I wanted to call this- the spine is made up of living/ changing tissue- disc herniations can heal, bones can become dense, bone spurring can be absorbed- how is that for catchy?
Basically, your cells are changing all of the time, depending on how you use them. You are bioplastic.
To check this concept out, let's explore the discs a bit more closely.
The intervertebral discs are the specialized cartilage that are contained (in very stiff and tight fibrous containers) between the vertebrae. It is important to note that this cartilage is very stiff- not like jelly, but just a little less stiff than bone, with a gel like center. They are meant to squish a bit like firm tires.
The NOI group calls the discs our “force transducers”. They help us sustain loading forces during compression, and they also help us create movement between the spinal bones.
Similar to all cartilage, they are injured when we have excessive movement or excessive loading forces.
When you sprain your ankle, do you relate to that ankle still being sprained, even 20 years after the fact? Or do you denote that the ankle was sprained (which is a fancy term to note that the ligaments are over stretched) but is now healed?
With the spine, it seems to be a fact, that when we have an injury we carry that injury into the present moment. We tend not to relate to the impermanence of our injured state- my disc was herniated, my spine was sprained, instead we may think that our spines are still herniates, strained, sprained.
The truth is that most soft tissue (non-bony) injuries heal within 6 weeks. It certainly can take longer, this is the general rule and does not apply to everyone.
There is one soft tissue that is outside of this rule, and that is our cartilage. When our cartilage has been killed off, it is true we cannot grow more.
But what if we can bring in muscles to stabilize our segments, to control the available joint range that is left and nourish and protect our remaining cartilage? What if we heal the tissues surrounding the cartilage? (Bear in mind, cartilage is aneural, meaning it does not have sense receptors to report pain). Can this keep us in function and out of pain? A lot of times, emphatically, yes. A really great tool to review cartilage behavior and protection, is to check out the information from Overcoming Arthritis, writings and workshop from November 2021.
We can use what we know about how our tissues are changing all of the time, to know that our spines are also changing all of the time.
I want to briefly remind us all of the 3 phases of healing that all tissue- be it skin, bone or disc, goes through on its way from injury to health.
1) Inflammatory phase:
Time Frame: 1 hour after injury generally to 10 days post injury
Chemical cascade is unleashed (heat/redness): white blood cells clean up debris, cause vasodilation/ vasoconstriction, cellular signals for proliferation phase to begin
Actions to take: control edema and swelling (PRICE-protection, rest, lymphatic massage, ice, compression, elevation )
It is extremely important to PRICE during the inflammatory phase. Taking care of where your tissue is in each phase, translates directly into how well you heal.
2) Fibroblastic phase:
Time Frame: 3 days- 1 month post injury
Wound contracture, re-epithelialization, collagen production
Too many cells may be laid down, and also, in a fashion that is all over the place- the goal of the next phase is to help organize the new cellular material
Action to take: Protect new tissues, *Soft tissue work to begin to break unwanted adhesions usually can begin here, sensory integration
How quickly and completely this phase proceeds can determine ultimate healing.
3) Remodeling phase:
Time Frame: 3 days post injury to 2 years out of injury
Help remodel tissues that had been injured so they can resume tolerance to their usual stress/ strain
Action to take: eccentric loading for muscle tissue, muscle activation and eventually hypertrophic, neuromuscular re-education, sensory integration, continue assessing abnormal adhesions and working to help normal alignment. Without remodeling, we feel that “scar tissue” is present- enough tissue is there, but it is not functioning for us like we need it to.
You will notice there is a tone of overlap between the different phases of healing. We often need a friend or trusted source outside of ourselves, to tell us the phase of healing we are in.
There are specific tools and principles of discs that Physical Therapists will use to help nurture your disc material along these phases of healing. It is important to understand that, just like all other tissues, your discs can and will heal if you learn the right tools for working with them.
A couple of simple orthopedic concepts that each of us can begin to work with today and employ to help our spines and specifically the discs that help us endure loading:
1) Unload the spine when you can
2) Stabilize/ stiffen your spine and learn how to complete functional movements without involving spinal motion
1) In terms of unloading the spine, please consider the chart below. Lying down or reclining are the best options. Standing up is better than sitting. Make sure not to slump sit, none of us want to use up the precious life force of our spine doing that!
2) Spinal stiffness and stabilization is the whole name of the game in Practical Strength. Learn how to move your limbs and progressive increase loads that your muscle can meet and handle with a safe spinal training program. If you are not in PS and are uncertain where to start, Stuart McGill’s basic four exercises are a great jumping off point.
Join us next week, where we will look at remodeling/ reshaping the bones of our spines by using our progressive muscle strength.
Until then, happy conscious changing!
Changes in spinal alignment will eventually create changes in bone density. Changing spinal alignment and bone density requires 6-8 months of consistent, specific and evidence supported effort.