Disc Herniations and Schmorl’s Nodes

Written By: Dr. Evan Steinke, B.Sc, DC.

Lower back pain can stem from a wide range of issues including disc herniations, however, not all herniations are the same. Schmorl’s nodes, named after the pathologist Christian Schmorl, were first described in 1927 and are a form of herniation. While they can occur in any part of the spine, they are most common in the middle and lower regions.

To better understand what a disc herniation is let’s first look at the structure of the spine. The spine is made of a series of vertebrae, bony structures with a hollow channel running down the back side that encases our spinal cord. Vertebrae by themselves we be extremely rigid and cause our backs to be stiff and unable to bend. To be flexible, the bones are connected to each other by a series of discs. The discs are made of a fibrous outer layer that allows for some movement between bony levels and an inner gelatinous layer that allows for shock absorption.

Disc herniations, sometimes referred to as “slipped discs”, are when the disc sandwiched between the two bony vertebrae is ruptured in such a way that the inner gelatinous fluid is released. The most common form is when the posterior aspect of the disc is ruptured, and the fluid pushes out towards the spinal cord. This can trigger nerve irritation that leads to symptoms such as pain, numbness, or weakness wherever the affected nerve travels (often down the leg).

Schmorl’s nodes differ in that they are a vertical type of herniation. Rather than the inner fluid of a disc being pushed out the front or back it is pushed up or down into the bony vertebrae. Despite their first description nearly a hundred years ago there is still no consensus on the cause of Schmorl’s nodes. Some researchers view Schmorl’s nodes as a secondary finding of an underlying disease such as Scheuermann’s disease or lumbar disc degeneration. In fact, most Schmorl’s nodes are asymptomatic, and they are often incidental findings on imaging reports such as Xray or MRI. However, in some patients they can cause significant chronic pain and lead to reduced quality of life.

Treatment for Schmorl’s nodes often begins with conservative care, such as chiropractic, as they are often seen in conjunction with other spinal conditions. If unresponsive more invasive treatments such as nerve blocking or surgery can be considered.

If you suspect that you might have a Schmorl’s node mention this article to your chiropractor or physician. Expect your doctor to do a thorough examination and to rule out other possible causes of your symptoms first and be ready for possible imaging such as X-ray or MRI.

Contact AST to schedule your appointment today.

References:
1) Kyere KA, Than KD, Wang AC, Rahman SU, Valdivia-Valdivia JM, La Marca F, Park P.
Schmorl's nodes. Eur Spine J. 2012 Nov;21(11):2115-21. doi: 10.1007/s00586-012-2325-9. Epub
2012 Apr 28. PMID: 22544358; PMCID: PMC3481099.
2) https://radiopaedia.org/articles/schmorl-nodes-3?lang=us

Tips for Choosing a Backpack for Kids

By: Active Sports Therapy

As we get our kids ready to go back to school, buying a new backpack seems to be a late August tradition. Although kids will often choose their pack based on colour and design, there are a few tips that you should watch for when narrowing down their choices.

Backpack features that reduce the incidence of back pain can be:

Shoulder straps that are not only padded but adjustable. They should also ideally be a width of about two inches or more.
Padded along the piece that will sit against the child’s back.
Look for a material that is lightweight such as canvas.
Chest straps and waist belts can be helpful to distribute the weight, especially if your child has to walk more than a few blocks.
In some cases, when textbooks and other heavy items are involved, a pack with wheels might be something to consider.

In terms of wearing the backpack, please remember the following:

Wear two straps up at all times. Sometimes it feels more convenient to use just one strap but over time it can certainly cause imbalance and one-sided injuries.
Stand upright. If you notice your child has to lean forward while walking to support the load, then there is too much weight in the bag for their body size.
Heavy items should go in first and be located in the main compartment to keep the weight close to the body. Smaller items such as pencils, rulers and calculators can go in the smaller, outside compartments.
If you notice the pack flip-flopping from side to side as they walk, the culprit is usually loose straps, so tightening them should stop this problem.
If your child is complaining that their back, neck, or shoulders are sore, you should take steps to immediately reduce the weight.
Help your kids develop their organizational skills with regular clean-outs of unneeded items as well as knowing what they will and won’t need that day at school. This will allow them not to tote unnecessary items daily and from school.

If your child is complaining of pain, however, it’s important to listen to them as it could be a symptom of a larger problem or an issue that needs to be looked at by a professional. At Active Sports Therapy we have both sport and family chiropractors equipped to assess and treat your little one if needed.

*This blog is not intended to officially establish a physician-patient relationship, to replace the services of a trained physician, naturopathic doctor, physical therapist or chiropractor or otherwise to be a substitute for professional medical advice, diagnosis, or treatment. [/vc_column_text][/vc_column][/vc_row]

Change Your Core and Change Your Life

By: Dr. Corey Finan DC and Ellen Rossiter, PT

What is the “Core”

The “Core” in human terms is used to describe a series of musculoskeletal tissues that function together to provide a rigid structure by which the torso is able to transmit power from the upper body to the lower body and vice versa. Together they comprise most of the muscles, ligaments, and tendons of the body in some manner.

This area of the body is integral to human movement because in order for an individual to product correct motions and actions (walking, running, throwing, etc) there must be a fixation point on the axial skeleton that can provide stabilizing action for the extremity muscles to move from.

The core muscles are made up of the muscles from the whole back, including deep rotator muscles that stabilize the spine and long muscles that stabilize one’s torso. Of course, everyone has heard of the abdominal muscles too, and their contribution to the core. These include Transverse Abdominus, Rectus Abdominus, and the Abdominal Obliques.

Most people forget this aspect, but there are also muscles from the hip that contribute to the core, including the Psoas and the Adductors in the front, and the Gluteal Muscles and Hamstrings in the back.

Another important group of muscles that play a role are those of the Pelvic Floor which form the bottom of the pelvis and contribute to overall intra-abdominal pressure creation.

Perhaps the most important muscle involved in core control is the Diaphragm.

Functional Stabilization

As you can see, there are many muscles that make up and contribute to the ‘Core’ that we all hear so much about and if one muscle (even part of one, such as with a trigger point) is dysfunctional then the entire stabilizing function is disrupted and the quality of movement is compromised.

So Why Does My Back Hurt and How is it Related to My Core?

Here are a few reasons why one might experience back pain from an issue with the core:

The Core = muscles on the front, sides and back creating pressure
The Core not engaging properly = decreased intra-abdominal pressure = some muscles do more work - usually the back!
Usually fine for a while, but the muscles in the back end up overworked and underpaid = stiffness/soreness/pain

And here are some more specific examples:

Sitting

Against the back of the chair
Hunched forward - phones and computers
Not using the core!

Previous injury

Compensation patterns for a long time
Eventually, things get too tight and too tired = pain

Workouts

Exercise without appropriate positioning
Working outside of available mobility and strength
Not using core properly

Pregnancy

Increased lordosis, different rib positioning
Stretching the abdominal muscles!
Pelvic floor impacted

What Can You Do to Ensure a Strong Core?

A great place to start is with your breathing! That diaphragm muscle that we mentioned above is both a muscle of respiration and a postural muscle. Correction of a faulty respiratory pattern is actually integral to the success of any rehabilitation program that aims to address the movement system.

Here is how you might practice and strengthen this muscle and pattern:

Start by lying down on your back or sit, feet flat on the floor.
Ensure proper posture
- Hips equal pressure on the floor or chair (based on position)
- If sitting: sit tall, shoulders relaxed, ribs down (not flared out)
- If lying: bend the knees, feet flat on floor; relax the shoulders

Place your hands in the following positions, one on your chest and the other on your belly.
Increase belly expansion, and minimize chest movement while you take deep breaths in and out.
If this goes well, the next step is to bring your hands to cradle your lower rib cage (thumb on your back rib cage, fingers on your front rib cage) and continue breathing.
Breathe into your belly, while trying to expand into your sides. You want your breath to fill all areas of your lungs, and expand your entire rib cage both front and back. Think of this as breathing along the lines of an “A” line dress, where the lines flow down and out all around your body.
To see a video of this technique - please visit Dr. Corey Finan's video explanation here

It sounds simple but it really can take some practice to ensure you’re doing this right. Once you’ve mastered this first step to building your core, you can move on to more challenging groups of exercises. Did you know that you can book in with your chiropractor or physiotherapist if you think your core is related to your back pain or movement issues? They can assess where you are at and help to build a safe and effective set of exercises to help you change your core, and change your life!

Tips for Your Workspace from a Physiotherapist

[vc_row][vc_column width="1/1"][vc_column_text]By: Ellen Rossiter, PT

If you are someone who does computer work, then it's likely you tend to spend most of your day sitting, be it at your desk, at meetings, or sitting with clients. This also means that you’re likely spending a lot of time on your computer, on the phone, and in positions of reading and writing.

The resulting pain points for most people may include:

Neck/Headaches
Low Back/Hips
Forearms/Wrists/Elbows

Although everyone is different, there is a posture we call Home Base, which is a position that allows most bodies to relax. To bring yourself to Home Base, remember the following:

Sit tall and do not over arch your back
Chin down, back slightly - no chin poking!!
If you are at a computer, should see the top 1/3 of the screen when looking straight ahead
Shoulders down and relaxed (not up near the ears)
Arms hanging at sides, elbows at or lower than 90 degrees
Wrists should be relaxed
Back supported when possible
Sit evenly on both “sit” bones
Hips and knees at 90 degrees
Ensure your feet are supported

Regardless of your posture, there is one thing to keep in mind. “Motion is lotion!” What that means is that you need to move throughout the day.

Movement is the most important thing to remember so:

Shift positions frequently throughout the day
Set a timer to remind you to move if necessary
Crossing your legs in not evil…just don’t stay there all day
Check in with your body and listen for pain points and tight areas that might need attention

Here are a few other things to think about when sitting down to work:

Put books under your laptop if you're working with one to raise it up. Switch to both with and without books occasionally.
Support your lower back with a rolled up towel or small blanket (Tip: Once you get your roll to the perfect size, put an elastic band on either end to hold your roll in place so you’ll always have it ready)
If you don’t have an official work space if you’re working from home, then be sure to switch it up from the table to the kitchen island and anywhere else that might allow your body to not be stuck in one position for too long. You can have some positions that are sitting, and some that are standing.

If you’re experiencing pain that is resulting from your workspace, a session with a Physiotherapist can help you identify some simple changes that you can make that might make all the difference. A custom stretching routine for your specific pain points is something a PT can create to help you enjoy a pain free workday.