The spine forms an integral component of the axial skeleton that supports and stabilizes the upper trunk and lower limbs by promoting optimal coordination with the help of central and peripheral nervous connections. The vertebrae are aligned in a linear fashion to promote a mild gliding motion across the vertebral column. Annular fibrosus is a thick ligamentous cord that supports the external aspect of intervertebral joints and forms a jelly-like support.
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’s 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.