood vessels carry the necessary protein and other components that promote healing. So if you land funny hopping out of your truck and herniate a disc, all hope is not lost. The proximity of this blood to your disc allows for nutrients to flow over and patch things up. Now we do know from countless studies that the best predictor of injury is... a previous injury. Does that mean that the location gets weaker? That it was weaker before? That your activities place greater demand on that specific area? Who knows.

What we do know is that things feel better when they can move fully and properly. I know this because it's what I do with people every day. PT's, chiropractors, osteopaths, all claim to do this. Whether you are training muscles or getting adjusted, things are moving. Ideally, things are moving more and more comfortably overtime, while the disc is healing. You protect it by down-regulating painful activities, and then building them back up over time. Simple as that. Right?

No, not really.

Often times pain is present even after the movement deficiency is cleared up. Patient's experience noxious pain, often exacerbated by the internet and possibly even health care providers telling them that a movement is "bad for their back" or the spine doesn't like to flex. What a bunch of nocebic nonsense (psychological bullshit). Someone with authority tells you something is bad and you brain almost always believes it. There is a HUGE psychosocial aspect to chronic pain that is not fully understood. But then again, few things in complex systems are fully understood. And don't be naive, the human body is complex. The human brain can construct some wild stuff. Like pain that is not attributed to significant damage! The last thing you want to do here is not move.

Movement is good. Even when there are changes that are not able to "heal". Degenerating discs are normal and non-painful. It's not a disease it's life. If you don't cut your toe nails and they grow longer, is that a form of acromegaly? No, its normal. Cut your nails though. It may be unwanted but it is a natural process.

Pain associated with degenerative changes almost always improve with greater movement variability and strength.

Moral of the story is get moving. Don't rush it, but get moving. If you are hurt then seek out a medical professional who can help, and whether you do or you don't, go slow. After a back injury, build back up over time. Improve your resiliency with training your body to move. And most importantly, share this blog with your friends and stop the distribution of harmful messages about back health.

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