Question
Hello.  I'd be very grateful for your advice, please.  I was lying on my back and involuntarily twitched my lower back sharply. Three days later, I got bad sciatica and backache; I have a mechanical problem with the lower back, but no previous disc problems.  An osteopath says I probably have a small anular tear at L5, of a few millimeters, if that. I have scared myself looking at the internet and seeing that anular tears can be very serious. What is the prognosis, please, for a very small tear? I have a good range of movement, although sitting down does hurt after a while, even quite a way from the L5 area, especially as I'm usually leaning forward.  

Thank you in advance for your help, and best wishes

Lysianne

Answer
Dear Lysianne,

The annulus is the outer portion of the disk and is composed of tough fibrous bands.  This portion can tear with or without a disk bulge.  The annulus itself is almost powerless to heal tears of its substance due to the poor blood supply, but small annular tears can improve over time with specific exercises to strengthen the low back, specifically focusing on the multifidus muscle, and with minor decompression such as cox flexion/distraction.  A simple procedure performed in many chiropractic offices which results in appreciable pain reduction in only a few visits.

One problem is that you have diagnosis from your osteopath, that cannot be confirmed unless you get an MRI of the low back...the gold standard for the diagnosis of any disk pathology.  Otherwise, sacroiliac pain (the large joints in the pelvis) can mimic disk pain patterns.  A functional orthopedic examination of the low back will help to differentiate these two issues, but the MRI is the only true way to know for sure.  The treatment for sacroiliac dysfunction is just manual adjustive techniques, while cox flexion/distraction is better for disk issues.

I would suggest that you seek out a chiropractor who has the ability to do both and get a functional examination.  We often see appreciable reductions in pain quickly, but again you need to additionally learn the rehab exercises for the multifidus muscle in the low back to stabilize the area. Your chiropractor should be able to teach you these, if not, you can find them on the internet: look up multifidus exercises, bird dog exercises, cat/dog exercises, and prone extension exercises for more information.

For more information on disk bulges, the annulus, and the anatomical structures I have mentioned above, feel free to look at my website, I have multiple pages dedicated to these subjects complete with illustrations.

Hope this helps Lysianne, good luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net