Yarrow Bulding, ca. 1909
“Know Thyself”
Season 1- Episode 1
There is a phrase from the annals of human thought coined by many great philosophers from many different eras that struck me today like a bolt of lightning from the hand of Socrates himself. That phrase is: “Know Thyself.”
I had a revelation while doing some research for this blog. The revelation was simply that I needed to re-learn everything! I realized it was time to re-evaluate all of the information I have accumulated over the years, look at it critically, and re-formulate it all in a logical order so that not only my patients are better informed but that I myself have a clearer understanding of exactly what information is most vital-and more importantly- most useful. There is a great deal of information “out there” about health-related topics yet sadly a large percentage of it is either inaccurate or out of proper logical context. This is especially true with regards to Complementary Medicine.
In looking at some themes for this “series” I primarily wanted it to catch people’s attention so they would hopefully tell others about this small place within cyberspace. A difficult task for me was to try and make this series interesting enough so that it became a trusted and popular resource. I also hoped to publish solid information that anyone could acquire and reflect upon for free. People should not have to spend over $100,000 and suffer 8+ years of difficult study like I did to get excited about the human body and how to best care for it.
Initially I was at a loss for ideas as to what I would write. I considered doing some episodes about healthcare politics and how the healthcare system is not sustainable, etc. etc., but a colleague suggested I try and remain positive and good-humored, which I intend to do. Besides, not a day goes by in the standard media where scores of pundits and columnists are parroting opinions about healthcare (even though most never have made a career taking care of human beings). It is my view that most folks are probably bored to tears by all the rhetoric and repetitive themes which are like a broken record-or worse- a scratched DVD!
Next I considered writing about so-called “alternative medicine” and, cough, Chiropraxis, I mean, Chiropractic (If I were given a quarter for every time someone misspelled that word, or said it wrong, I could have paid my student loans off a long time ago).
The subject of Chiropractic made perfect sense! I could write all about how there are 24 vertebrae, and, yawn, they are divided into three main sections; cervical, yawn, thoracic, yaawn, and lumbar…zzzzzzzzz…The reality instantly dawned on me like a whiplash injury: in all my years of private practice I have never really met people who were extremely interested in Chiropractic, other than Chiropractors! Just kidding! In my opinion, if you suffer from insomnia and want to know how to cure it permanently in 30 seconds, I recommend a Chiropractic Radiology Seminar. Again I am only kidding- there are many bright intellectuals who are very curious about Chiropractic. The thing I have come to realize is that some of the fundamental facts about the human body, and particularly the spine, are misunderstood by the public, Physicians, and even more embarrassingly, (grimace) Chiropractors. There are many common phrases and ideas in health care which are assumed to be true that are in fact errors.
“I said Chiropractor, not Choir practice”
- Herman, by Jim Unger[i]
So without further ado I will begin the real writing and not joke around so much. Obviously I can’t really compete with the mainstream media for your undivided attention, but here goes nothing: If many of us feel health information and healthcare politics to be a confusing and repetitive, boring subject, I submit to my readers that this series is not! You may just find reading this website worth your time. Even more amazingly you might even chuckle a few times too.
So what does “Know Thyself” have to do with this? It is the central theme and “prime directive” (an ode to all you Trekkies) of this series. Over the next several months I will be dedicating my efforts in hopes that you may absorb clear facts about the human body to further your own self-understanding. I feel it is very important, and so should you! As one of my mentors once coined: “I deal with a subject which I consider to be one of the highest, if not the highest studies to which the human mind can turn- life, health, disease, and correct living.” [ii]
Introducing the foundation of the body, the connecting link of the human spine: [Drum Roll]
The Intervertebral Disc
(Part One of Three)
Perhaps no other part of the human body is more ill-quoted than the cartilage substance crazy-glued between the back bones, known as the “Disc.” In this episode we will demolish some myths about the disc and demonstrate how amazing this structure really is- to give you a solid understanding about one of the more misunderstood structures of the body.
One of the classically ill-informed phrases I hear patients say dozens of times a year in my clinic is: “I was told I had a slipped disc.” Believe it or not I have heard (and read in respected publications) Chiropractors and MD’s use that phrase, slipped disc. Speaking of philosophers, as the great Homer (Simpson) said so eloquently: “D’oh!” Let’s understand right from the beginning and once-and-for-all: DISCS DO NOT SLIP!
They do however, unfortunately,
1. Bulge (Herniate).
2. Protrude, prolapse, or sequester, but these terms are really the same thing as a bulge, being different only in anatomical degree and location.
The intervertebral disc is an amazingly strong part of the body and contrary to most imaginations it is not really soft, and it is definitely not something that slips in any way.
Illustration 1- The Intervertebral Joint
Looking from the left side at two lower back bones (vertebrae):
click to enlarge 
All Images provided appear courtesy of the Health Education Assets Library (HEAL) and the International Association of Medical Science Educators (IAMSE)
The discs are ridiculously strong, and in fact are the strongest structures in the human spine, if not the whole body. This is not surprising when you look a bit closer at their form and structure. The annulus, which is the fibrous surrounding part of the disc and is effectively its ligament, is composed of immensely strong collagen fibres, which are gathered together into fibrous bundles, which undergo considerable interweaving and “plating” maximising their structural stability and resilience. Then to even further increase strength, the structure is then laminated. As a matter of fact, grotesque studies on cadaver spines, stripped of all the supporting structures, such as ligaments and muscles, have shown to have immense disc strength so that when spines subjected to huge forces and ridiculous trauma (for example forces equal to a 20 storey fall onto concrete) the vertebral bones will break or shatter before the disc will bulge or fail! In other words- the disc is tougher than the backbones.
Illustration 2- The Intervertebral Disc
Another statement which is still a gigantic mistake and something that has been “swept into the realm of normalcy” is: “the disc is a shock absorber.”
The truth, which was a revelation to me in my school days, is in fact:
The disc is NOT a shock absorber. Never has been, never will be. The reality is the disc is simply a bone separator and pivot point which allows spinal movements so that you can swing a golf club, bend forward and back, side-to-side, etc. You might ask: why this is important? It is very important because if you understand that other parts of your body and spine actually absorb the energy of day to day life, you then can realize that it’s vitally important to maintain a strong and healthy framework around your spine. You also will realize (as will be seen in future episodes) that a true disc injury is DEFINITELY NOT SOMETHING YOU EVER WANT TO EXPERIENCE! In reality once a disc is bulging and causing problems, it is very much a difficult condition to deal with. Thankfully, the vast majority of the time back pains, even severe pains, are not disc injuries. But don’t just take my word for it; I reference a superb book by Robert A Dickson, MA, MB, ChM, FRCS, FRCSE, DSc (that’s a lot of letters isn’t it?) who is Professor of Orthopaedic Surgery at the University of Leeds and director of the Yorkshire Regional Complex Spine Treatment Centre, as well as the Director of the University of Leeds Centre for Spinal Research, and W Paul Butt MD, FRCP(C), FRCR (who clearly missed his calling and should have been a proctologist) is a Musculo-skeletal and Spine Radiologist at St James’s University Hospital and Senior clinical lecturer in Orthopaedic Radiology at the University of Leeds. These doctors have worked together for decades and arguably have more experience in real-world spinal surgery than anyone else in the universe. Their text “The Medico-Legal Back: An Illustrated Guide” is fantastic. To quote:
The intervertebral discs are protected by ligaments of enormous strength. The notion that discs can be affected by anything other than, say, a very high-speed road-traffic accident or a fall from a great height is, therefore, quite untenable. The idea that you can “slip” a disc bending or twisting or sneezing is (...) ludicrous.
Where joints have big ranges of movement, the ends of the bone are covered with a thin layer of white shiny cartilage referred to as hyaline cartilage. This can be seen, for example, at the end of a chicken drumstick. Hyaline cartilage is less tough and less strong than another type of cartilage, called fibrocartilage, which is very similar to the structure of a ligament. In the spine fibrocartilage occurs in intervertebral discs, and makes the disc by far the strongest structure in the human spine. [iii]
To further quote regarding the second fallacy of the disc being a “shock absorber”-
Dr James Smeathers has spent much of his professional life studying the biomechanics of discs (…) He wrote a very readable review article nicely entitled Shocking news for discs,[iv] and in the first few paragraphs pointed out that orthopaedic surgeons, amongst others, commonly refer to intervertebral discs as shock absorbers and such statements still appear in orthopaedic textbooks despite the fact that there is not one iota of evidence to support such a notion. He demonstrated that as normal people move about, more than 80% of the load is taken by the legs and only about 16% by the spine, and this is dealt with by the ligaments, muscles and vertebrae, and not by the discs. The discs are, therefore, not shock absorbers, but rather are a part of the spinal joint (mobile link), which in moving allows the ligaments to stretch and absorb the energy.[v]
Until next time, I hope these two facts will shed some light about this amazing part of the human body. More about how it is damaged and the mechanisms of disc degeneration next week in part two of this episode! Most importantly, part three shows you how to protect and improve the health of this important structure.
To Be Continued…
References
i Unger, Jim The Herman Treasury Andrews McMeel Publishing 1988
ii Shelton, H. Human Life: It’s Philosophy and Laws Health Research Publishers 1979
iii Dickson, RA and Butt, WP. The Medico-Legal Back: An Illustrated Guide Cambridge University Press 2004
iv Smeathers JE. Shocking news about disks. Current Orthopaedics 1994,8: 45–48
v Dickson, RA and Butt, WP. The Medico-Legal Back: An Illustrated Guide Cambridge University Press 2004
