If you are one of 31 million Americans experiencing back pain, neck pain, or low back pain, a "slipped" disc1 or herniated disc may be the cause.
But what exactly is a herniated disc, and how does it become injured?
The spine consists of 24 blocky bones (vertebra) stacked on top of each other in a flexible column that allows our body to move. Between each vertebra sits a soft, rubbery cushion made of cartilaginous fibers and hydrated proteins known as an intervertebral disc2.
(picture from Google images)
Intervertebral discs act as shock absorbers2 for our spine, much like brake pads in a vehicle. Discs absorb the impact of numerous physical activities: running, bending over, sitting, jumping on a trampoline, and more. Intervertebral discs also absorb physical forces sustained in stationary positions like sitting at a football game or in front of a computer for long periods.
Intervertebral discs are located along the spine in our neck, mid back, and lower back2. They also bend and twist with movements of the spine, allowing our bodies to be flexible.
How do they accomplish this? Intervertebral discs are shaped like jelly donuts with a tough, fibrous outer portion known as the annulus fibrosis and a soft, gel-like2,3 inner portion called the nucleus pulposus. This combination of a more rigid exterior and softer interior allows it to distribute the forces we encounter with our everyday activities and physical exertion – all because this bendable disc absorbs the forces of physics.
How does an injury occur to an intervertebral disc?
When you put too much pressure on one side of the disc, the jelly is pushed to the other side. Disc injuries can happen from one traumatic “squeeze” of the disc (jumping off a ski jump or lifting weights incorrectly) or more slowly from repetitive “squeezing” of the disc in the same pattern (sitting with poor posture for long periods of time or bending incorrectly over and over again)
In the video above, you can see a disc bulge and herniation on a demonstration model.
The term "slipped disc," more accurately known as a bulging or herniated disc, refers to some damage that has occurred to either the annulus fibrosis, the nucleus pulposus, or both3,4. Damage to this tough exterior of the intervertebral disc can also irritate the nerves on the outer third of the annulus fibrosis, causing pain1 and other sequelae to occur.
The damage can be minor – think of a small papercut that heals just fine on its own. Sometimes, the outer portion of the intervertebral disc tears, resulting in large bulges in the annulus fibrosis4,5. This is typical of a disc bulge. The pain is typically local to the lower back and hips without radiation of symptoms into the lower leg. This condition responds more quickly to conservative care such as class 4 laser therapy, flexion-distraction therapy, muscle release, core and hip physical therapy and gentle chiropractic adjustments.
If the tearing and damage to the annulus fibrosis are extensive, the nucleus pulposus or jelly from the inside of the doughnut, may leak out. This is categorized as a disc herniation. These disc injuries are more severe. This is likely to cause pain, numbness, tingling, and even weakness to shoot down your leg past your knee due to the pressure and inflammation around the nerve.
Compromise to the disc structure is commonly thought to occur from accidents or traumas, but this is not always the case. Although injuries from traumatic accidents like sporting injuries, vehicle collisions, or slips and falls can cause damage to the disc, degeneration, or accumulated wear and tear on the body, it can also cause discs to become more susceptible to injury and damage! Sometimes degeneration occurs from age, but it also can occur naturally.5
Thankfully, the rubbery discs in our spine are a lot stronger than a jelly doughnut!
Although intervertebral discs can be injured, there may not be any symptoms. Having a disc injury may not always be painful or even result in pain or a loss of function.
If there is a disc bulge or herniation, surgery is not always necessary6 to relieve the problem, either. Boulder chiropractors Alyx and Steve Brown and Boulder physical therapist, Colleen McGinnis have years of experience in providing back pain relief to thousands of Boulder patients.
It's when signs and symptoms, such as pain and a decreased ability to perform regular activities, may indicate the need for some intervention.
The mechanism of a disc herniation
The vertebrae and intervertebral discs of the spine surround and protect the spinal cord: the information highway connects the brain to the body's nerves. The nerves exiting the spinal cord travel outward, innervating both the left and right sides of our bodies.
Injury to a disc can create a bulge that pinches one of the nerves exiting the spinal cord. This is known as nerve impingement. Signs and symptoms depend on where the disc is located and whether the disc bulge or injury is pressing on a nerve.
If this is the case, depending on where the pinched nerve is in the spine, it can result in pain, weakness, or odd sensations called paresthesia in an arm or leg!
Signs of a disc herniation causing nerve impingement include7:
Arm or leg pain. If pain is left in the upper or lower extremities, it is usually only on one side.
A disc herniation in the neck may cause pain and discomfort in the shoulder and arm.
If the disc herniation is in the lower back, it may cause pain and discomfort along the beltline, thigh, and even into the foot.
This pain can feel sharp or shooting when you cough, sneeze, or move into certain positions.
Weakness. A disc herniation may pinch the nerve, resulting in muscles controlled by the nerve becoming weaker.
Paresthesia. This may feel like tingling, numbness, strange sensations, or even ants crawling on the skin. The areas of the body that experience these symptoms are often supplied by the nerve being impinged.
Certain conditions increase the risk of developing disc herniations and disc injury. These are:
Weight. Obesity and excess body weight places additional stress on the discs, primarily in the lower back.
Occupation. People with labor-intensive jobs have a greater risk of developing back problems. This includes repetitive lifting, pulling, pushing, twisting, bending at the waist, and leaning from side to side.
Genetics4,8. Some people inherit a predisposition to developing a disc herniation.
Smoking. Smoking decreases the oxygen supply to the disc, causing the cartilaginous fibers to break down more quickly.
Is your pain coming from a spinal disc injury?
What should you do if you suspect you have a disc herniation? Because the nature of this injury is mechanical, which means it occurs in relation to the muscles, joints, and bones of the body, addressing the musculoskeletal components and making changes to overall bodily movement becomes a crucial part of an effective treatment plan.
This isn't to say a person with a disc herniation needs to stop all activities and engage in bedrest.
Management of a disc herniation will depend on whether the condition is acute (sudden onset) or chronic (repeatedly occurring over time). It will also depend on the severity of symptoms and the size of the injury to the disc.8 This can be determined by severity of symptoms, results of orthopedic tests that we do in office, and MRI imaging. If extra imaging is necessary, we can write a prescription for an MRI.
Thankfully, with the right interventions and tools, intervertebral discs can heal. At Boulder sports chiropractic, we use a few services to first get you out of pain and secondly fix the reason it started, for good.
Class 4 laser therapy - lightforce laser - we use light energy to help decrease your inflammation and get your pain levels down
Flexion-distraction therapy - we use a special table to decompress your spine. This takes the pressure off the disc and allows the “jelly” to resorb back into the disc.
Dry Needling - using acupuncture needles paired with electrostimulation (tens machine) we can activate supportive muscles in your lower back and hips
Physical therapy - using the correct exercises we can activate your core and hips to stabilize your lower back. This prevents ongoing irritation and long term flare ups.
Deep tissue massage therapy - to decrease your muscle spasms and help restore normal movement of your hips and lower back will help decrease pain.
Is a doctor's appointment necessary?
If you're having back pain, you may want to see your Boulder chiropractor to determine if you have a disc herniation or a less severe cause of lower back pain. Both our chiropractors and our physical therapist are trained doctors with the necessary educational background to diagnose and treat your lower back pain. A chiropractor can be an asset in directing the course of care best for recovery if you have a disc injury or other musculoskeletal condition.
Give our office a call if you feel you may have a disc injury or other condition causing your pain! Treating disc herniations and related conditions is right up our alley, and we have many methods to manage your care safely, effectively, and compassionately. In most herniated disc cases, a physical exam and a medical history are all that's needed for a diagnosis. If you have another condition or extensive injury is suspected, you may be referred for x-rays or MRI to better visualize what is going on in your back.
Our office is well-equipped to assess, diagnose, and treat mechanical conditions — like disc herniations and pinched nerves — through gentle, conservative interventions that don't include injections or surgery. Make your appointment today. Living in pain is not an option if you have disc-related pain!