Discopathy - something I've learnt today from a 25yrs exp French osteo

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Permalink Reply by Sabine on November 24, 2007 at 7:45am

Please say just for me...........what means IDD/PIVD/DDD. Either I`m to "young" for these things or they have differnt names in german.

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Permalink Reply by Ross on December 22, 2007 at 12:55pm

osteopathy needs proper regulation across the EU so badly, ive heard of really crappy courses and really short ones too (like 6 months) its terrible that osteopathy is being abused and diluted in this way. incidentially if L5 if flexed you shall have a increased load on the anterior annulus causing a increase of pressure through the posterior part which is weaker so yes i spose it could (if you subscribe to fryette's law). this is VERY basic spinal mechanics a good book for you is clinical anatomy of the lumbar spine and sacrum by bogduk and twoomey

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Permalink Reply by Clement Rhein on December 23, 2007 at 10:54pm

Would Bogduk say its a load of balloks then?... :-)

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Permalink Reply by Clement Rhein on November 24, 2007 at 11:10am

:-) 2010 grauation = 1st year? That would mean you are perhaps a bit too young, my fault. By the way, I've gathered that about 99% of the time when somebody asks a question is not "just for me". Somebody is going to read this and think, ho, so that's what it means. I have a very simple principal that I apply: if a question popes into head, ask it. Sorry, nothing amazing, just that :-)
Asking a question is great coz it creates an exchange. e.g. when in class, a question from a student will give feedback to the teacher regarding how the class is doing/understanding. Then the knowledge from the answer goes to everybody in the class (everybody that is listening that is ;-)). So by asking a question you do yourself a favor, you give to other student this knowledge (coz perhaps without this question this knowledge would have never been shared), and you give feedback to the teacher. An't that great! Then there a bonus, coz if your shy (I think loads of us are...) then you feel better about yourself.
ANYWAY, Clem, shutup.

IDD: internal disc disruption
PIVD: Prolapse intervertebral disc
DDD: degenerative disc disease

What I meant was bascically discopathy = a problem with a disc.
Where are the most common discopathies? L5 + L4
They may be assymtomatic. In fact, it seems to be that most DDD are!

IDD is bascically where where is damage to the disc, or to be more precise an annular fibers tear (that I think you've learnt in anatomy now, so you know better that I :-)). But there is no protusion of the nucleus pulposus.

PIVD is the SLIPPED DISC, where the nucleus pulposus has come out of the annular fibers and gets stuck between the PLL (posterior longitudinal ligament) and the disc or goes sideways towards the nerve root. It can push into the vertebral foramen or nerve root, cause inflammation, and irritate/compress the spinal cord or nerve root.

DDD tends to result from PIVD or IDD. The disc has suffered abuse/damage, and becomes degenerative. the nucleus pulposus becomes smaller or inexsitant and the disc bascically shrinks. The two vertebrae become closer to one another. That compresses the facet joints - increase pressure - which result in O/A (osteoarthritis - degeneration). The problem, appart from pain, stiffness, decreased function of the L. spine is that it may impinge the spinal cord, called spinal stenosis (surgery!). Because its a degenrative process it is thought to become present in 40+. But I have some mild ones already and I'm only 23, so...

Now, the interesting question for us as osteopaths is what can predispose to discopathy (IDD/PIVD/DDD)?
Ok, so there is the good old environmental factor. If the blok is a 25 yrs old male doing digging every day - repetitive flexion, sidebending, rotation. These components place maximum pressure onto the annular fibers from the nuleus pulposus. Plus with an added load. And one day, boom!
So, if you ask me I'll say SD (somatic dysfunction)! If, say L5, is in SD, one side will move more than the other. This side will become overworked with every movement that happens in the body e.g walking. So that's with the assymetry. But what about flexion/extension. If there is a flexion lesion, the L5 will move fine in flexion, and as the SD gets worse L5 may be stuck in flex all the time. The nucleus pulposus will be pushed posteriorly. So every movement done will be done with the disc pushing posteriorly. There's the predisposition!

Also, if say L5 and L4 are in flexion lesion, is the lordosis gonna be increased or decrease? Tricky question coz i think it can be probably both. However, if L5 & L4 are in flexion, it could be that the sacrum goes into counternutation to reduce the demande on the L. spine to go into extension. As a result the kyphosis will decrease as well (for balance - gravity), and how? By contraction of the paraspinals, which isn't the most comfortable in my experience :-). Contraction of muscle means decreased movement/restriction. As we know, cervical movement goes all the way down to T4. So if the thoracic restriction goes up to T4 there could be some neck involvement, such as? HYPERMOBILITY. Where? C5-6. What does it lead to? O/A. Bla bla bla...
I've been manipulating thoracics after thoracics thinking "Ah! SD here will get the L. and C. spines to work harder, so make it move! Now, I'm looking back to the good old L5.

Hope that helps a bit. Sorry if its rather long...

By the way, I'm getting rather rusty, which part of the disc is innervated? outer 1/3 or 2/3?

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Permalink Reply by Sabine on November 24, 2007 at 1:20pm

Thanks for this long answer...I think I know what you mean with IDD and so on. The german words are Protrusion and Prolaps.
So I´m not in the 1. year but in the first half of the third...( we have to study 5 years)...
I not able to discuss with you all this question, because we just do the ilium, the spine will be the next thing.
But we´ve done something about disc aging in histology.
I think we say that disc aging can lead to DDD. And 75 % is genetic...triggered by chemical and mechanical causes.
Disc aging starts between 30-50 ( sometimes 20') The reason is the changing compostion of the discus:
Kreatinsulfat stays but chondroitin 4-sulfat diminishes ( first in the nucleus)....from this it follows that there´s fewer water ....so fewer resistance for compression forces(nucleus) ...and the anulus has to do the work for the nucleus.
But the anulus fibres change too.....change of function => change of connective tissue more collagen type I more crosslinks.
=> lower vascularisation
If than comes a trauma....ruptur of anulus f.

Couldn´t it be that our body creates a dysfunction in the part where we have disc aging? ...We haven´t done something like that, so please excause if this is too silly. :-)))

....and a last thing...I think you´re right we have to discuss more. It will make as thinking ...

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Permalink Reply by Clement Rhein on November 24, 2007 at 1:48pm

Nice one maty! Cheers
What did you do during the 1st and 2nd year? Physiology, neurology, osteopathy, not anatomy?
So... why do we get disc aging? There are DNA strains that have the information that "ha, we're gone 30 now, 4-sulfat out you go!"? :-) Why would our DNA have that?
Something I came across in the 3rd year was that DDD (seems to be the same as disc aging?) is caused by an end plate fracture. The end plate is the inferior and superior aspect of the vertebral body, where the disc is in contact with the vertebral body. Because nutrients go through the end plate, if there is a dysfunction at the end plate, the chemical balance of the disc is disturbed. ...Then I get a bit vague... The nucleus pulposis becomes more watery rather than gelly-like, so it can pierce the annnulus fibrosus easier. Is that the same as Keratinsulfat & 4-sulfat story? are you able to send your references through at all? A little scan of your notes perhaps...

Do you know the diference between a hernia (herniated disc) and a prolapse (PIVD)?
Does disc aging happens with everybody?

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Permalink Reply by Sabine on November 24, 2007 at 3:50pm

Yeah, we did so much things the last 2 years: maths, physics, biochemistry, paläoanthropology (?), english, biology, anatomical palpation, anatomy, physiology, histology, microbiology, pathology for eyes, ears, skin, lokomotory system, and so on....;-)
I can´t say why the DNA shoud say...." now...no more of this substance". We only say genetic and the process starts at about 30. Why it starts, I don´t know....
I think disc aging is a histologic process, its not a disease....it can cause a disease....perhaps because of disc aging the nucleus gets smaller und you become what you call DDD.

Hernia and prolapse ...I think bulging, than protrusion, than hernia, isn´t a protrusion ....the nucleus material comes out...but not so much irritation on the nerves...and hernia compresses the dura? I hope you know it better.
I would say disc aging happens with everybody, ....but problems must not occur.

Sure I can try to scan my notes ( if I find my scanner) , but they´re german with much of my own abbreviations.
Oder sprichst du etwa fließend Deutsch und ich quäle mich hier mit englischen Erklärungen ab??? Das wärs ja jetzt. :-))))

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Permalink Reply by Clement Rhein on November 24, 2007 at 8:40pm

But offcourse! this last sentence sums it all.

To ben un grossen osteopath

I cannot speak German! So don't worry about your notes, too bad.

Why do they get you to do math and physics and stuff in the first two years? Is it to make it a scientific degree coz the osteopathic stuff is too airyfary for the Germans ;-). Was it helpful for the rest of the course?
What do you think about your course in general? How does it work in Germany regarding the differences in schools? How many schools are they? Its not regulated is it?

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Permalink Reply by Sabine on November 25, 2007 at 10:08am

Good question. I don´t really know why we have to do those courses. Maybe they try to create osteopathy as a german study course. And in many universities here you do a base study period, before the real study program starts. But who knows. I think I will never use or need maths or physics again. I always thought it was wasted time. Biochemical lessons were ok, it was a little bit useful for histology. I think it would be possible to cancel the first year.
In germany you can study osteopathy fulltime (for all people having never studied any other medical things) or part-time( for physiotherapists, doctors etc.)
For the part-time courses we have many colleges/schools here. And I think all of them have a different curriculm.
But we have until now only one fulltime osteopathy college. (where I´m now) Part-time and Fulltime require a 5 year study.
After a 5 year study you can make the D.O title.
But you´re right everybody here can call himself an osteopath, even after a weekend course.
I think we have about 10 schools in germany.
What about england and france? How does it work with 4 years.
How many students are you in one year? We were about 20 at the beginning. Now the years after us are about 40.
What about your practical lessons. How many teachers have you for how many students. ( We have one for 20 and when there are more students we have an alumni, too. )

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Permalink Reply by Dave Colley on November 25, 2007 at 4:33pm

www.chirogeek.com

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