Morning has broken and it’s time to start your day.

You slowly rub the sleep from your eyes, fling the warm, enveloping covers off your body and allow the frigid air of your bedroom to jolt you further from your reverie.

“Why does my back feel so stiff?” is your first fleeting thought as you hunch forward on the edge of your bed, pawing for your fuzzy slippers with your feet. Your sleep-drunk legs have trouble locating their targets so you bend farther forward through your back to add some visual assistance.

You pull yourself to a somewhat upright position, stumble to the bathroom, turn on the tap, bend down to the sink and splash the last vestiges of sleep from your being…

So maybe you don’t dream of saving the world, and perhaps you don’t have fuzzy slippers. Heck, you might not even wash your face.

But if you’re like most people, you likely go through some of the same movement patterns I’ve just described.

What’s the big deal?

The big deal is that your intervertebral discs (yup, the same ones that are involved in “slipped discs“), according to Dr. Stuart McGill’s research, are actually in a more hydrated state after a night of slumber, which puts them at higher risk for injury (disc herniations, disc bulges etc) with certain types of movements, most notably flexion.

Why do the discs “inflate”?

After having spent six to ten hours in a horizontal position while sleeping, the effects of gravity are minimized through your spine. So instead of being compressed (as they are when you’re upright), your discs are unloaded to a certain degree and actually suck up fluid like a sponge. This is why you’re actually taller after waking.

What can you do about it?

This is the simple part. Avoid flexion (bending forward) through your spine until the discs have had a chance to lose some of that fluid.

See, I told you, simple.

McGill’s research suggests that it will take about an hour after waking for this to occur. After that golden hour, it’s safer to bend that way.

Now the hard part: avoiding flexion means you’ll have to modify how you get out of bed, how you sit on the edge of your bed, how you wash your face, brush your teeth and even sit on the toilet.

And depending on how fast you are at getting pretty in the morning, it would also mean you’ll have to avoid slouching at the breakfast table (you do eat breakfast right?).

These are all automatic habits you’ve been reinforcing for years. It’s not going to be easy to change them, but as a former low back pain sufferer, I can honestly say that I prefer dribbling toothpaste down my chin than having bolts of lightning shoot down my leg.

Yours in movement.

Dev Chengkalath

In the last blog post, I discussed some of the bony and cartilaginous structures that make up the back so today I’ll spend some time discussing the neurological tissues. These include the brain, the spinal cord and the nerves that branch off from them.

Neurology and related disciplines are in constant states of evolution and the study of the human nervous system can be extremely complicated. For the purposes of relieving your low back pain, I’ll keep the information as basic as possible.

You don’t need to know how a car is built to be able to drive one right?

The brain: This is the control centre of your body. It’s the primary component of the central nervous system (CNS) and is responsible for receiving, processing, analyzing, learning, sending, and organizing information from many sources. When it comes to relieving low back pain, this is your most important tool!

The Human Brain: Control Centre

By using your learning capacity, you can start changing the actions, movements or positions (the “causes”) that keep you in pain. And as you know if you’ve been reading any of my previous posts, the easiest way to remove the pain is to remove the cause.

Spinal Cord: The spinal cord is the second component of the CNS. The spinal cord is a tube-like bundle of neurological tissues, supporting cells and associated structures that extends down from the brain through the spinal canal formed by the stacked vertebrae.

Its main functions are to send, receive, and transmit various signals and nerve impulses to and from the brain and other tissues of the body. It’s also able to independently create certain reflex actions or patterns (e.g. the Knee Jerk Reflex: leg kicking out when your knee is tapped by your doctor’s rubber hammer).

Nerves: The nerves of the body originate from the spinal cord and travel throughout the body into the extremities (Bonus Knowledge Bomb: the exceptions are the cranial nerves which originate directly from the brain). Nerves serve a similar function to the spinal cord and their main function is to transmit messages between the various body tissues and systems and the CNS.

Often, but not always, the part of the nerve that originates off of the spinal cord (the nerve root) will be implicated as the source of the pain in various types of  low back injuries such as disc herniations or bulges.

The Lumbar Nerves

So there you have it, a quick and brief overview of the neurological tissues that are involved in low back pain.

In the next post, I’ll go over the soft tissues and their involvement.

Yours in movement.

Dev Chengkalath

In reality there is no such thing. The term is used to represent what is known as a bulged disc or a disc herniation.

In order to understand this type of injury, it’s imperative to understand the anatomy of the structures involved.

In this installment of the “slipped disc” series, I’ll be describing the anatomy in question and how it relates to the pain you may be feeling.

As you’re probably aware, the body is composed of a variety of different tissues and structures that all work together to create or resist movement. The back is no different.

It is made up of bones, muscles, tendons, ligaments, cartilage, fascia, neural and other connective tissues.

Muscles of the back

The idea behind this post isn’t to bombard you with all the intricate details of human anatomy. Rather, you should use this info as a knowledge foundation of how your anatomy may be placed under undue stress and injured.

Again, as a reminder, carefully note the difference between “cause” and “source”. This is very important as the anatomy of the back is usually related to low back pain as being the source of the pain, rather than the cause of the pain.

Now that the rationale for needing to know the anatomy has been presented, let’s get down to the business of learning the anatomy.

One of the easiest ways to understand how the spine and its components work is to separate it into three major components:

1.   The Spinal Column (Bones & Discs)

2.   The Neurological Tissues (Brain, Spinal Cord  & Nerves)

3.   The Soft Tissues (Ligaments, Muscles, Tendons & Fascia)

Today, we’ll spend some time on the  first component (the spinal column) which for our purposes will include the vertebrae (the bones) and the intervertebral discs (cartilage between the vertebrae).

The Vertebrae: The vertebrae are made up of the living, dynamic bony tissues that interconnect and interact to make up your spinal column and give it its distinctive shape and curvatures. The vertebrae sit atop each other, create specific curves for each region, and attach through articulations called “facet joints”.

stacked spinal vertebrae

There are five groupings of vertebrae, which include: the cervical (neck), thoracic (upper and mid-back), lumbar (low back), sacral, and coccygeal (tailbone) vertebrae.

spinal curves

In a broad sense, each of these curves plays an important role is allowing your body to deal with the various stresses that are placed upon it, most notably, the constant, unyielding effects of gravity.

Intervertebral Discs (Cartilage): Sitting between each of your cervical, thoracic and lumbar vertebrae are cartilaginous discs, which act as shock absorbers and allow for spinal movement.

Intervertebral Discs

These discs are composed of a tough, layered outer shell (annulus fibrosus) and a gel-like inner layer (nucleus pulposus). A good way of thinking of these is imagining a jelly filled doughnut. The doughnut itself would represent the annulus fibrosus while the jelly within would represent the nucleus pulposus. These structures are the ones implicated in disc herniation injuries when the inner nucleus pulposus bulges out into, or out of, the outer annulus (the misnamed  “slipped discs”).

disc bulge sequence

Again, to be perfectly upfront about the potential for problems with discs that are bulging do bear the following in mind: these discs are often affected by processes related to aging and injury (e.g. degenerative disc disease) and may show signs of wear and tear without demonstrating any clinical symptoms of pain or dysfunction.

Hopefully the above gives you a little better understanding of the bony and cartilaginous structures of the low back.

In the next post, we’ll cover the neurological and other soft tissues.

Yours in movement.

Dev Chengkalath