![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/02\/Jelly-donut-3-300x204.jpg?resize=300%2C204\")
By user: debivort<\/a> (Own work) or CC-BY-SA-3.0 via Wikimedia Commons<\/a><\/p><\/div>\n The Jelly (or jam) Donut Theory suggests that your intervertebral discs behave like jelly donuts. If you flex forward you can squirt (bulge) the “jelly” (nucleus pulposus) out the back of your disc (annulus fibrosus) in disc related injuries. This is the logic used to explain why you shouldn’t flex your spine too much \u2013 that flexion pain is most likely disc pain, and extension pain is most likely of facet origin.<\/p>\n Emma Maaranen wrote this detailed description of The Jelly Donut Theory<\/a> for Focus Bodywork in 2013.<\/p>\n Well, it looks like The Jelly Donut (Theory) might actually be less full of jelly and more full of BS (excrementi bovinus<\/em>*).<\/p>\n A review of 4 studies on the behaviour of our \u201cjelly donuts\u201d (intervertebral discs) show that old understandings of disc behaviour are basically wrong. Why?<\/p>\n 1. Until very recently we couldn’t even see intervertebral discs on imaging (MRI became more common in the 1990s). Most of the theories around disc bulges were created even earlier than the 1960s.<\/p>\n 2. The concept of \u201cjelly\u201d is a very poor analogy for the nucleus pulposus, because:<\/p>\n … adopting different postures deforms the nucleus pulposus and therefore, changes the position of the nucleus pulposus but there is no apparent nucleus pulposus migration within the intervertebral disc.<\/em><\/p>\n Nazari et al 2012<\/a><\/p>\n<\/blockquote>\n In other words, the \u201cjelly\u201d changes shape when you move, but it doesn’t move forward or backwards within the disc.<\/p>\n 3. One (thesis) study did show \u201cmovement\u201d of the nucleus pulposus (but read point 4 to understand why it\u2019s not really moving).<\/p>\n … between group comparisons identified that the asymptomatic subjects also demonstrated significantly greater posterior sagittal plane NP (nucleus pulposus) migration than the DLBP (discogenic lower back pain) subjects. <\/em><\/p><\/blockquote>\n In other words, the jelly “moved” in healthy, pain-free spines, but barely moved in the painful spines. So the idea the \u201cjelly\u201d squirts out in painful backs is unlikely. Alexander, L 2014<\/a><\/p>\n 4. With spinal movements it\u2019s not actually the nucleus pulposus that moves but more the disc itself \u2013 the annulus fibrosus (the pastry of the donut). A much more thorough investigation of disc movement showed during extension:<\/p>\n NP (nucleus pulposus) margins remained unchanged relative to the vertebral body but moved anteriorly with respect to the IVD (Inter Vertebral Disc)<\/em><\/p>\n Kim et al 2017.<\/a><\/p>\n<\/blockquote>\n So it\u2019s more the case the donut moves around the jelly, at least in healthy spines.<\/p>\n 5. It\u2019s very possible that the discs themselves actually bulge anteriorly in flexion and posteriorly in extension.<\/p>\n Anterior and posterior IVD margins moved posteriorly with respect to the vertebral body in extension. <\/em><\/p>\n Kim et al 2017<\/a><\/p>\n<\/blockquote>\n 6. The final word actually goes way back to 2000 and this summary of intervertebral disc findings by Edmonston et al (2000):<\/a><\/p>\n Lumbar spine position was found to be associated with small measured changes in anterior disc height and nucleus position, however, this response was variable within and between individuals. The theoretical concept of a stereotypical effect of spinal position on the lumbar IVD is challenged by these initial data. Since the health of the disc is often unknown in clinical practice, manual therapy treatment for lumbar spine pain should be based on the symptomatic response to movement and position rather than biomechanical theory<\/strong>.<\/em><\/p><\/blockquote>\n Discogenic back pain is very real but before you start talking about discs as the cause of your clients\u2019\/patients\u2019 back pain, please keep in mind that:<\/p>\n Most low back pain is non-specific (commonly cited as 90%) \u2026 In the previously mentioned Australian study (1172 patients with acute low back pain in primary care), fewer than 1% had specific causes for their pain.<\/em><\/p>\n Maher et al. published in the Lancet, 2017.<\/a><\/p>\n<\/blockquote>\n Be careful when making assumptions around the drivers of pain, especially when it comes to discs and backs. At one time, discogenic pain was the hot new topic in back pain care, and we can still see the echoes of that today. Literature around backs and discs are everywhere, hence why the term \u201cslipped a disc\u201d is a household term (psst … you cannot \u201cslip\u201d a disc). But please understand concepts such as The Jelly Donut Theory were developed before we had the capacity to be able to see inside human bodies while they are moving, at least without some level of torture involved.<\/p>\n Instead, it is much more statistically correct to assume a client\u2019s spine is healthy and functional but they are obviously in pain, and so you need to treat each person with a clean slate and not jump to conclusions.<\/p>\n Listen and let the client tell their story. Then you are helping in a way that is specific to them.<\/p>\n Okay, so who\u2019s up for coffee and a jelly donut?<\/p>\n *Editor\u2019s note: I failed Latin.<\/p>\n Maher et al, 2017 Non-specific Low Back, <\/em>Lancet Vol 389 No. 10070 pp 736-747<\/p>\n Nazari, J. et al 2012 Reality about migration of the nucleus pulposus within the intervertebral disc with changing postures <\/em>Clinical Biomechanics Vol 27 No 3 pp 213-217<\/p>\n Alexander, L. A., 2014. The effect of position on the lumbar intervertebral disc<\/em>. Available from: http:\/\/openair.rgu.ac.uk<\/a><\/p>\n Kim, Y.H., et al 2017 Effects of Cervical Extension on Deformation of Intervertebral Disk and Migration of Nucleus Pulposus <\/em>PM&R Vol 9 No.4 pp 429-338<\/p>\n Edmonston, S.J., 2000 MRI evaluation of lumbar spine flexion and extension in asymptomatic individuals <\/em><\/p>\n Manual Therapy Vol 5 No.3 pp 158-164<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" The Jelly Donut Theory has been used to explain how our intervertebral discs move and cause pain. Aran Bright challenges this theory with recent research and common sense.<\/p>\n","protected":false},"author":1,"featured_media":558,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[30,20],"tags":[17,12,171,169,170,168],"class_list":["post-557","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-massage","category-research","tag-aran-bright","tag-back-pain","tag-disc-bulge","tag-discogenic-pain","tag-intervertebral-disc","tag-jelly-donut-theory"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/02\/Jam-donuts1.jpg?fit=1280%2C960&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":1577,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/04\/10\/why-placebo-is-lit\/","url_meta":{"origin":557,"position":0},"title":"Why Placebo is Lit","author":"admin","date":"10\/04\/2019","format":false,"excerpt":"Myotherapist and educator, Aran Bright shares why he believes that massage therapists should be embracing the power of placebo.","rel":"","context":"In "Clinical Practice"","block_context":{"text":"Clinical Practice","link":"https:\/\/blog.amt.org.au\/index.php\/category\/clinical-practice\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/closed-door-791954_1920.jpg?fit=1200%2C794&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/closed-door-791954_1920.jpg?fit=1200%2C794&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/closed-door-791954_1920.jpg?fit=1200%2C794&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/closed-door-791954_1920.jpg?fit=1200%2C794&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/04\/closed-door-791954_1920.jpg?fit=1200%2C794&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":1411,"url":"https:\/\/blog.amt.org.au\/index.php\/2019\/02\/20\/does-poor-function-always-cause-pain\/","url_meta":{"origin":557,"position":1},"title":"Does Poor Function Always Cause Pain?","author":"admin","date":"20\/02\/2019","format":false,"excerpt":"Is it time to stop the assumption that changes in function are the cause of pain? Myotherapist and educator, Aran Bright thinks it is.","rel":"","context":"In "Clinical Practice"","block_context":{"text":"Clinical Practice","link":"https:\/\/blog.amt.org.au\/index.php\/category\/clinical-practice\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/02\/gears-1666494_1920.jpg?fit=1200%2C800&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/02\/gears-1666494_1920.jpg?fit=1200%2C800&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/02\/gears-1666494_1920.jpg?fit=1200%2C800&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/02\/gears-1666494_1920.jpg?fit=1200%2C800&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2019\/02\/gears-1666494_1920.jpg?fit=1200%2C800&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":2615,"url":"https:\/\/blog.amt.org.au\/index.php\/2020\/05\/20\/a-portrait-of-the-artist-as-a-therapist\/","url_meta":{"origin":557,"position":2},"title":"A Portrait of the Artist as a … Therapist?","author":"admin","date":"20\/05\/2020","format":false,"excerpt":"How do we get our best results and communicate effectively with our colleagues and clients? Art of course, as Aran Bright explains.","rel":"","context":"In "Professional Practice"","block_context":{"text":"Professional Practice","link":"https:\/\/blog.amt.org.au\/index.php\/category\/professional-practice\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/05\/painting-808011_640.jpg?fit=640%2C495&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/05\/painting-808011_640.jpg?fit=640%2C495&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2020\/05\/painting-808011_640.jpg?fit=640%2C495&ssl=1&resize=525%2C300 1.5x"},"classes":[]},{"id":807,"url":"https:\/\/blog.amt.org.au\/index.php\/2018\/05\/30\/trigger-points-myofascial-pathology-or-a-fight-starter\/","url_meta":{"origin":557,"position":3},"title":"Trigger Points – Myofascial Pathology or a Fight Starter?","author":"admin","date":"30\/05\/2018","format":false,"excerpt":"Start a discussion on trigger points and heated debate ensues. Ever the peacemaker, Aran Bright takes us through each side of the argument so that massage therapists can decide for themselves.","rel":"","context":"In "AMT"","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/05\/Aran7.png?fit=1200%2C636&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/05\/Aran7.png?fit=1200%2C636&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/05\/Aran7.png?fit=1200%2C636&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/05\/Aran7.png?fit=1200%2C636&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/05\/Aran7.png?fit=1200%2C636&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":446,"url":"https:\/\/blog.amt.org.au\/index.php\/2017\/12\/27\/is-pain-science-just-a-pain-in-the-gluteus-maximus\/","url_meta":{"origin":557,"position":4},"title":"Is Pain Science Just a Pain in the Gluteus Maximus?","author":"admin","date":"27\/12\/2017","format":false,"excerpt":"By Aran Bright (This article originally appeared in the June 2017 AMT Journal 'In Good Hands'.) It is all about helping people, not just science If you are reading this, there is a very good chance that you are one of Australia\u2019s professional, dedicated massage therapists. You\u2019ve spent days, weeks,\u2026","rel":"","context":"In "AMT"","block_context":{"text":"AMT","link":"https:\/\/blog.amt.org.au\/index.php\/category\/amt\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/12\/Pain-Sparkle.jpg?fit=1200%2C675&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/12\/Pain-Sparkle.jpg?fit=1200%2C675&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/12\/Pain-Sparkle.jpg?fit=1200%2C675&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/12\/Pain-Sparkle.jpg?fit=1200%2C675&ssl=1&resize=700%2C400 2x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/12\/Pain-Sparkle.jpg?fit=1200%2C675&ssl=1&resize=1050%2C600 3x"},"classes":[]},{"id":156,"url":"https:\/\/blog.amt.org.au\/index.php\/2017\/10\/04\/what-is-interoception-and-why-does-it-matter\/","url_meta":{"origin":557,"position":5},"title":"What is interoception (and why does it matter)?","author":"admin","date":"04\/10\/2017","format":false,"excerpt":"Massage Therapist and Educator, Aran Bright introduces the concept of interoception ahead of the one-day workshop he is co-presenting at the AMT Mini Conference 2017.","rel":"","context":"In "News and events"","block_context":{"text":"News and events","link":"https:\/\/blog.amt.org.au\/index.php\/category\/news-and-events\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/09\/amt-conf-2016_1.jpg?fit=1024%2C683&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/09\/amt-conf-2016_1.jpg?fit=1024%2C683&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/09\/amt-conf-2016_1.jpg?fit=1024%2C683&ssl=1&resize=525%2C300 1.5x, https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/09\/amt-conf-2016_1.jpg?fit=1024%2C683&ssl=1&resize=700%2C400 2x"},"classes":[]}],"_links":{"self":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/557","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/comments?post=557"}],"version-history":[{"count":4,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/557\/revisions"}],"predecessor-version":[{"id":566,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/posts\/557\/revisions\/566"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/media\/558"}],"wp:attachment":[{"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/media?parent=557"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/categories?post=557"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.amt.org.au\/index.php\/wp-json\/wp\/v2\/tags?post=557"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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<\/p>\n![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2018\/02\/jelly-donut-5-300x200.jpg?resize=300%2C200\")
<\/p>\nTake Home Message<\/strong><\/h6>\n
References<\/strong><\/h6>\n
About the Author<\/strong><\/h6>\n
![\"\"](\"https:\/\/i0.wp.com\/blog.amt.org.au\/wp-content\/uploads\/2017\/12\/Aran-150x150.jpg?resize=150%2C150\")
Aran Bright started his career as a massage therapist in 2002 after graduating from the Australian College of Natural Medicine in Queensland. In 2006, Aran completed his Diploma of Remedial Massage and, in 2007, his Bachelor of Health Science in Musculoskeletal Therapy. Aran graduated from University of Queensland with a Graduate Certificate of Sports Coaching, completed a Certificate IV in Fitness and an Advanced Diploma of Myotherapy. He currently runs his own businesses, Bright Health Training<\/a> and Brisbane Workplace Massage<\/a>, with his wife, Sheree.<\/p>\n