Healing of painful intervertebral discs: implications for physiotherapy Part 2 — pressure change therapy: a proposed clinical model to stimulate disc healing

Sarah Key, Michael A. Adams, Manos Stefanakis

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In Part 1 of this paper, we presented a comprehensive review of the literature, regarding pathophysiology of discogenic pain. Based on the evidence presented, we are suggesting clinical, self-management strategies to promote disc healing and treat disc pain in general. Objectives: To suggest a physical therapy protocol for self-management of disc injuries and stimulation of disc healing. Major findings: Inflammatory process after injury to the outer annulus is the most likely source of discogenic pain. Annulus is the tensile load bearing ‘skin’ of the disc and its histology and pathology are similar to other collagen tissues like tendons and ligaments. Conventional physiotherapy wisdom for the management of tendon and ligament injuries is applicant to annular tears. Disc pain without injury is common due to development of stress concentrations in the disc especially during prolonged, end-range postures. Spinal motion segment depends on an optimal disc function. Strategies for management of associated pathologies like apophyseal joint pain and muscle spasm are also considered on this paper. Conclusion: Physical therapies should aim to promote healing in the disc periphery, by stimulating cells, boosting metabolite transport, discouraging adhesion formation, and preventing re-injury. The self-treatment approach presented in this paper, can potentially provide pain relief to a large number of back pain sufferers. This approach can be applied through information sessions and classes to help deal with the widening back pain pandemic.

Original languageEnglish
Pages (from-to)34-42
Number of pages9
JournalPhysical Therapy Reviews
Volume18
Issue number1
DOIs
Publication statusPublished - 1 Feb 2013
Externally publishedYes

Keywords

  • Back pain
  • Manual therapy
  • Rehabilitation
  • Self-management

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