• Disc Injury


    Discs are anatomical structures that are situated between the spinal vertebrae. They provide a cushioning between the hard bones, as well allowing for movement of one vertebra on top of another. In addition, the discs also create space between the vertebrae that allow for spinal nerves to pass in and out of the spine.

    There are 23 discs in total. They are present between all vertebrae, except between the two top vertebrae of the neck (C1-C2) and between the top vertebrae and the skull (Occiput-C1).

    The disc is made up of an outer tough fibrous ring called the annulus fibrosus and an inner jelly-like portion called the nucleus pulposus. The outer part of the disc has good blood supply, but there is little to no blood supply to the inner disc. Spinal movement is therefore needed to pump nutrients in and waste products out from the middle part of the disc.

    Nerves only penetrate part of the way into the disc, meaning the inner disc is not pain sensitive.


    Most spinal injuries (including disc injuries) are the result of:

    • Repeated micro trauma, such as bending, lifting and poor posture
    • Lack of spinal flexibility
    • De-conditioning of the deep spinal muscles leading to a lack of core stability

    The uneven stressors caused by these problems can eventually lead to a degenerative tearing the outer annulus fibrosus. This tear/s will cause the inner nucleus pulposus to be pushed out and will present as one of the following:

    • DISC BULGE: Here the annulus has only partially torn. The nucleus ‘bulges’ out, but does not push all the way through the outer fibrous ring.
    • DISC HERNIATION/PROLAPSE: A herniation and prolapse describe the same injury. In this case the tear is larger and the nucleus has fully ‘protruded’ out from the fibrous ring.
    • DISC SEQESTRATION: In this case part of the disc that has protruded out has broken free and floats within the spinal canal.
    • DISC DESICCATION: This is a breaking down of the disc due to loss of fluid. It may be considered normal in an older person, but when it occurs in someone under 60yrs it is suspected to be as a result of injury or increased stress on the disc.

    Disc injuries can become serious because of their close proximity to the spinal cord and spinal nerves as they exit the spine. Particularly in the case of a disc prolapse or sequestration, the offending disc can physically compress or chemically irritate the nerves causing pain and other symptoms. This happens most commonly to the spinal nerves as they exit the spine through a small opening called the intervertebral foramen (IVF).


    Many disc injuries produce no symptoms at all and most will heal over time without the need for surgery. If a disc injury is causing symptoms, often the pain is felt as a deep ache that may refer down the arm (if the injury is in the neck) or leg (if the injury is in the low back). Pain can vary in intensity and be either sharp or dull.

    Other disc signs may include:

    • Spinal or referred pain when coughing
    • Disc pain when slumping forward
    • Referred pain may be more intense than spinal pain
    • Pain that becomes worse when sitting (this may happen with other spinal conditions also)
    • Referred pain when lying on back and raising one or both straight legs (low back disc only)


    If the disc is compressing an exiting spinal nerve, classic radicular signs might be present. These include:

    • Pain and loss of sensation (pins and needles) along the distribution of the nerve
    • Loss of strength to the muscles that receive nerve supply from the damaged nerve
    • Reduced or absent muscle stretch reflex

    The radicular signs will vary depending on which spinal nerve is affected. For example, the Right S1 nerve root at the base of the spine can be compressed by a disc prolapse at either the L4/5 or L5/S1 level and give the following signs:

    • Pain and/or tingling felt in the right buttock and referred to the back of the thigh and lower leg and into the under surface of the foot
    • Loss of muscle strength required to press up onto balls of feet
    • Loss of Achilles reflex – when you tap on an Achilles tendon with a reflex hammer the foot should contract downwards
    • Decreased sensation on the under surface of the foot – usually tested with a pinwheel


    This is made based on clinical findings and confirmed with either a CT scan or MRI (preferred). X-rays can show disc degeneration based on thinning of the disc space, but cannot show any detail with the disc itself.


    Almost all mechanical spinal injuries, with the exception of fractures and dislocations, do better in the long run if you return to gentle movement, rather than prolonged bed rest.

    While it might be beneficial to rest lying on your back with your knees bent for short periods, this should be combined with simple walking as soon as you are able to.

    Other self-management includes:

    • Avoid sitting, lifting, bending
    • Walking
    • Ice 15min x3/day
    • Low back support belt
    • Very gentle extension exercises.
    • Low force chiropractic techniques


    • Lifestyle changes – lose weight if required, eat well, sleep well and become more active
    • Improve ergonomics at work and home
    • Improve posture
    • Update your bed if no longer supportive
    • Don’t sit with your wallet in your back pocket
    • Improve core stability and strength of low back
    • Chiropractic care
  • Facet Joint Disorders


    Facets are the small, paired joints situated at the back of the spine, behind the spinal cord. They guide movement of the spine as well as absorbing 10% of the weight that goes through the spine. The disc absorbs the other 90% of the weight.

    Facet joints are covered with smooth cartilage that allow for the joints to slide on one another. Each joints in covered by a joint capsule, which is rich in nerve endings to detect movement and pain.

    Pain emanating from facets is sometimes called facet syndrome. It is one of the most common of spinal complaints and typically responds very well to chiropractic care. Facet disorders do not usually involve the spinal nerves, but rather the smaller branch off the spinal nerve called the dorsal rami.

    Referred pain can still be a feature of facet syndrome, but it does not follow a radicular pattern as is often seen with a disc prolapse. Disc injuries are more likely to refer all the way into the hand (from the neck) and foot (from the low back). Facet disorders tend not to refer past the elbow or knee.


    • Intermittent pain of varying intensity
    • Tenderness to pressure over the inflamed facet joint/s
    • Pain that is worse when bending backwards – this compresses the facets
    • Pain worse with standing still for long periods, but relieved by squatting
    • Pain that initially improves with sitting, but then becomes worse


    This is based on clinical findings and X-ray, which may show degenerative or other changes in the facets. Injecting the facet joint with a pain-blocking anesthetic is the most definitive form of diagnosis. Relief with this technique is diagnostic, but only performed in severe cases.



    • Avoid standing for long periods, or other aggravating activity
    • Walking
    • Ice 15min x3/day
    • Very gentle flexion exercises
    • Chiropractic care


    • Lifestyle changes – lose weight if required, eat well, sleep well and become more active
    • Improve ergonomics at work and home
    • Improve posture
    • Up date your bed if no longer supportive
    • Don’t sit with your wallet in your back pocket
    • Improve core stability and strength of low back
    • Chiropractic care
  • Muscle Strain/Tear


    There are many muscles important in the healthy function of the low back. These include:


    These muscles form the base of the pelvis and attach to the ‘sit bones’ (ischial tuberosities) on either side as well and the pubic bone at the front and coccyx at the back.

    The pelvic floor is important for pregnant women because the stretch and weakening of these muscles can predispose women to have issues with urinary and bowel incontinence in later life. Importantly, this muscle is also essential for spinal stability in both women and men. It is good to practice contracting this muscle in different postures to help restore and maintain proper tone.


    Along with the pelvic floor, this is another very important core muscle for the low back. The transverse abdominis (TA) is the deepest of the abdominal muscles. When it contracts it draws the abdomen in and stabilizes the spine. This contrasts with the stronger and more superficial abdominals that flex the spine forward when they contract (such as doing a sit-up).


    The multifidus are a group of deep muscles that fill the space either side of the central bony bumps of the spine (Spinous process). The multifius are made up of 3 layers of short muscles, the deepest of which runs from the outside of one vertebrae and attaches to the spinous process of the vertebrae immediately above.

    This is another of the core muscles. The multifidus contracts to stabilize the spine before the larger muscles contract to move the body.

    When the muscle weakens or is de-conditioned, some of the muscle fibres are replaced with fat in a process called fatty infiltration. In this state the muscle looks similar to a cheap cut of meat. Fatty infiltration is usually seen in individuals with chronic low back pain. The right type of targeted exercise can reduce this process.


    This is the large and superficial muscle that gives shape to our buttocks. It is a strong hip extensor, which is used when you squat or get out of a chair. This is a common muscle for trigger points that can cause back pain. In older individuals degenerative tears may occur.


    This is a deeper muscle to the gluteus maximus. The gluteus medius originates from the top and back of the pelvic bone (iliac crest) and inserts into the outer point of the hip.

    When this muscle contracts in the neutral position, it pulls the leg away from the midline. It is a very important muscle because during gait, as it supports the body on one leg to prevent the pelvis from dropping to the opposite side.

    Strengthening of the gluteus medius is often required to improve hip and pelvic stability.


    This is a deep buttock muscle that sits below the gluteus medius. Importantly, the sciatic nerve passes through (or in some cases in front of) the piriformis. Contracture or spasm of this muscle can produce sciatic pain (pain down the back of the leg) in a condition known as Piriformis Syndrome.


    The iliopsoas is a group of 3 muscles that originate from the front of the lumbar vertebrae and discs and the inside of the pelvic bone (iliac fossa). From deep in the abdomen the muscle runs forward and out to attach on the lesser trochanter immediately below the hip joint.

    This is the muscle most commonly implicated in a hip flexor strain; an injury that occurs commonly in athletes involved in sprinting and kicking. This can be a sudden (acute) injury/tear or a repetitive (chronic) strain.

    Pain is felt in the groin and is aggravated by running of kicking.

  • Sacroiliac Joint Dysfunction


    There is a right and left sacroiliac joint (SIJ) that is located at the base of the spine. It is formed between thesacrum in the middle, and the left and right ilia on each side.

    The SIJ is a particularly strong joint that transfers weight from the hips into the spine, at the same time allowing for a small amount of movement.

    The SIJ can be damaged by postural/repetitive strains that occur over time, or from sudden forceful trauma. The following factors can contribute to SIJ dysfunction:

    • Poor core stability
    • Leg length differences
    • Obesity
    • Pregnancy
    • Sedentary lifestyle
    • Occupations that require heavy lifting, bending and twisting


    Pain associated with SIJ Dysfunction is usually one-sided low back and buttock pain that can sometimes refer onto the groin and front and side of the thigh. Pain can be worse with movement of the lower spine and hips, especially weight bearing movements such as bending and climbing stairs. Tenderness is usually present directly over the joint.


    Clinical examination is usually all that is required to make a diagnosis. X-rays might be required to check to degenerative changes and pelvic unleveling. MRI is rarely required, unless a disc prolapse causing buttock pain is suspected or there are concerns about other pathology.


    The management of SIJ dysfunction varies depending on whether the pelvis is stable or unstable. An unstable pelvis is often seen during and after pregnancy, producing pelvic girdle pain. See Pregnancy

      • Reduce weight bearing activities such and running, jumping climbing stairs – even reduce walking if severe pain
      • Wear SIJ belt to stabilize the pelvis
      • Gentle non-weight bearing exercise – such as straight kick swimming (freestyle and backstroke)
      • Heat/ice
      • Postural correction
      • Lifestyle changes
      • Soft tissue techniques to help supporting muscles
      • Low force chiropractic adjustments – such as pelvic blocking
      • Avoid jumping and running
      • Gentle slow moving, weight bearing exercise
      • Soft tissue techniques to help supporting muscles
      • Postural correction
      • Lifestyle changes
      • Soft tissue techniques to help supporting muscles
      • Chiropractic adjustments – this may include pelvic blocking, instrument adjusting and manual adjustments if suitable
  • Spinal Stenosis


    Spinal stenosis is the narrowing of the canals in which nerves pass through the spine. When this occurs in the central spinal canal, which houses the spinal cord, it is called central canal stenosis. When it occurs in the space where the spinal nerves exit the spinal canal (inter vertebral foramen or IVF) it is calledforaminal stenosis.


    If the narrowing is large enough then spinal stenosis can cause back pain, buttock and leg pain, and numbness. Symptoms are typically worse with walking and relieved with rest.


    The two most common causes of spinal stenosis are degenerative and acute severe disc prolapse.

      • Occurs in older population (>60yrs)
      • Osteoarthritic bone spurs and swelling of ligaments (hypertrophy) encroach into the central spinal canal or IVF
      • Symptoms tend to develop slowly over time
      • Occurs most often in 30-50yr group
      • Prolapse is large enough to encroach into central spinal canal or IVF
      • Symptoms may come on quickly and can be associated with intense pain

    Other possible causes of spinal stenosis include tumour, infection and Paget’s disease (bone over-growth disorder).


    • Central spinal stenosis that compresses the spinal cord gives Upper Motor Neuron (UMN) signs:
      • Muscle spasticity
      • Increased muscle stretch reflexes – tapping on your muscle tendon gives an exaggerated muscle contraction
      • Weakness
      • Extensor Babinski sign – when the under surface of the foot is stimulated the toes curl up (normally curl down after 1yo)
      • This occurs more commonly in the neck, with the weakness and other signs seen in the legs
    • Foraminal stenosis that compresses the spinal nerve as it exits the spine gives Lower Motor Neuron (LMN) signs:
      • Flaccid muscles that may atrophy (shrink in size)
      • Decreased or absent muscle stretch reflexes
      • Weakness
      • Normal Babinski response – toes curl down

    Because the spinal cord finishes at the mid lumbar (low back) level, most central spinal stenosis and the lower lumbar spine actually compresses the spinal nerves (rather than the spinal cord). This gives LMN signs rather than UMN signs.


    The clinical picture can give many clues. X-rays are useful for identifying central and foraminal stenosis caused by degeneration and bone spurs are easily visible. A CT scan or MRI is better for confirming a disc prolapse.


    The spinal cord finishes at the mid lumbar area in adults. The lower lumbar and sacral nerves branch off the cord and descend further down the spine to exit at lower levels. These nerves and called the cauda equina because of their resemblance to a ‘horse’s tail’.

    Stenosis that is central in the low back can compress cauda equina. If compression is severe it can cause numbness and tingling into the inner thighs and a loss of bladder and bowel control, a condition known as cauda equine syndrome. This is a serious condition and requires urgent decompression surgery to avoid long-term neurological damage.


    Most cases respond well to conservative treatment, which includes gentle mobilization techniques and exercise. In some cases surgery is necessary depending on age and severity.

  • Sponylolisthesis


    A spondylolisthesis is a forward slippage of one vertebra on top of another. In children this is most often caused a defect in the pars interaticularis, which connects the body of the vertebra at the front to the neural arch at the back. In older adults it is more commonly related to degenerative changes.

    It is estimated that around 5% of the population have a spondylolisthesis and occurs most commonly in the lower vertebrae of the lumbar spine (low back).

    Before the vertebrae has fully ossified (become bone) and is still held together with cartilage, physical pressure on the cartilage areas causes a type of stress fracture so the front ‘body’ part of the vertebra slips forwards.

    It is thought that sports that involve significant extension (backward bending) – such as gymnastics, ballet and contact sports – may be a factor that leads to spondylolisthesis.

    Eskimos have a higher incidence of spondylolisthesis and this is thought to be due to having infants placed into an amauti (a garment that wraps around a young child and worn over the shoulders of the parent). While having many practical advantages the amauti also often positions the low back in an extended, weight bearing position.

    The forward slip of a spondylolisthesis narrows the spinal canal and may cause stretching and damage to the spinal nerves as they pass through the canal. Small forward slips (Grade 1-2) are usually managed well with careful Chiropractic care, exercise and lifestyle advice. Large slips (Grade 3-4) may require surgical intervention, especially if muscle wasting or loss of bladder control develop. Many people with spondylolisthesis experience no significant pain what so ever.