Diseases, Disorders information

The reason for that is the arrangements of these lamellar fibers. They can’t normalize torsional stress, and that makes this very, very vulnerable to injury. The result of that is the degenerative cascade starts in the third decade, we are all starting to lose water content from our discs in the 30s. The annulus tends to fissure and tear, it become mechanically incompetent and can of course, be a source of pain related to the innervation of that structure, and a very, very common source of pain I would submit to you. Well, if we look at mechanical pain, what does that really mean. There are two types of pain when you are dealing with spinal problems, one is mechanical pain, the other is neuropathic pain. Mechanical pain tends to be back pain or pain radiating not distal to the knees, kind of a Sclerostoma referral pattern. Radicular pain obviously radiates distally, or in the case of a femoral entrapment in L3-4 nerve root, anterior thigh, very different in character. Neuropathic pain tends to be burning, lancinating, stabbing, mechanical pain, kind of a dull, aching, more difficult to localize. They can go together, but often times, different problems that is pure back pain will be mechanical, where as sciatica due to disc herniation will tend to be more neuropathic. If we look at the mechanical side of this, what are the characteristics of mechanical pain? It tends to increase with activity, any activity that tends to raise intradiscal pressure will increase back pain in someone whose disc is the primary pain generator and that’s an important clinical clue. The easiest way to find that out with a patient, is ask them, do you have more pain when you’re sitting or standing? If they say I have more pain when I am sitting, that probably means it’s discogenic because the intradiscal pressure is much higher then you’re sitting than when you’re standing.
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A senior orthopaedist named Nokimsun in Sweden proved that many years ago when he stuck pressure transducers in the discs of normal volunteers, although how normal you would be to volunteer for that would kind of be a point, and found that the intradiscal pressure when you’re sitting, is much, much higher when standing, and the reason for that is in the way the disc is designed. We are supposed to have a nice lumbar lordosis, a nice hollow. If you look at the individual to your right and to your left, look at how they are sitting, tend to sit reversing your lordosis in flexion, intradiscal pressure goes right up through the roof. If you then add a mechanical environment to that, particularly vibration, which also shows to raise intradiscal pressure, the pain should be worse, so another good tip-off for somebody with back pain on the basis of a disc, I have more pain when I am sitting and I can’t stand to ride in a car, that should tip you off to a discogenic source of back pain. Again, mechanical pain can increase with range of motion if you are thinking of disc pain, anything with flexion should be worse, tends to decrease with recumbency, you should very seldom have night pain, that is a red flag to think about, a neoplasm or atypical mechanical behavior.
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