Disc Injury

There is a disc between each vertebral bone in the spine. Basically, the disc is a shock absorber. It is very much like one of those gel inserts you put in your shoe. The outside consists of rings of rubbery material (the annulus) and the inside is a gelatinous liquid (the nucleus). The design provides for mobility and shock absorption that reduces stress to the spine. However, if enough stress occurs to the disc, it can start to cause damage and disc injury.

 

Signs & Symptoms

Disc injury typically presents as localized sharp pain in the spine that can spread to other areas. The low back is the most common location for disc injury. Patients often experience an inability to stand up straight forcing the classic forward bent position with a side-to-side waddle. The motion of the spine is often painfully restricted. You may notice spasm or shifting/leaning to your spine. In more severe cases you may have to place your hands on furniture or walls to walk around. There is typically sharp pain upon coughing or sneezing that can send you straight to your knees. If a nerve is being pinched by the disc it can result in pain shooting down one or both legs, or even cause numbness or weakness in the legs/feet.

 

Causes

Mechanical Disc Injury is Typically Repetitive

Injury to the vertebral discs typically occurs with improper lifting or bending habits. Often, this is a slow process over time until there is a particular incident that leads you to believe it was a single event instead of a long time coming. Disc injury usually starts with a tear. If the tear is bad enough, the nucleus begins to migrate from the center position into the tear which causes an abnormal shape of the disc. This abnormal shape interferes with the movement and position of the spine.

When the shape of the disc is distorted, but the nucleus has not yet migrated outside of the confines of the disc, we call it a “disc bulge”. This problem can continue to worsen. The disc injury becomes a herniation at the point where the nucleus travels past the outermost layer of the disc. There are a variety of other terms used to describe differing shapes and phenomenon that can occur with herniations including: protrusions, prolapses, and sequestrations, but we won’t get into those here. The take-home point is that disc injury over time will create these disc bulges and herniations that result in a change in shape and position of the disc material. In and of itself, this is painful enough, but there is an even more significant problem that can occur. It can lead to compression of the nerves in the spine!

Disc Injury Can Cause Pinched Nerves

The nerves of the spine go from the brain and descend inside the spine as the spinal cord. From there, they exit out of the sides of the spine as nerve roots. The nerves carry messages to and from the brain: like sensation, pain, and signals to move the muscles. If a disc herniation is compressing these nerves, it interferes with the signal. This can create pain, numbness, tingling, spasm or weakness in your legs. This is when you can start to get sciatica.

Disc herniations can compress nerves of the spine in two main ways: nerve root compression, and central cord compression. The herniation can poke out to the side contacting the nerve root, or it can herniate centrally putting pressure on the cord. Pressure on the cord is by far the worst case scenario. This can even be life threatening if it occurs in the wrong place. It could also cause paralysis, loss of bowl or bladder control, and a variety of other terrible issues. Luckily, these dire situations are rare.

Disc Injury Can Lead to Degeneration

As the process of disc injury continues, the disc begins to whither and desiccate causing loss of disc space. This creates another situation that we call degenerative disc disease (DDD), which can also lead to narrowing of the space that the nerve needs to exit the spine. If this space is narrowed to the point that it compresses the nerve, we call this stenosis, and it can cause the same sort of nerve problems as a herniation.

 

Treatment

So, what can a Chiropractor do to help you with your disc injury? A Chiropractor’s job (first and foremost) is to identify which type of disc issue is occurring, and determine whether physical treatment is safe or if you will need surgery. If it’s safe, then we can correct the position of your spine with a variety of different treatments. This will take the stress off of the disc and stop the process of the disc degeneration from continuing.

Once the position is corrected, the disc can have a chance to heal; especially with the right nutrition. A Chiropractor will usually perform spinal manipulation to correct the position and movement in your spine. This typically brings a lot of relief. I like to use electro-muscle stimulation to calm down the muscles and reduce local pain or pain down the affected limb. Additionally, traction or decompression can be used to take the pressure off of the disc and centralize the nucleus to reduce the herniation. Once the pain is under control, I use progressive rehab techniques to train the muscles of the body to hold the spine in the corrected position. This step is important to stabilize the joint so the problem doesn’t just come back the next time you bend over to pick up a pencil.

 

Prognosis

Disc Injury prognosis almost entirely depends on the severity of disc damage. A simple tear can repair as long as the biomechanical dysfunction can be corrected, and the disc is allowed to heal. More severe cases may require surgical intervention to remove disc material pressing against the nerve. If you suspect you may have a disc injury, it is best to contact a physician like a Chiropractor who can help you with proper diagnosis and treatment.