• INJURIES - Why do my knees hurt and how to avoid it (if possible)

The spine is an anatomical region that is injured very frequently and the epicenter of the

most frequent cause of sick leave or disability

in the workforce.

It is an area that is surrounded by a tremendous

black legend

: "Do not operate.

Do not touch your spine because you are in a wheelchair

."

If, every time you heard that phrase, you had set up a wheelchair factory and sold one, you would now be a millionaire.

It is true that, sometimes, the results are not as expected and, after surgery, complications are difficult to resolve, but their incidence is small.

Because it hurts?

The lumbar spine is made up of

five vertebrae.

Between each of them, there is a

disk

that is a kind of pad whose function is to cushion loads or impacts.

However, and after recent studies, the spine is considered a

functional unit

made up of the vertebrae, the disc that separates them, the posterior joints that provide stability and support to the vertebral assembly and, finally, the muscles.

The spine is like a crane and the muscles, the tensioners that keep it standing.

The

intervertebral disc

is formed, in the center, by a structure called

nucleus pulposus

whose composition is 90% water, type 2 collagen and cells similar to those found in the articular cartilage of any joint.

This nucleus is surrounded by the

fibrous annulus

- made up of 60% water, type 1 collagen and cells similar to cartilage - that surrounds it like layers of onion.

It is a structure that does not have any vascular supply or nerve endings.

So where does the oxygen come from so that it doesn't necrose?

From the bone of the vertebrae that is in contact with the disc

.

It is called the

end plate

and, to be more graphic, it is like the floor and ceiling of the space between each vertebra that houses the disc.

That bone does have an important vascularization and many nerve endings that are

what make us feel pain when something does not go well

.

Obesity, age, tobacco, repeated overloads ... There are many causes that can cause injuries and inflame this plaque causing pain.

Automatically,

the supply of oxygen and glucose to the disc is altered and it acts like a flat tire

.

Then, it becomes dehydrated and unable to bear the weight of the vertebra.

But there is still more.

The space between vertebrae collapses and collapses, causing the bones to rub against each other, causing pain.

This inflammation of the bone or end plate that nourishes the disc causes

stress on the articular facets of the spine

that unite and stabilize the vertebrae together, causing their

premature aging

and producing

sarcopenia

, that is, an atrophy of the supporting muscles. to the spine, which ends up being filled with fat cells and functionally weakened.

When the annulus breaks and

the content of the nucleus pulposus 'falls out of place'

- something similar to when we squeeze a container of toothpaste - it invades the medullary canal and

compresses the nerves

, causing pain in the leg.

More than 90% of hernia cases occur in a posterolateral direction at the level of the L4-L5 and L5-S1 vertebrae, with the consequent compression of the corresponding L5 and S1 nerves.

HOW IS THE PAIN?

The pain is manifested in the lower part of the back, radiating to both buttocks or only one, and can reach, through the back of the thigh, to the foot.

The

intensity of the discomfort

will depend on the level of the hernia and will increase with activities such as lifting or leaning forward, sneezing, coughing, or sitting.

On the contrary, it will decrease with bed rest as long as a pillow is placed under the knees to keep them flexed.

When the damaged root is

L5,

the pain radiates to the posterolateral side of the thigh, the back of the calf, and the inside of the foot.

If it affects

S1

, the sciatica shows a similar distribution in the thigh and calf but radiates to the lateral part of the foot.

Recurrent episodes of pain

are also very characteristic

.

What does this mean?

That, despite experiencing a significant improvement after prescribing a treatment with intramuscular corticosteroids, the discomfort will return if the patient does not modify his work activity or continues to 'mistreat' his back.

'CORE' and GROWTH FACTORS

Despite the fact that most patients respond to analgesic treatment with anti-inflammatories, muscle relaxants and rest, once the pain has been overcome, it is essential to strive for prevention to avoid its recurrence.

In this sense, it is essential to do a

good work of strength to tone the 'core

', that nucleus of our anatomy that supports the spine and its union with the pelvis, giving stability to the entire trunk.

The muscles that compose it are:

-Abdominal musculature:

the anterior rectus is the muscle of the 'tablet';

the obliques -both internal and external- and transverse, as well as the quadratus lumbar (back muscle that contracts and hurts in low back pain) and the intrinsic musculature of the back that is called this way because it is the one that is attached to the vertebrae and runs down the spine from the pelvis to the neck.

-Pelvic floor musculature

: joins the

pelvic

bones together, giving the proper tension like the net in a trapezius.

Loss of muscle tone in that area, as occurs with age, childbirth or surgery in the area, can cause urinary incontinence or prolapse of the uterus (it sags and may be visible through the vagina).

-Gluteal musculature

: gluteus maximus, medium or minimum.

It is essential, both for our daily lives and for any sports activity.

Can a disc that has become dehydrated and appears black on MRI be improved?

The latest studies say yes, and that is thanks to

disc, joint and muscle infiltration with plasma rich in growth factors

.

The procedure is as follows: blood is drawn from the patient, carefully centrifuged and activated, and infiltrated.

The beneficial effects at the spine level are more than noticeable:

-Increased vascularization

of that border area called the end plate (bone that provides blood supply to the disc).

In this way, oxygen and glucose arrive, making the cells live and can repair the damage that has occurred.

As with Clark Kent, who was a normal guy who 'turned' into Superman if there was a problem or a catastrophe, cells transform, fix and return to their initial state, thanks to growth factors.

-Generation of endocannabinols

: they are substances with a very important analgesic power.

The more they are released, the more pain relief.

-By increasing oxygen in the muscle area

, that atrophy, that sarcopenia is reversed and the muscle is once again clean of fat cells, leaving a muscle ready to strengthen it.

ANTONIO RÍOS LUNA

is a specialist in Traumatology and Orthopedic Surgery.

Ironman 'and marathoner, he is the author of five books:' From the chair to the marathon ',' Stories in sneakers', 'A crutch on Everest', 'A blank mind' and 'Four hours'.

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