Lecture running and disc disease

Running and degenerative disc disease

Upper Chesapeake Medical Center spine Conference

Friday March 3, 2017

Is running detrimental for LBP?

Sagittally oriented safranin-O–stainedsections of an adult human lumbar intervertebraldisk (top) and a degenerated intervertebral disk(bottom). Disk matrix stains purple and collagenblue. In the adult disk, the peripheral annulus fibrosus,containing collagen, stains blue (arrowhead).The inner annulus fibrosus and nucleus pulposus,containing GAGs, stains purple. The central portionof the nucleus pulposus, where reticulin, collagen,and elastin fibers are located, stains faintly blue.The degenerated disk has lost purple-staining GAGsfrom the nucleus pulposus and annulus fibrosus. Itconforms to Pfirrmann grade IIII degeneration.

Loss of GAG in NP

GAG staining

Pfirmann: Spine 2001 Sep 1;26(17):1873-8.

Collagen fibrils 140,000x mag

Collagen: most abundant protein• Table 22-3Major Collagen Molecules

• Type Molecule Composition Structural FeaturesRepresentative Tissues• Fibrillar Collagens• I [α1(I)]2[α2(I)] 300-nm-long fibrilsSkin, tendon, bone, ligaments, dentin,

interstitial tissues• II [α1(II)]3 300-nm-long fibrilsCartilage, vitreous humor• III [α1(III)]3 300-nm-long fibrils; often with type I Skin, muscle, blood vessels• V [α1(V)]3390-nm-long fibrils with globular N-terminal domain; often with type I Similar to type I; also cell

cultures, fetal tissues• Fibril-Associated Collagens• VI [α1(VI)][α2(VI)] Lateral association with type I; periodic globular domains Most interstitial tissues• IX [α1(IX)][α2(IX)][α3(IX)] Lateral association with type II; N-terminal globular domain; bound glycosaminoglycan

Cartilage, vitreous humor;• Sheet-Forming Collagens• IV [α1(IV)]2[α2(IV)]Two-dimensional network All basal laminaes• SOURCE: K. Kuhn, 1987, in R. Mayne and R. Burgeson, eds., Structure and Function of Collagen Types, Academic Press, p. 2;

M. van der Rest and R. Garrone, 1991, FASEB J. 5:2814.

Glycosaminoglycan

PG: Chondroitin Sulfate

PG: Keratan Sulfate

Annulus Fibrosus

Herring

Fine fiber nerve ending staining in a rabbit discThe outer 3mm is innervated

Load with respect to posture of spine

Schmorl Node

Age versus degenerative changes on MRI on ASx patients

1% loss of height during the day ie 6 feet 72” equals ¾ inch

British astronaut Tim Peake in action running the London marathon while strapped to a treadmill at the International Space Station. While the official 2016 London Marathon was being run in London, Peake ran 26.2 miles on a treadmill in three hours 35 minutes 21 seconds, while aboard the apace station in orbit 250km above the Earth

6 NASA astronauts, IVD, L3L4 level, 6 months,4x HNP probability in one year, 2-3 hr day treadmill,Bike, weights, in the past 5 cm height increase, nlHeight variation 1-2 cm

Decreased area by 19%;mostly recovered 68% in 6 weeks

8 young subjects (18-23y male)30 minutes running (70%HR) with MRI pre and postMeasurement of disc volume thoracic and lumbar

6.3% loss of IVD heightsimilar to marathon runners 6.9% loss o IVD volume

17 males (20-27y) and 14 males (50-57y) from Duke or the areaC7 to s2 were measured with a plumb line, skin marked and measure with a special tapeMeasure6 mile paved run at a comfortable pace

Studying the effect of running on the intervertebral disc extracellular matrixQ: can 3 weeks of running stimulate matrix production and cellular proliferationMethods: 12 running rats 12 nonrunning rats, measured cell count, protein expression, apoptosis, proteoglycan expressionResults: 25% increase in cells, collagen 2 strongly expressed in runners, increased proteoglycans.

30 patients chronic LBP, 2 groups, climb routs 10 sessions in 8 weeks, at least one hour a weekClosed chain,

Oswestry Disability Index

Tae Chi

Yoga

Mindfullness basedStress reduction techniques

thanks