AOPA Pilot Magazine - April 2011 - 36

FLYWELL

BY DR. JONATHAN SACKIER

A broken record

outh have no idea what a vinyl record is, so “sounding like a broken record” means nothing to them. Spinning those discs with friends—

the culprit— sciatica means pain experienced from sciatic nerve irritation. Disc rupture affecting nerves can produce muscle weakness; low back discs can cause problems with gait, bladder, and bowel function—warning signs. Back problems usually resolve with rest, heat, muscle relaxants, and anti-inflammatory drugs (ibuprofen). Some swear by acupuncture, yoga, and a firm mattress. If you experience no improvement, worsening symptoms, or referred pain, see your happy memories, but broken discs? Mine came doctor. Examination may reveal impact on natural coaching kids’ soccer. In my mind the maneuspinal curvature—pronounced bulging backward Jonathan Sackier is a surgeon and ver worked perfectly: Drag back, turn, and the or forward and tilting away from the affected side private pilot living ball would be on my left foot. Reality differed: an because of muscular spasm. Unending pain lastin Virginia. ing more than a few weeks, inability to raise one unpleasant sound from behind and blinding pain leg beyond a certain angle, or signs suggesting shooting down my leg. I had just joined 80 percent of folk suffering back pain—in my case, acute disc nerve impingement may inspire your physician to prolapse. Back pain takes many forms with numerous causes. order an MRI, which shows bony and soft tissues. In longstandFor this column it’s broken discs. ing cases an electromyogram is used to detect nerve-muscle Everyone knows what a disc brake is, but the term “slipped impulses. With failure of the above therapy, a steroid injection disc” may cause many to have inaccurate notions of what the may prove beneficial. This may not help you win the Tour de discs in our back look like. The spine consists of bones, nerves, France, but may get you through your day without pain. discs, muscles, and ligaments. The 33 vertebral bones include Chronic sufferers may be helped by TENS—transcutaneseven cervical (neck), 12 thoracic (chest), five lumbar (low ous electrical nerve stimulation, or tiny electric shocks that back), five fused sacral (pelvis), and four fused in the coccyx or interfere with pain pathways. Sometimes surgery becomes “tailbone.” The spine should be in a straight line north-south necessary, certainly with obvious nerve damage and functional with two forward curves (lordoses) and two backward curves loss. Procedures involve removing impinging disc material (kyphoses). Central vertebral holes accommodate the spinal (discectomy), enlargement of space for nerves to exit the canal cord; little windows (foramina) allow nerves to pass to arms, (laminectomy), and, occasionally, fusing vertebrae together. legs, and so on. Strong muscles surround the spine, and fibrous Operations are performed via conventional back incisions or ligaments hold bones together. Between vertebrae (other than under microscopic guidance (microdiscectomy) purportedly the skull and the first vertebra) sits a disc allowing movement, limiting surgical trauma, although recovery times are similar. providing shock absorption, and preventing bone-on-bone Techniques to destroy errant disc material or treat nerves with friction. The disc has a tough outer shell (anulus fibrosus) and injected chemicals or energy sources via needles remain of jelly-like interior (nucleus pulposus). Think jelly donut, only less uncertain value. After removing a diseased disc surgeons may tasty. Pressure on one area of the anulus squishes the interior fuse vertebrae to prevent instability and vertebrae rubbing nucleus, distributing stress. Discs are named by the vertebrae together. Artificial discs have been introduced but have yet to they separate, so that between last lumbar and first sacral ver- become commonplace. tebrae is L5/S1—one of those most commonly injured. One is at higher risk of back problems if overweight. Think Sudden movement or uneven force (as in my Bend It Like about it: Exceed the maximum gross aircraft weight and probBeckham move) can tear muscle fibers or ligaments, or cause an lems may ensue—and the same goes for your back. Inactivity anular bulge or rip and nucleus jelly to escape. A munched-on and poor technique when lifting heavy weights also put one at donut can ruin your shirt with dribbling jam. A breached disc risk. Regular exercise, especially core-strengthening exercises can also ruin your day, its jelly pressing on nerves in canal or such as Pilates, helps prevent problems. As nasty as disc problems can be, back pain can be a warnforamina. It is not just physical pressure of nucleus on nerve, but also chemical irritation. Understanding this mechanism ing sign of other, more serious diseases such as osteoporosis, enables comprehension of symptoms experienced. various cancers, and abdominal aortic aneurysm. Other than sudden intense pain, one might suffer limitation So enjoy old records and avoid broken discs. Take care lifting of movement and inability to stand straight; a few whiskeys can the tool box or clambering under the wing, watch your weight, have the same effect. Additionally—especially if the nerves are and keep your nucleus inside its anulus! affected by disc damage—constant, “referred” nagging pain might be felt elsewhere, such as the hip and knee when L5/S1 is E-mail the author at jonathan.sackier@aopa.org. 36 • APRIL 2011

AOPA PILOT •

AOPA Pilot Magazine - April 2011

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