MRI's, Peyton Manning and Herniated Discs

Continuing on my MRI theme...so what if you go as far as to have surgery on a herniated disc based on MRI findings and you aren't any better after surgery.  We all know people who have had spine surgery and are not any better afterward.

One of my mentors in the MDT world Dr. Yoav Suprun, tweeted this Sports Illustrated article about Peyton Manning.  You know we all love the Manning family here in New Orleans.  It was especially hard for me to hear that Peyton had a herniated disc in his neck.  I always think "What If?"  What if Peyton had seen a MDT credentialed or diplomaed therapist before he had his surgery.  What if he saw one today?  What if he came to see me?  What if?

So let's talk a little about herniated discs.   It would probably be a good place to define what a herniated disc is.  A herniated disc is an MRI finding.

A disc has two main jobs:  one is to allow movement between the vertebra or bones in your spine and two they act as a shock absorbers.

The nucleus pulposus, or center of a disc,  is the consistency of jelly in an old jelly doughnut.  It is gel-like to absorb shock so that every time you move or are touched by something you don't "zap" your spinal cord.  That would be debilitating.  The nucleus is surrounded by several layers of ligaments known as the annulus fibrosus to keep the nucleus pulposus in place.  These are very strong ligaments but would leave an indentation if you touched one with your finger.  It is designed this way so it can allow movement.  An interesting fact is that there are no pain sensitive structures or nociceptors in the nucleus of the disc.  However, there are many in the annulus. Your symptoms will vary depending on where you touch the annulus.  

When you age, beginning around the ripe old age of 12, you begin to develop little cracks and fissures in your discs.  They are all over the place.  You will hear it termed degenerative disc disease, but really it is just normal aging.  With prolonged sitting or other repeated postures the jelly-like nucleus will find one of these cracks or crevices and can cause a bulge (See A.).

A herniated disc (See B)  is a bulge that changes the shape of the disc leaving the annulus (or ring of ligaments) intact. This doesn't necessarily cause pain or weakness.  In fact, many people have herniated discs and disc bulges on their MRI's that they didn't know they had! I bet that if you took an MRI of my discs, they would look like old rubber gaskets that have been left out in the sun.  I would have bulges and herniations all over the place.  However, they aren't touching anything painful or blocking motion so what do I care?  However, if your herniated disc is causing you problems and the annulus is intact, McKenzie MDT physical therapy can generally help.  If the disc ruptures and breaks the annular wall as in picture C, this is a surgical problem.  However, your body has a tremendous way of healing itself, so if you elect not to have surgery your body can absorb this in about a year. 

Again,  your treatment at Grimm Physiotherapy is based on your symptoms such as pain, weakness, loss of proprioception...that you show in your evaluation, not on your MRI.  I always tell potential patients, I am different.  MDTor the McKenzie method is different.   "Everyone deserves a good mechanical assessment and treatment plan!"  Check out grimmpt.com or call 504-228-0524 to set up your evaluation today.