Annular Tears

What is an Annular Fissure?

If you were to look at a picture or model of the spine, you would see that between each vertebra is a disc of tissue that looks like a tire. This disc is a natural shock absorber that limits the stress on the spine when twisting, lifting, bending, etc. The inside of this “tire” is filled with a gelatinous material (called the nucleus pulposus) that flexes and stretches as the body moves. A hard coating of protective thick material, called the annulus fibrosis, surrounds this nucleus. The annulus has nerve fibers but unfortunately no blood supply (“avascular”), which is why injury to the discs are very difficult to heal, much less treat.

The outer edge of the annulus, or the “treads on the tire,” is filled with blood vessels and nerves. As you get older, that inner gelatinous material can dry out and eventually cause a condition called “degenerative disc disease.” This nucleus pulposus diminishes inside the disc, causing the vertebrae to move closer together. Imagine that tire losing air, reducing the shock absorption to the rest of the vehicle or body. This disease causes the nerves to come closer together.

Actions such as twisting, bending and heavy lifting put pressure on the outer rings of the annulus and can weaken them. The fiber in the outer ring can actually rip or tear from the stress, creating a tremendous amount of pain. Imagine a thick rubber band that his been dried out and made brittle by the sun.

The pain from an Annular Fissure is also referred to as an Internal Disc Disruption. It comes from the gelatinous material on the inside touching the pain-carrying nerve-fibers on the outer edge of the annulus. When the inner material reaches those nerve centers, it causes a tremendous amount of pain. If the tear becomes big enough that the nucleus pulposus reaches the outside of the disc, that is called a disc herniation. This can cause back or leg pain and weakness. If the fissure is located in the lumbar spine, it can affect the legs and is called Sciatica. If it is located in the cervical spine it is called Cervical Radiculopathy.

What Causes of Annular Fissures

Annular tearing generally comes from a combination of trauma and degeneration. Genetics may also have an influence on the development of this syndrome in that your body could develop weak annulae. Small tears can form from simply sitting or twisting. Certain exercise or heavy labor may also contribute greatly to these tears. The standard wear and tear on a body can have more of a lasting effect than you ever realized.

Types of Annular Fissures:

The three main types of annular fissures are listed below in order of progression:

The rim lesion – A horizontal tear of the outer annular fibers of the disc near their attachments into the ring apophysis. They are often associated with bone spurs.
The concentric tear – The splitting of the lamellae of the annulus in a circumferential direction. Trauma (not aging or degeneration) is usually the major cause of this type or tear, specifically from excessive twisting as in a golf swing or throwing a discus in track & field. Research shows that for reasons yet undiscovered, the lamellae lose the ability to “stick together.” This loss of adhesion is called delamination.
The radial tear – A horizontally oriented tear that goes from the inner nucleus pulposus through the entire outer region of the disc. These are significantly associated with the aging process and disc degeneration.

The symptoms you might see with annular fissures are swelling, pressure, pain and sharp, stabbing sensations.

Spinal Decompression Therapy and Annular Fissures

If you have read our previous articles on Spinal Decompression Therapy, you will know that our tables have a computer that controls the “distraction force” and the spine is slowly stretched to provide gentle and painless decompression of the “jammed” spinal joints and discs.

This “separation” creates a “sucking” vacuum that directs much-needed nutrients, oxygen and fluids into the injured annular fissure and nucleus propulsus (which is avascular as explained earlier) and this can begin the annular fissure healing process. In essence, the interior of the disc receives the hydration and nutrients it needs to combat the drying out process that takes place in your nucleus pulposus and could lead to an annular fissure.

Some people also present to us with excessive “movement disorders” of ligaments in the lower spine or an annular fissures that are very large and precarious. In this case, our treatment may be contra-indicated initially until your condition is stabilized and we can help you with this too. If you’ve been diagnosed with an “annular fissure” or a disc “protrustion”, “herniation” or “bulge”, Spinal Decompression Therapy can help. Of course, we need to make sure you are an appropriate candidate for the non-invasive procedure. If you have found that other treatments have not helped, it is time to try Spinal Decompression Therapy.

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“I searched everywhere for an answer to my back pain and the nagging sciatica in my right leg. Painkillers helped for a while but I knew that wasn’t the long-term solution. After an MRI scan confirmed my L5 disc was bulging in my low back ..."

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“I suffered a whiplash injury in 2008 and one of the discs in my lower neck was injured. I tried many different types of treatment and was desperate to avoid surgery. A friend told me about this new Spinal Decompression Therapy..."

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What is Non-Surgical Spinal Decompression?
Will Spinal Decompression Therapy treatments hurt? Is it safe?
Is Spinal Decompression Therapy new?
Will I require an x-ray, MRI or CT scan?
Why is Spinal Decompression Therapy more successful than other treatment options?
Why the need for exercises and other therapies?
How much will it cost?
Can Spinal Decompression Therapy help my pain?
Will my pain go away for good?
How long will my treatment program be?

What is Non-Surgical Spinal Decompression?

Non-surgical spinal disc decompression is a non-invasive treatment for acute and chronic spinal pain associated with herniated, ruptured, bulging or degenerative discs and sciatic leg pain or spinal stenosis associated with these conditions. It is also used for the treatment of conditions such as facet syndrome, spondylosis and even failed spinal surgery. It is safe and effective without the normal risks associated with invasive procedures such as injections, anesthesia or surgery. Spinal decompression works through a series of alternating decompression and relaxation cycles with a total treatment time of 12-25 minutes.

The theory behind non-surgical spinal decompression is that significant distractive forces, when applied to the lumbar spine in variable directions can create a negative pressure in the center of the intervertebral disc, thereby creating a suctioning effect or “vacuum phenomenon” in order to retract or reduce the size of the herniated or bulging disc's gelatinous internal nucleus pulposus, thus diminishing or eliminating nerve compression, while at the same time creating an osmotic gradient which helps bring nutrients and water into the disc. Since intervertebral discs have poor circulation, they depend upon receiving their nutrition through diffusion across the endplates of the vertebrae above and below.

The appeal of non-surgical spinal decompression is that it is a non-invasive, non-surgical, drug-free alternative treatment for low back pain, sciatica, disc degeneration, disc bulges, disc herniations, and facet syndrome. There is copious anecdotal evidence of its effectiveness and more case studies are being published demonstrating very positive results in patients who have tried other conservative treatments that have failed.

Will Spinal Decompression Therapy treatments hurt? Is it safe?

Spinal Decompression Therapy treatments are one of the most gentle and comfortable therapies available. The treatments utilize equipment with proven safety and efficacy. Most patients report a mild sense of stretch on their back or hips, and often fall asleep during treatment sessions.

Is Spinal Decompression Therapy new?

Although traction therapy has been around for thousands of years, spinal decompression is relatively new. Advances in equipment and procedures have dramatically improved effectiveness. Cork Spine & Disc Rehabilitation Centre is the only clinic in Co. Cork that uses the Kennedy Neural-Flex Decompression table. We believe this to be the most sophisticated, technologically advanced, state-of-the-art decompression system in the world. Dr. Doug Meckelborg is currently the only “Kennedy Certified Practitioner” in Co. Cork.

Will I require an x-ray, MRI or CT scan?

After your initial consultation at our clinic and a comprehensive physical examination, it will be determined whether diagnostic imaging is required. Often, MRI (Magnetic Resonance Imaging) scans, or in some cases, CT (Computerized Tomography) scans help to confirm the diagnosis and elucidate the nature and extent of the underlying problem. If required, we would refer you to one of the clinics in Cork that provide such services.

Why is Spinal Decompression Therapy more successful than other treatment options?

Spinal Decompression Therapy is a comprehensive program of the newest traction techniques and targeted “core” stabilization exercises. Doctor skill, combined with the decompression table and computerized traction head, are the keys. Proper assessment, correct positioning and the use of pre-programmed patterns of distraction and relaxation reduces intervertebral disc pressure, thus allowing necessary nutrients to “enliven” and accelerate disc healing. In addition, we use other adjunctive treatments that have proven effectiveness in spinal care. It is this multi-faceted approach that makes the overall treatment so effective. Additionally, the disc has been shown to be a predominate site of pain in many spinal conditions, so treating it as directly as possible makes sense. The blending of focused decompression to the site, rehabilitation to the supporting structures, and overall strengthening of global musculature makes the treatment unique.

Why the need for exercises and other therapies?

Along with the damage in the disc we also need to treat the supporting spinal muscles. A complete program targeting the function of the stabilization muscles is a vital part of Spinal Decompression Therapy. Our hope is not only to help heal the disc but enhance muscle control and support of the low back or neck. A gradual breakdown of the foundational support of your back or neck is what puts undue stresses on the discs and leads to pain and loss of function. Exercise and adjunctive therapies will assist in rehabilitating these structures.

How much will it cost?

We offer affordable and individually tailored programs of spinal care depending on the nature of your condition and the extent of care needed. Most major insurance companies in Ireland (VHI, Quinn Direct, Hibernian Aviva) will cover a portion of your care. You always have the choice as to the extent of care you receive. Our staff will review all costs, payment options and insurance coverage up front. We want to help, and believe finances shouldn’t stand in the way of you and good health.

Can Spinal Decompression Therapy help my pain?

Though each patient is different and no doctor can guarantee 100% success, our office is seeing great results from spinal decompression therapy. Damaged discs, joint dysfunction and poor spinal muscle control are among the most common problems underlying mechanical back pain. Our treatment program addresses both of these core problems. The Spinal Decompression Therapy creates a controlled decompression of the vertebral discs to decrease disc pressure thus increasing blood and nutrient exchange. This exchange of fluids is something the damaged disc desperately needs to help it heal from the inside out. Muscle strength, control and endurance can all be improved with other facets of Spinal Decompression Therapy that include specific controlled exercises.

Will my pain go away for good?

Although it is difficult to predict the future, our experience is that most patients do find long-term relief or effective management of their pain when they complete the entire program of treatments. Regular home exercise and periodic visits to our clinic will help in maintaining your spinal health and reduce the probability of reoccurrence. As with any comprehensive rehabilitation program your continued home care exercises and discretion in some daily activities is key to long-term relief.

How long will my treatment program be?

It depends on the nature of your injury as well as the complexity and extent of the rehabilitation needed; however, we typically begin with 3-4 treatments per week for 1 month followed by re-examination to assess progress. The treatment is administered over a reasonable time frame and your response is continually evaluated. Further treatments may be necessary or a reduced frequency may be recommended at that time. The rehabilitative phase may include additional Spinal Decompression treatments, with other adjunctive spinal therapies to enhance the results.