Many spinal complaints are diurnal.

Diurnal Cycle - 1That is, most of the time there are symptoms of pain related to the day-night, or diurnal cycle. Very often patients will have pain in the morning after the spinal discs have swelled up during the night while lying down. This is required to recover  the significant compressive loads while upright during the day as the discs lose up to 16% of their volumetric fluid and need to re-imbibe (drink) that loss to prepare for the next day.

In 2009, I published a debate paper on a topic that is dear to my heart in the Journal  I believe there are so many more hydraulic mechanisms to learn in the spine as it relates to gravity. In a paper published titled, “The influence of gravity on REM sleep“, these researchers reviewed the volume of literature on REM sleep and mammal mass and came to the same conclusions as I did…..REM sleep is different in aquatic and land mammals and is also related to weight. It is also not a fluke (ha ha) that I have a whale spine hanging in my treatment room.

Sleep and SpineIt was with great excitement to see another researcher write about this topic. And more importantly, It reveals the reasons why we need sleep. I believe it also eludes to how we need to pay closer attention to cartilage, the dynamic tissue of the spine.

With degenerated discs or discs that have small tears in them, the influx of water into them will bother these cracks as the load of the human body squeezes the new fluid though them, like a wedge, and aggravates the little nerves that innervated the annulus. A common symptom of this is morning stiffness. Recently, I developed a spine model with a surgeon and you can see it here. If you watch the video you can see the interposed disc herniation with the granulation tissue. This is often the source of the pain when it hurts to put on your socks first thing in the morning, for example. But don’t worry, it doesn’t mean you need surgery as there are several treatment and exercise strategies to lessen this.

We have known that the spine can lose up to 17mm of height over the course of the day but what do we know about other cartilagenous joints like the knee, for example? In a recent article in the Journal of Biomechanics, researchers found that that the knee behaves similar to the discs in the spine. According to this research, it makes sense to do your exercise involving your knees ( like walking or running ) in the first half of the day when the cartilage is at its fullest volumetric strength.

 

Diurnal variations of cartilage are an important clinical concept that I believe we know more about now that can help patients of cartilage damaged pain. Whether you are walking Westwood Lake in Nanaimo, or taking a stroll on Neck Point Park in Nanaimo, be mindful of diurnal variations for getting the maximum exercise benefit. Offloading is becoming the new regenerative science for spine.