1 Farrer Park Station Road, #08-14, Farrer Park Hospital (Connexion), Singapore 217562
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ALLEVIATE PAIN CLINIC
We see patients with a variety of Pain-related conditions.
Annular Tears and Their Role in Low Back Pain
The spine is a complex structure made up of vertebral bones that are separated by intervertebral discs. These discs are essential for maintaining spinal stability, absorbing shock, and preserving disc height. In this blog, we'll explore the anatomy of the intervertebral disc, focusing on annular tears, a common cause of low back pain, particularly in younger patients. We'll also discuss treatment options for this painful condition.
Understanding the Anatomy of the Intervertebral Disc
The intervertebral disc is located between the vertebrae of the spine and serves as a cushion that absorbs the pressure and shock exerted on the spine. Each disc consists of two main parts:
- Nucleus Pulposus: This gel-like substance at the center of the disc contains water-binding proteins that allow it to absorb and resist compressive forces. Its high moisture content plays a crucial role in maintaining the disc's function and flexibility.
- Annulus Fibrosus: The outer layer of the disc is made of tough, concentric rings of collagen fibers that give the disc its strength and elasticity. This outer layer protects the nucleus pulposus and helps distribute the pressure across the spine.
One of the challenges in healing an annular tear is the limited blood supply to the disc. This restricts its ability to heal naturally. The intervertebral disc is innervated by various nerves, including the sinuvertebral nerves, which contribute to pain perception and regulation.
What is an Annular Tear?
An annular tear occurs when the outer ring of the disc (the annulus fibrosus) becomes damaged, either through a traumatic injury, repetitive stress, or degenerative changes over time. This tear can irritate the nerves that innervate the disc and cause significant discomfort. The tear may also disrupt the normal function of the disc, leading to inflammation and pain.
Symptoms of an Annular Tear
While some annular tears are asymptomatic and may only be discovered incidentally in older individuals, younger and middle-aged adults are more likely to experience significant pain, especially following trauma. The pain is often localized to the lower back and can worsen with certain movements that place stress on the disc, such as:
- Bending
- Twisting
- Prolonged sitting
In some cases, the pain can radiate to the hips, buttocks, or thighs, particularly if the tear affects the lower spine.
Diagnosing an Annular Tear
Diagnosing an annular tear typically involves a combination of clinical evaluation, diagnostic injections, and imaging studies. During the clinical evaluation, your doctor will assess your medical history and perform a physical examination to look for signs of disc injury. The most effective imaging technique for detecting an annular tear is Magnetic Resonance Imaging (MRI).
However, not all annular tears result in symptoms, and the presence of a tear on MRI does not always correlate with pain. If your doctor suspects that the tear is the source of your pain, they may recommend a provocation discography. This procedure involves injecting a contrast dye into the affected disc to see if it reproduces the pain, helping to confirm the source of the discomfort.
Treatment Options for Low Back Pain from Annular Tears
When it comes to treating annular tears, doctors at Alleviate Pain Clinic, located at Farrer Park Hospital, Singapore, take an individualized approach. Most patients start with conservative treatments, which can be effective in managing pain and improving mobility. Common conservative treatments include:
- Physical therapy: To strengthen the muscles around the spine and improve flexibility.
- Activity modification: Avoiding activities like heavy lifting or twisting that can aggravate the injury.
- Pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may help control inflammation and pain.
- Rest: Allowing the body to heal through periods of rest, while avoiding overexertion.
- Weight management: Reducing the pressure on the spine by maintaining a healthy weight.
