Bryan Christie

Injury Tip Sheet:  Annular Tears

Learn what you need know to help treat and prevent this source of back pain.

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

• A tear in the annulus fibrosis, the thick outer ring of the disc
• Can sometimes be a precursor to a herniated disc
• Most commonly seen in the lower back
• Can be found incidentally on a MRI and may not cause symptoms

What you need to know

What are annular tears?

• Each vertebral disc is made up of an inner and outer layer.  The annulus fibrosis is the outer later, shaped like a ring around the softer, gel-like nucleus fibrosis center portion of the disc.
• When the annulus fibrosis is injured in any way, small tears or fissures can occur resulting in an annular tear
• Annular tears can progress to a herniated disc if the inner part of the disc, the nucleus pulposis, begins increasing pressure on the outside layers of an annulus.  A herniated disc is the result of the central portion, the nucleus pulposis, pushing through the outer layer.

Signs & symptoms

• The annulus fibrosis has numerous nerve endings, therefore any damage to the outer ring of the vertebral disc may result in lower back pain.

When should I see a doctor or other professional?

• You should see a doctor if you have persistent pain especially if you have pain at night
• If you experience a loss of motor function, bowel or bladder dysfunction, numbness, tingling, burning, or persistent symptoms you should see your physician
• Your doctor may order additional tests and may refer you to a Physical Therapist to address pain, decreased range of motion, and strength deficits

Causes

• Most annular tears are a result of degeneration of the vertebral disc as the body ages
• Tears can occur from single sudden trauma
• Poor postural habits during sitting and being over-weight are contributing factors to low back pain.

Risk factors

• If there are any weaknesses in the outer layer of the disc, the nucleus pulposis is more likely to extend outwards under extreme pressure
• People over 50, especially men
• Sports where the body experiences sudden force, especially with bending and twisting maneuvers, may place athletes at greater risk

What you can do

Prevention

• The key to preventing back injuries is to build stability in the core region and improve lower extremity strength and flexibility.
• Ensure that when you perform heavy lifting you use proper technique
• If you have a history of back injuries, it is important to pay special attention to maintaining strength in the muscles of the core and the lower extremities so as not to re-injure the back

Recommendations for treatment and rehab

• You should work with your physician to develop a comprehensive treatment plan.
• Typical treatment involves anti-inflammatories (if appropriate) to manage the pain and inflammation,, and physical therapy  to return the muscles in the core  to their normal activity as well as to address other muscle strength and flexibility deficits.
• Active rest is used for management of acute pain; however, it is important to maintain a relatively active lifestyle to maintain strength and flexibility
• Use of ice within the first few days of the onset of low back pain will assist in controlling pain and inflammation.  Heat and massage therapy can be incorporated after acute pain decreases especially helpful with stiffness and prior to stretching and activity.

What can I do to stay active?

• Walking as tolerated can be incorporated if it does not increase back or leg pain.
• Gentle pain-free stretching as tolerated.

Related posts:

• Injury Tip Sheet: HNP
• Battle of the Back Injuries
• Injury Tip Sheet: Back Sprains and Strains
• Injury Tip Sheet: Facet Syndrome
• Injury Tip Sheet: Hamstring Strain