What Is A Disc Herniation?(And Other Disc-Related Disorders)
“Do I have a slipped disc?”
This is a very common phrase that we hear in our Chiropractic office. Fortunately, your discs do not ‘slip’ out, nor do they ‘fall out’ or ‘go out of place.’ It is also good to know that disc-related pain is very common. The twenty-three disc’s that are between all but one vertebral joints in your spine have a huge role in supporting your spine and thus the rest of your body. They also are not as scary when injured as they seem. This article’s purpose is to help you understand what exactly discs are, what their role is, what happens when they become injured, how we treat a disc injury and the true danger level of a disc injury.
WHAT ARE DISCS/WHAT DO THEY DO?
First, to understand the disorders of a disc and how the medical community treats them, it is important to have a comprehensive foundation as to what discs are and what they do. Discs also known as intervertebral discs (IVDs) are fibrocartilaginous structures, that for generality, are classified as a ligament. This classification is due to their supporting role in helping to form the central joints of the spine.1 The main functions of a disc are to absorb forces, contribute to the shape of the spine and limit certain directional motions in the spine.2 There are two main physical features of an IVD; the annulus fibrosus and the nucleus pulposus.1 Imagine there is a car tire placed between each of your vertebrae and your annulus fibrosus is the equivalent to the car tire in this instance. The annulus is extremely durable and strong as its function is to bind the vertebral bodies.2 This part of the disc is also the only portion that is innervated, which means there are nerve endings (specifically pain nerves or noiciceptors — if you read the Body Knowledge April 2019 article, you’ll know exactly what that is). This is important to note because this means that the annulus fibrosus is the only portion of the disc that can sense pain when injured. There are also many other nerve endings that exist along the spine in these locations that communicate the position and movement of the spine to the brain. A strong supportive tire is usually filled with air that supports the shape and cushions the tire. In this case, the nucleus pulposus is the air. The nucleus pulposus is a gelatinous material that is contained within the center of the annulus fibrosis. While you lay down, the nucleus pulposus fills with water, increasing the disc’s ability to act as a cushion.2 As you stand and sit the pressure on the spine causes the nucleus to lose water and as you age, the disc becomes more and more dehydrated and fibrotic, losing its ability to act as that cushion. While degeneration is a natural process, it may cause some pain in certain individuals.
WHAT ARE DISC-RELATED DISORDERS/WHAT DO THEY CAUSE?
The two main disc disorders that occur are disc bulges and disc herniations. While there can be discogenic pain (meaning there is irritation of the nerves or minute injuries causing pain coming from the disc) as well as low back pain sourced from neighboring structures and soft tissues, for the purpose of this article the main points of discussion will be on herniations and bulges. A disc bulge is when there are micro-tears occurring in the annulus fibrosus (tire) layers causing a weak section in the fibers.1 This weakness in the annulus allows the gelatinous nucleus to push the annulus outward but it is completely contained. The bulge has the potential to cause pain by pressing on local nerves and nerve roots. The nerve roots are what supply motor and sensory function to the body. Irritation to the local nerves can lead to localized low back pain and it can also cause what is known as a radiculitis.2 Radiculitis can lead to symptoms of pain that that is felt in the arms or legs. Irritation to the nerve roots can cause numbness, tingling and weakness in the arms and legs, this is what is known as radiculopathy. While numbness and tingling are not very severe symptoms and are more easily resolved, weakness is a sign of a more severe injury and requires more immediate intervention. A disc herniation is when the nucleus reaches the edge or periphery of the annulus fibrosus fibers, meaning there is a greater amount of damage or tearing that has occurred to the annulus fibers than in a disc bulge. While a disc herniation is greater damage to the disc itself, the experience of symptoms and pain can be less severe, more severe or equal to another person’s experience with a disc bulge. If there is nerve damage present once the disc is healed properly the nerve itself has the capability to heal as well, albeit at a relatively slower rate. Reducing the inflammation and irritation through treatment will remove the nerve pain and allow the nerves to heal. It is common to experience just arm or leg symptoms since the nerve root that supplies those areas are affected by the disc, this is why it is important to see a spine specialist when you have spine-related pain or extremity symptoms.
HOW DO WE TREAT THEM?
“How do you ‘fix’ a disc problem?” First, it is important to know that every injury and condition is treated on a case-by-case basis. Discogenic pain can be relatively easy to treat. As with many injuries a typical approach for treatment is conservative approaches first and invasive approaches second. Conservative care includes pain reduction by increasing motion and decreasing pressure on the nerve via soft tissue work, manipulation to the spine and nearby structures, and importantly, retraining of the motor patterns in the area to prevent additional injuries.4,6 Surgery is also an option but is often not necessary if conservative care trials are successful. Studies have shown conservative care and surgery for discogenic related injuries have very similar outcomes, the difference lies in cost and surgery requires additional rehab following the operation whereas conservative care includes rehabilitation is part of the treatment initially.3,5
This is where chiropractic and conservative care come in. With extensive training in spinal injuries, soft tissue and adjusting techniques are used as tools to help mitigate pain and allow proper joint mechanics to allow the disc to heal itself. All of this can lead to a decrease in pain and for the nerves to heal if there is nerve damage present. If you are experiencing spinal pain or are concerned if you having disc-related pain, don’t hesitate to seek treatment. Ask us about disc conditions and how to manage it at Evergreen Spine and Sports Medicine.