Category: Biomechanics

Poor posture, unbalanced tight and weak muscles, stress, over training and joint dysfunction are all possible causes of low back pain. Frequently we see patients who may present with acute low back pain and sciatica.

Sciatica refers to back pain caused by a problem with the sciatic nerve. This is a large nerve that runs from the lower back down the back of each leg. When something injures or puts pressure on the sciatic nerve, it can cause pain in the lower back that spreads to the hip, buttocks and leg.

The most common symptom of sciatica is lower back pain that extends through the hip and buttock and down one leg. The pain usually affects only one leg and may get worse when you sit, cough or sneeze. The leg may also feel numb, weak or tingly at times.

The symptoms of sciatica tend to appear suddenly and can last for days or weeks.

Most people who get sciatica are between the ages of 30 and 50. Women may be more likely to develop the problem during pregnancy because of pressure on the sciatic nerve from the growing uterus and foetus. Other   causes include a herniated or bulging disc and degenerative arthritis of the spine.

What is a bulging disc?

To understand what a bulging disc is, we must first understand the anatomy of the spine.

Put simply, the spine is made up of individual vertebrae stacked on top of each other. Between each vertebrae is an intervertebral disc that provides a cushion so the vertebrae don’t rub together.

The discs between the vertebrae have a gel like material inside (called a nucleus pulposus).

A great way to think of the discs is like that of a balloon filled with water – these discs help resist compressive forces on the spine.

When a disc bulges, the gel like material inside gets pushed back towards the nerves and structures of the spine. This bulge can sometimes        compress nerves in your spine and cause pain, tingling / or burning sensation and / or other symptoms.

It is important to note that a bulging disc doesn’t always touch the nerves and, for many, a bulged disc doesn’t even produce any pain at all. However, it could progress to become a herniated disc eventually, which can be problematic.

What causes a bulging disc?

· Seated with poor posture for long periods of time.

· Repetitive bending, lifting and twisting, especially with poor form.

· Heavy lifting with poor form due to stress on front of spinal column causing disc to bulge out back.

· Can also result from osteoarthritis.

· Trauma such as a car accident.

How is a bulging disc different from a herniated disc and which is worse?

In most simple terms, a herniated disc is when the fluid material from the disc ruptures through the outer layer of the disc and now spills out. This material can directly compress on spinal nerves and spinal structures. If you use the water balloon example but now imagine the balloon has burst under pressure, that’s a herniated disc.

A bulging disc can be resolved over time if managed well, whereas the herniated disc will just scar down since the annulus (outer layer of disc) has ruptured.

A nice visual spine model is provided below differentiating between normal, bulging and  herniated discs:

What are the symptoms of a bulging disc in the lumbar spine?

· Low back pain.

· Leg pain (not absolute).

· Decreased lumbar lordosis (lower back curvature becomes flattened – flatter lower back over time).

· Lumbar and hip muscle tightness.

The wrist is one of the most delicate, complicated and vulnerable joints in the body. It’s classed as a complex joint, meaning multiple bones slide against each other to create a more complex movement – necessary in such a tight space and to be able to withstand the compressive forces wrists can handle! It’s capable of every movement possible from a joint in the body. 

The 7 small bones of the wrist sit between the two forearm bones and the long bones of the hand. Their location is from our tree dwelling ancestors and allows the hand to close and open, as well as working with the elbow to rotate up to (and sometimes over!) 360 degrees. Those same tree dwelling ancestors are responsible for some of the muscles acting on the wrist. There are very few muscles that exist in the wrist, the only main one called pronator quadratus. The rest live in the forearm and pass tendons across the wrist into the fingers or hands.

These tendons are the most vulnerable part of the wrist to injury and pass in a series of sheaths around the outside of the wrist, linking the wrist to conditions like tennis and golfers’ elbow. 

The most well known wrist injuries, along with the most common, are traumatic injuries from falls and impact – the typical ‘fall on out stretched hand’ or FOOSH. The small bones and corresponding joints make the area particularly susceptible to injury in this way.

However, other injuries can come in the form of repetitive strains to any of the joints or tendons and can also show in some of the nerves that pass through the wrist into the hand. The most common of these being carpal tunnel syndrome. Other tunnel syndromes are more rare but do exist, the next most common being a tunnel of gunyon syndrome, also known as a handlebar palsy.

That name is a giveaway as to the most common population to get this type of injury! However, it isn’t just cyclists – anyone with pressure on the ulnar side of the wrist (little finger side) with a gripped fist can be in the firing line, particularly with vibration, so power tools are a common cause.

Something to bear in mind with tunnel syndromes or any injury to the nerves in the hand or extremity is that it’s very important to rule out any other pathology or cause, as conditions such as type 2 diabetes are significant risk factors – they are also very commonly present in pregnancy! 

The high usage of the wrist in nearly any movement using the hand leads to overuse or repetitive strain injuries being very common in the wrist – linked with overuse in sports, actions like using scissors in hairdressing or using keyboards excessively. 

Some of the more interesting aspects of the wrist include a muscle left over from our tree dwelling evolutionary forebears, that isn’t present in everyone, called palmaris longus. This tenses the connective tissue of the hand and assists wrist flexion. One theory as to its development is that it assists climbing primates (and possibly climbing humans?!).  Did you know, the wrist bones in horses have fused to create their longer lower foreleg bones, meaning the joint that looks like their knee / elbow on the front leg is equivalent to our wrist! 

Treatment of the wrist is often complex – reduction in load through rest and active treatments in the form of exercise or stretching are common. Many different methods of management can be performed by chiropractors including taping, acupuncture, manipulation and massage. These are effective in many types of wrist injury but, due to the complex nature of the joint and the structures passing through it, make sure to seek advice from a qualified professional (chiropractor, GP, physiotherapist or similar) before any sort of  intervention! 

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