Various patho-physiological factors can lead
to an annular tear. Age-related degenerative changes are the most common cause
of annular tearing or injuries. With the physiological aging process, the
annular fibrosus becomes thinner and rigid (due to loss of elasticity). Any
forceful activity or pressure can then lead to tearing of the annulus. Obesity
is another cause or contributor to damage to the annulus. Strenuous physical
activity (especially during sports training or contact sports), excessive
bending, twisting or rotation of spine as well as occupations that involve
weight lifting or excessive rotational activities of spine can also lead to
annular tearing.
Annular fibrosus does not receive any blood or
nerve supply (except the outer layer of the ligament that is sensitive to
pain). That why most injuries or mild tearing of annular fibrosus go unchecked
unless the ligamentous tear is associated with other complications or injuries
too. Research conducted by T W Stadnik suggests that weak/ damaged annular
fibrosus and the resulting protrusion of disks is a fairly common condition
that is reported in approximately 40 to 80% of normal asymptomatic adults.
Common symptoms that are experienced by most individuals are lower back pain
that increases in intensity with activities like coughing, sneezing, bending or
twisting. The pain may be dull aching type, pin and needle sensation in the
back region or sharp shooting. In the case of lower lumbar involvement, pain
may also involve the lower limbs and pelvic region and the intensity of pain
improves with standing.
If left untreated, Stadnik suggested the risk
of complications increases due to poorly supported intervertebral discs
(leading to displaced nerve roots, lumbar disc herniation and interruption of
the supportive ligamentous complex).
Physical therapy exercises aim at restoring
normal connectivity and alignment of vertebrae that reduces the pain and
numbness symptoms due to nerve involvement. Research and statistics suggest
that surgery is almost never indicated for the management of annular tearing.
If a healthy tissue environment and non-stressful conditions are maintained,
the tear may resolve spontaneously without requiring any therapy or treatment.
In order to provide a healthy environment to
the healing tear, physical therapy is the most useful treatment. A registered
and licensed physical therapist can employ a variety of modalities depending
upon individual cases. Massage is helpful in stimulating the blood supply to
the healing tissues. In addition, massage therapy is also helpful in inducing
soothing relief of pain symptoms by relaxing the stiff muscles and joints. Due
to aging, chronic inflammation due to annular tearing and other factors,
muscles and ligaments around vertebrae also suffer significant damage leading
to weak and hypotonic ligaments.
Before realignment, electric stimulation is
usually initiated to relieve intense pain and also to stimulate muscles to
maintain strength and stability. Low impact exercises maintain compliance,
flexibility and strength of muscles, joints and ligaments. Hydrotherapy is
known to improve the circulation of blood in tissues and also controls
inflammation and pain. Moreover, hydrotherapy is also helpful in alleviating
swelling, stiffness and edema around the tore annulus. Spinal realignment is an
aggressive form of physical therapy that is employed in cases when the
ligamentous tearing is associated with minor dislocation or non-alignment of
vertebral joints. Ultrasound waves are used by physical therapists to deliver
warmth and heat to regenerating tissues that also induces soothing pain relief
in the case of sprains, dislocations and tearing of annular fibrosus.
Although it is not possible to prevent the
physiological aging process, the degenerative processes can be delayed and
slowed with the help of physical therapy exercises, especially if you are at
risk of developing annular tearing or degeneration.
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