Scientific literature shows that the intervertebral disc is the biggest source of back problems. Due to improper use of the spine, material from within the core of the disc may leak into the surrounding tissue of the disc, known as the annulus (annular ligament).

Surprisingly, this leaking process may initially take place without it being noticed and without damaging the fibers in the annulus. These ‘micro-leakages’ do however cause extra pressure in the fibers adjacent to the site of leakage. Under normal circumstances the pressure in these fibers is equal, allowing the disc to absorb weight evenly. If however the pressure in some fibers is increased, this section of the ligament is at risk of tearing when the spine is being stressed by weight or movement.

The fibers of the annulus consist of collagen, just like the other ligaments of the body. When it tears, one will have the same experience as with e.g. a torn ligament of the ankle: instant pain, stiffness, and not being able to use in a normal fashion. Micro-leakages are not visible on X-ray or MRI (in 2019). Even small tears of the ligament are often invisible. This is the reason why in the vast majority of cases no proper diagnose is made. This does of course not mean that there is no cause.

In this book the relation between acute lumbago, hernia, sciatica and chronic back pain is explained. In addition it outlines the best strategy for treatment, including possible (endoscopic) surgical interventions.

Special attention is given to prevent recurrences, which occur in 50% of the cases within the first year. Reversing the micro-leakages by means of specifice exercises play an important role.

A new test, the Ipel Test, is described and explained in Appendix VII. With this test the presence of micro-leakages may be diagnosed. It also provides guidance in how to reverse these leakages and thus reduce, if not eliminate, pain.

Menno Iprenburg
Jan Willem Elkhuizen