If you experience lower back pain while bending over, lifting, or just taking part in day-to-day activities, you may have an annular tear. Annular tears are relatively common, but they have a tendency to go undiagnosed as the degree of pain associated with this condition varies from person to person.
In order to understand what an annular tear is and why it can result in severe back pain, it’s important to review the anatomy of the back. Your vertebra is connected to your disc by a ligament featuring a strong ring of cartilaginous fibers. This ring encircles the nucleus of the disc, protecting its gooey, shock-absorbing center. The substance contained within your disc is designed to experience daily wear and tear, but after years and years of use, it could eventually lead to a ruptured disc and a torn ligament. The resulting tear is referred to as annular tear. If the nucleus of the disc is forced through this tear, it’s called a herniated disc.
An annular tear is a potentially serious condition that may require surgery to prevent severe pain. Keep in mind that the outer annulus fibrosus ring is chock-full of nerves, which means a tear is going to result in substantial pain if these nerves are damaged. Some annular tears heal over time, but they can be reaggravated rather easily and they’re all unique to the person experiencing them. Want to learn more about annular tears? Below, we cover everything you need to know to determine whether or not it’s time to pick up the phone and call Florida Surgery Consultants.
Common Causes of Annular Tears
Annular tears typically develop over time in the lumbar spine or lower back, which means the main cause is simply getting older. That’s right, the older you get, the weaker your body becomes, and the disc in your back takes A LOT of punishment during that time. If you live an active lifestyle or take part in regular heavy weightlifting, especially lifts involving twisting motions, your chance of damaging the annular fibers increases.
Another common cause of annular tears is car crashes and other physically taxing accidents. Excessive body weight can also put additional strain on your vertebrae and discs, which, over time, whittles away at your vertebral discs and annulus fibers. Some other causes include degenerative disc disease (DDD) and bone spurs. Genetics can also play a role in the formation of annular tears as the strength of the collagen in your annulus is a byproduct of your genes.
Types of Annular Tears
There are three types of annular tears: transverse, radial, and concentric.
- Transverse: the outer rim of the disc is a highly sensitive area. Transerve tears extend from here to the nucleus, which means individuals with this type of tear almost always experience significant lower back pain.
- Radial: less painful than transverse tears, radial tears occur along the innermost portion of the annulus. These tears can grow until they hit the rim of the disc.
- Concentric: these tears form in the ring around the nucleus of the disc. They are oftentimes the product of torsional injuries caused by excessive twisting.
Who is at Risk for an Annular Tear?
If you’re a male or female between the ages of 20-60, and you commonly complain about lower back pain, you are a candidate for an annular tear. Remember, this isn’t a rare condition, but the back is complex and symptoms can arise for any number of reasons. Below, we profile three potential annular tear cases.
You will likely notice that these cases have very little to do with one another besides the fact that the individual is suffering from lower back pain. This is important to keep in mind as we proceed, and if you decide that it’s time to consult a doctor, you’ll want to ensure that you spare no detail in explaining the pain you’ve been experiencing.
Bobby Biceps, Age 27
Bobby is an avid lifter who likes to be the first one in the gym each morning. He proudly proclaims that “it’s chest day” every single day and aims to be a professional bodybuilder in the future. Bobby is young, spry, and energetic, but he’s been neglecting his lower back pain to keep up with his intense workout regimen. Sometimes, his back goes out for no reason at all, and he’s unable to complete his workouts. After dealing with the pain for months on end, he consults a doctor and discovers that he has an annular tear.
Frida Fenderbender, Age 39
Frida is a health-conscious mother of two who works from home, cooks six nights a week, and takes yoga and pilates classes. One day on her way to pick up the kids from soccer practice, another driver ignores a stop sign and crashes into Frida’s car. Soon after, she starts to experience pain when sitting and, as a result, driving becomes nearly unbearable. Frida never experienced pain like this before in her life. Upon visiting her doctor, she is shocked to discover that she has an annular tear.
Gustav Gray, Age 60
Gustav has worked his whole life. After leaving the trenches, he spent most of his life in the construction industry. His thirty years of labor eventually resulted in his current role as a contractor, but he finds himself in and out of the doctor’s office constantly for his recurring back pain. The MRIs look normal, and none of the treatments or medications that have been offered to Gustav have helped. Eventually, he visits Florida Surgery Center and discovers that he has an annular tear.
Three people of varying ages, genders, and lifestyles can all have annular tears given the right circumstances. The types of pain they experience and the treatment they must use to recover will also differ. If you experience frequent lower back pain, pay attention to what your body is telling you and take note of how often and where it occurs.
Types of Pain
Back pain can make taking on rudimentary activities a complete chore. It can be hard to sustain activity for more than a few minutes before lying down to take a rest. In fact, some individuals suffering from annular tears are bedridden by the pain.The pain that accompanies an annular tear can vary, but it typically falls into one of the following categories:
- Lower back pain that starts bad and gets worse during exercise, stretching, etc.
- The back goes out suddenly after months without issue, leaving one sidelined for days or weeks.
- Sitting upright for extended periods of time causes agonizing pain.
- Groin or testicular pain.
- Pain that persists after taking pain pills.
- Sporadic pain, numbness, or burning in the feet, legs, or buttocks.
- An individual could experience no pain at all if the annular tear is minor.
But what actually causes the pain from an annular tear? There are three main reasons: mechanical, chemical and immunogenic. Mechanic pain occurs from the disc fragments that enter the annular tear. Chemical pain is related to the inflammation caused by degenerating disc fragments in the annular tear. They release cytokines and TNA alpha, two chemicals that cause nerve sensitivity in the legs, feet, and buttocks. Finally, immunogenic pain is caused by the chemicals released as the result of an immune response to the disc fragments that shouldn’t be in the annular tear.
Non-Surgical Treatment Options
If you want to avoid surgery, you need to be prepared to give your body between 18 months and two years to heal. This is due to the fact that the annulus fibrosus has a restricted blood supply that slows healing. You can also be prescribed anti-inflammatory medication to help reduce pressure. Steroid injections can be used to help ease the pain of an annular tear. Other non-surgical treatments include chiropractic treatments, spinal traction therapy, and physical therapy.
One drawbacks to non-surgical treatment is that this injury can be reaggravated quite easily. You may need to adjust your lifestyle to reduce the chance of re-injuring yourself; even a small slip-up could undo all of your progress.
Surgery for an Annular Tear
When conservative treatments don’t prove effective, it may be time to consider surgery. A surgeon can use a laser to seal off the annular tear. This not only helps reduce the pain of the tear, it prevents the condition from growing worse or resulting in a herniated disc. An endoscopic discectomy can also be used to treat an annular tear. This minimally invasive procedure can help remove disc fragments from an annular tear — no bone or muscle removal necessary. Individuals with severe annular tears may need a disc replacement or spinal fusion surgery to replace the damaged disc.
Preventing Annular Tears
Annular tears will form over time as you get older, but you can modify your lifestyle to help slow down the degeneration of the annulus fibrosus through healthy dieting, moderate activity, and checking in with your physician regularly to monitor any lower back pain you start to experience. If you are already suffering from an annular tear, you can improve your condition and prevent future annular tears through surgery.
Conclusion
If you’re experiencing lower back pain that hinders your lifestyle, reduces your ability to be active, or affects your happiness, don’t suffer in silence. You could be one minimally invasive treatment away from experiencing the best of what life has to offer.
Still not sure if your back pain requires surgery? It never hurts to call the professionals at the Florida Surgery Center for assistance. An annular tear could be the thing stopping you from enjoying family dinners, bicycle rides with loved ones, and trips to places you’ve always dreamed of visiting.
