Massage & Bodywork

MAY | JUNE 2019

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2 3 4 Another important factor about disk structure is its relationship to adjacent tissues. There is a long and broad ligament on the anterior aspect of the spine called the anterior longitudinal ligament (ALL). The ligament helps maintain the position and integrity of intervertebral disks throughout the spine (Image 3). There is a corresponding ligament on the posterior side of the lumbar vertebra called the posterior longitudinal ligament (PLL), and it spans the length of the spine inside the spinal canal (Image 4). However, it is much narrower than the ALL and, therefore, limits the restraining capability of this ligament on the posterior side, which plays an important role in disk pathologies as well. Immediately adjacent to the PLL is the spinal cord, and the ligament is an important restraint to keep disk bulges from pressing on the spinal cord. Immediately adjacent to the posterior lateral aspect of the disk are the nerve roots that exit the spinal cord and pass through the intervertebral foramen (Image 2). This is the location where these nerve roots are vulnerable to compression by deforming disks. DISK PATHOLOGIES Multiple terms describe damage and dysfunction to the intervertebral disks. Recently, there have been concerted efforts to improve this terminology challenge with standardized terms and concepts defining disk pathologies. 1 Massage therapists may encounter these terms in clients who have seen other health professionals, and it is valuable to understand these terms so we have a good understanding of our role in addressing the client's complaint. There are three main categories of disk pathology: annular tears, disk degeneration, and disk herniations. Let's explore the definition and physiology of each variation to better understand what is occurring with spinal structures and the impact on local and distant pain conditions. Annular Tear An annular tear (also called an annular fissure) involves a disruption or separation between fibers of the annulus fibrosus. It may also occur when the annulus pulls away from one of the adjacent vertebral bodies (called an avulsion). Annular tearing and avulsion from the vertebral body is partly what occurs in a condition called spondylolisthesis, where the disk does actually move or migrate across the top of the vertebral body. There is no way to identify annular tears through any type of physical examination; these are determined with high-tech diagnostic imaging. Because annular tears frequently don't change the shape of the disk, they may not press on adjacent structures and cause any significant symptoms. Disk taller in front to support lordotic curve. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. Anterior view of the spine showing anterior longitudinal ligament. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. Posterior view of the spine with spinous and transverse processes removed showing posterior longitudinal ligament in relation to disks. Mediclip image copyright (1998) Williams & Wilkins. All rights reserved. Disk taller in front Intervertebral foramen where nerve roots exit Anterior longitudinal ligament Posterior longitudinal ligament Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 89

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