Physiotherapists in Bristol treat many different conditions including the issues profiled below.

Intervertebral Discs and Ageing

Ageing starts early in the discs and proceeds through life. Initially a loss of proteoglycan occurs, and as these chemicals attract and hold water into the centre of the discs, a degree of loss of hydration steadily occurs. The collagenous tissues lose some of their suppleness and resistance, becoming more brittle and more likely to suffer injury. As the discs have no central blood supply and rely on nutrition and oxygen diffusing in, a limitation of this process will accelerate the degenerative process going on in the disc centres. The tops and bottoms of the vertebrae, the endplates, are cartilage but can become calcified, further reducing supplies to the nucleus inside.

The outer part of the disc, the annulus, has layers of collagen material and these thicken and can develop defects. Overall the central disc material becomes drier, fibrosed and stiffer with a smaller volume as it loses water, throwing compressive forces onto the back of the disc annulus. The annulus becomes both stiffer and weaker with age, the increased stiffness perhaps offset by the increase in defects in the disc wall with time. Studies of discs have shown that they do not generally decrease in height with age.

Whiplash Syndrome

Whiplash syndrome is typically the result of low velocity car crashes. Usually affecting the neck, whiplash can also affect the lumbar spine as it is almost fully flexed in sitting, allowing the spine to be over flexed by even a small further movement. Most tissues in the neck can be injured in a rear shunt collision but the evidence points to facet joint injury as being the most likely cause of chronic pain and disability. Any warning about the impact can result in the individual tightening up the stabilising muscles around the spine but also increases the forces compressing the spine at the same time. This could allow the discs and vertebrae themselves to be damaged in a compressive injury.

If there is no warning of the accident then there will be no protective muscle contractions to prevent spinal injury, with the posterior ligaments taking stress as the head is bent forward and the posterior bony elements impinging as the head is bent back. The exact position of the head at the moment of impact is also important as if it is rotated then the structures can suffer a rotational injury which could involve the facet joints.