Spine

Disc Protrusion

A protrusion describes a so-called bulging of the intervertebral disc. Through an early structural disturbance and loss of height of the disc (so-called chondrosis), the disc usually bulges backwards towards the spinal canal. As a rule, a protrusion causes no symptoms as long as it does not exert pressure on nerve structures.

Diagnostics

First, X-ray images of the affected section of the spine are taken. In these, the suspicion of an early disc problem can already be raised through an indirect loss of height of the disc space. As the condition progresses — though only mandatory in the case of radiating or persistent symptoms — an MRI may be arranged.

Treatment

Treatment depends on the symptom picture. If symptoms are present, they can in most cases be treated with manual techniques, osteopathy, the fascial distortion model (FDM), physiotherapy and targeted muscle strengthening.

Disc Herniation / Lumbar Radiculopathy

Definition

In contrast to a protrusion, in which disc tissue bulges out over a broad base, a herniation is a genuine prolapse of disc material. This can still be in contact with the actual disc, or — completely detached from it (sequestered) — press on nerve structures, either in the area of the lateral nerve exit (neuroforaminal or recess stenosis) or centrally in the area of the spinal canal (so-called spinal canal stenosis).

Symptoms and diagnostics

Depending on the level of the disc damage and the position of the herniation, different patterns of radiating pain can occur. Disc damage in the lumbar spine therefore usually causes pain radiating into the legs, whereas herniations of the cervical spine usually result in pain radiating into the arms. If the herniation is centrally located, with consequent narrowing of the spinal canal, the attribution is no longer so clearly differentiated, and various disturbances below the affected segment can occur.

In addition to a thorough orthopaedic examination, it is also advisable to record a neurological status. With even pressure damage to a so-called mixed nerve (sensory and motor), there is usually first a loss of the sensory fibres, which becomes clinically apparent as reduced or altered sensation. As the condition progresses, the sensory component can also cease its function entirely. The motor fibres are affected only with stronger pressure damage, as they are usually better insulated. If they are also affected and a resulting paralysis is present, neurosurgical surgery must be considered. In most cases, however, surgery is not necessary.

Treatment

In the great majority of cases, targeted physiotherapy with muscle strengthening — after the initial elimination or reduction of pain through pain-relieving and anti-inflammatory medication — is sufficient. Osteopathy, traditional Chinese medicine and FDM can provide support. Particularly in the initial phase, it is always important to give the patient the necessary reassurance and confidence in their own body again. The overriding aim must be to avoid chronic pain — which is always more difficult to treat than acute pain — as far as possible. A good rapport between patient and physician/therapist is an essential part of treatment success.

If the symptoms do not improve despite intensive therapy, disc surgery can be considered even without neurological deficits. In my view, however, this should only be carried out for persistent radiating pain, and then only after a prior diagnostic/therapeutic nerve root block. Pure back pain is usually not amenable to surgical treatment.

Facet Joint Osteoarthritis / Osteochondrosis

Definition

Facet joint osteoarthritis describes the degenerative accompanying processes of the small vertebral joints (the facet joints).

Symptoms and diagnosis

In the course of the wear, bony attachments at the joints and the formation of effusion can occur. Both can be a cause of pain. The pain is usually increased by over-extension and compression — that is, axial loading of the spine. The attachments can in turn give rise to a bony narrowing of either the neuroforamen or the spinal canal. If, in addition, a certain age-related disc damage is also present, this narrowing is further intensified. The nerve structures are, so to speak, squeezed from front and back. In the course of the pure loss of disc height (chondrosis), accompanying reactions also occur over time in the end plates of the adjacent vertebral bodies. Owing to the reduced shock-absorbing effect of the altered disc, the bony structures are subjected to greater strain, which ultimately becomes apparent radiologically as a density or sclerosis. This is then referred to as osteochondrosis.

In most cases, plain X-rays of the spine are sufficient. As a rule, the affected section of the spine is imaged in two planes. I usually also recommend so-called functional images (forward and backward bending) in order to capture any structural loosening in the course of the wear. In the case of persistent symptoms, or with radiation into the extremities, an MRI can be carried out.

Treatment

In the great majority of cases, conservative measures lead to a clear improvement in symptoms. The individual measures include primarily physiotherapy with the aim of restoring mobility and simultaneous muscle strengthening, advice on behaviour and modifications of strain, osteopathy, TCM and FDM. In addition to pain-relieving and anti-inflammatory medication and muscle relaxants, physical applications can also be used.

Surgery is necessary only in exceptional cases (higher-grade neurological deficits or instability).

Osteopathy

What is osteopathy?

Osteopathy is a form of treatment founded by Dr. Andrew Taylor Still, which is fundamentally based on three areas: cranio-sacral, visceral (relating to the internal organs) and structural osteopathy (which deals primarily with joint blockages and muscle tension). The latter has much in common with other manual techniques. Chiropractic, too, ultimately arose largely from osteopathy. Osteopathy describes a holistic method that uses the therapist's hands for both diagnosis and treatment. The aim of the treatment is to restore the mobility of the individual structures. Treatment is primarily concerned with activating the body's inherent self-healing powers. Through these, the body is to find its way out of an apparent decompensation back into its compensation (inner balance).

Fascial Distortion Model (FDM)

Many people now know and trust the healing effect of osteopathy. Comparatively unknown, however, is that there is another very effective form of therapy that has for some years been used successfully, particularly in elite sport — namely the fascial distortion model, or FDM for short.

FDM is a relatively new treatment method that works extremely quickly for complaints of the musculoskeletal system. By applying targeted pressure and specific traction movements, the therapist reverses changes in the shape of the connective tissue and can thereby relieve pain very effectively, often after just one treatment session. As the name suggests, the key structure of the treatment in the fascial distortion model is the fascia. The fascia is the natural sheath of a muscle, which is primarily intended to allow the individual muscle groups to glide against one another as smoothly as possible. In the case of adhesions or dysfunctions, this is no longer possible without restriction and, above all, without pain, which is why the therapy aims to release these apparent adhesions or disturbances. The diagnosis — and the decision as to which technique is used — is guided by the patient's body language.

FDM was developed by the American physician Dr. Stephen Typaldos in order to increase the effectiveness of previously known treatment methods. In this way, complaints from the orthopaedic and traumatological field — such as back pain, strains, sprains and dislocations of various kinds — can often be relieved very quickly.