Can an annular disc tear heal itself?

Yes! An annular tear can heal over time. It “heals” by forming scar tissue over the torn area, similar to how your skin heals after a cut. However, once there is a tear the disc is at increased risk for another tear in the same area as the fibers have now lost their integrity and that area is weaker.

If I experienced one annular disc tear am I prone to additional tears?

Once you have had an annular tear you are at higher risk for having another intervertebral disc tear. This can occur again at the same location or in a completely different area. Studies have also shown that after an annular tear there is faster degeneration of your discs, vertebral body end plates and/or facet joints.

How do I prevent an annular disc tear?

The best way to prevent an annular tear from happening is by maintaining a strong core to help stabilize your spine. A healthy well balanced diet is also important for your spinal health. When your spine is stable and healthy, there’s less pressure on the discs causing it to break down and tear.

Annular Disc Tear

Understanding the Symptoms, Causes and Treatments

Understanding an Annular Disc Tear

An intervertebral disc is the shock absorber of our spine. Each disc is located between two vertebral bodies. These discs are made of a strong outer ligamentous ring called the annulus fibrosus and an inner jelly-like section called the nucleus pulposus. The annulus fibrosus and nucleus pulposus work together to evenly distribute pressure across the disc. An annular disc tear is a tear in the outer ligamentous ring. This ligament is composed of strong fibers which are highly innervated with pain receptors so when a tear does occur it can cause significant symptoms.

As the discs act as shock absorbers between the vertebrae, whenever there is a high impact activity, trauma, or exertional/straining movements this added pressure wears on the disc. With increased pressure the discs will start to break down, lose hydration and flexibility contributing to cracks and tears. Tears in the outer ring of the disc, the annulus fibrosus, can cause mild to severe pain depending on where the tear is located. Although annular tears can occur throughout the spine they are more common in the neck and low back as these are more mobile than the thoracic spine. The pain results from tearing of the ligamentous fibers, leading to inflammation which may aggravate surrounding neural structures.

As an example, imagine an intervertebral disc as a jelly filled donut. There is a jelly center, outer bread lining. Imagine squeezing a jelly filled donut very slightly. The jelly will start to seep through the pores of the bread but not expel outside of the donut completely. This is similar to an annular tear as explained above, the integrity is disrupted but the contents of the disc are still held inside the annulus.

Common Causes

Annular tears of the intervertebral disc can occur due to a many causes. Commonly they do occur as our discs naturally degenerate with age. When this occurs, the discs lose hydration and flexibility and therefore are at increased risk for tearing. Other factors contributing to annular tears include certain occupations or high impact activities putting intervertebral discs under added pressure.

Think of the disc as a rubber band, when new the rubber band stretches and then is able to return to normal. But with time, or more vigorous use or stretching it will start to crack and tear.

Here are a few examples of what can cause annular disc tears:

Natural degeneration of the spine occurs with age
- When this occurs, the discs lose hydration and flexibility and therefore are at increased risk for tearing.
Certain occupations or high impact activities cause added pressure to the intervertebral discs
- Repetitive lifting of heavy objects
- Running heavy machinery
- Consistent manual labor
High impact trauma
- Car accidents
- Whiplash injury
- Falls

Symptoms

Most annular disc tears can cause pain ranging from mild to severe. The degree of pain often is directly related to the location and size of the tear.

Symptoms associated with an annular tear typically include:

Pain and muscle spasm in the neck, mid or low back that can be described as sharp, dull, or aching.
Radiating pain or spasm in the arms or legs
Pain that increases with physical activity, sitting, or other positions that load pressure on the disc.
Pain that increases with coughing, sneezing, bending forward, or lifting.
Stiffness in muscles of the neck, mid back or low back.
Tenderness around the area of pain

Diagnosing Annular Disc Tear

Patients undergo a thorough medical history and comprehensive exam to evaluate their pain and symptoms. In addition x-ray imaging is used to evaluate a patients spinal anatomy and look for any underlying abnormalities. The imaging study of choice to evaluate for an annular tear is magnetic resonance imaging (MRI). This study evaluates the soft tissue structures. However there are some situations where tears are not visible on an MRI which is why the history and physical is so vital.

Treatment Options

Most annular tears improve and heal over time with rest, spine-specialized physical therapy, and over the counter anti-inflammatories. In some situations symptoms may warrant prescription strength anti-inflammatories or possible pain or muscle relaxant medication.

Spine-Specialized Physical Therapy →