Disc Conditions
The intervertebral disc is made up of two components, an outer
ligamentous wound covering, called the annulus and an inner jelly-like
substance called the nucleus pulposus. The nucleus provides the main
cushioning effect while the annulus acts as the container that holds
the disc between the vertebrae and keeps the jelly-like nucleus in
place.
The design of intervertebral disc is such that it can withstand a
tremendous amount of compressive pressure. In fact, under heavy lifting
with the spine straight, you would fracture the vertebra before you
would ever rupture a normal disc. However, the high load capacity of
our discs do not do well when we subject them to shearing (twisting)
force.
Bending while lifting and twisting is the most difficult stress for the
disc to handle. When a person bends forward, the pressure in the discs
of the lower back is nearly doubled. When an object is lifted,
especially far away from the body, this stress is multiplied even more.
If the person begins to turn as the object is lifted, shearing force is
transferred into the disc and the fibers that make up the outer
covering of the disc may begin to tear.
Tearing of the annular fibers (outer covering) of the disc can happen
slowly and gradually or abruptly in a traumatic situation. Small tears
may or may not exhibit pain. This is because the nerves that reach the
disc are very small and do not cover a lot of the area. Sometimes when
minor tearing occurs, the pain will be described as a twinge. On the
other hand, severe tearing almost always results in sudden, prolonged,
and worsening pain, which is accompanied by muscle spasm and possibly
referred pain into an extremity (arm or leg, depending on where the
disc damaged occurs.)
When tearing becomes extensive enough that the nucleus pulposus can no
longer be contained within the center of the disc, the jelly-like
substance that makes up the nucleus begins to migrate out. This
shifting of the nuclear material causes the joint to function poorly.
This in turn places the joint under added stress with during movement
and makes the disc even more susceptible to repeated stress injuries.
If annular tearing continues slowly, a condition called a degenerative
disc disease may result. This is a disc condition where the disc slowly
looses its elasticity through a repeated process of wear and tear. The
result is a thin disc that functions poorly as part of the joint
complex and also functions poorly as a shock absorber for the spine.
If annular tearing occurs quickly, or if a weakened disc receives
enough stress to tear through an already compromised area, the result
will be a shift of the nucleus from the center towards the outside of
the disc. This condition is referred to as a disc bulge or herniated
disc (slipped disc.) A small migration of nuclear material, 3mm outside
the disc or less, may be called a disc bulge or protrusion. A disc
herniation is generally larger. If disc material actually escapes and
separates from the outer edge of the disc a prolapsed disc is the
correct diagnosis.
Acute injuries can happen from any sudden tearing of the disc fibers.
Common activities and situations that injure discs are bending,
lifting, or twisting the spine, falls, or automobile accidents. The
symptoms will vary due to level, location, and size of the disc injury.
A herniation can happen in any part of the spine cervical (neck)
thoracic (middle back) or lumbar (low back) region. Of these,
herniations in the thoracic region are very uncommon. Disc injuries to
the lower back are more common from lifting and cervical disc injuries
are an all too common in severe whiplash injuries. A little known fact
is that lifting a heavy can actually cause a cervical disc herniation
if the disc was already weakened.
Chronic disc conditions can be the result of a poorly healed injury or
from excessive and repetitive stress. As more wear occurs, the disc
becomes dehydrated (dries out) and becomes thin. Calcium salts may try
to invade the disc and the surrounding tissue. This is the way the body
tries to stabilize the weakening disc. The result over time is joint
spurs (arthritis) and a poorly functioning back joint. Stiffness and
dull aching pain are usually reported in these classic cases of chronic
disc disease.
Discs that are bulging, herniated, or prolapsed often create sharp
pain, which may radiate into the extremities. A cervical disc
herniation may cause pain down and arm. Likewise, a lower back
herniation may send pain down a leg. The area the pain travels to is an
important clue as to the level of the disc injury. For instance, if the
last lumbar disc is herniated, pain may travel down the back of the
right leg and into the little toe. If the middle of the lumbar spine is
damaged at the third lumbar disc level, the pain will travel more
towards the front of the leg.
In the lower back, the position of the herniation also determines the
symptoms. For instance, if the disc herniation is near the center of
the spine, the pain may only be experienced in the back. The pain with
this type of herniation gets a bit better when you lean into the side
of pain and worsens when you lean away from the side of pain. A disc
herniation on the lateral side (away from the center of the spine.) may
only cause leg pain. The pain from this type of herniation decreases
when you lean away from the side of pain and worsens when you lean into
the side of pain.
Your Doctor of Chiropractic is specially trained in the treatment of
the spine and through careful history, examination, and imaging (x-ray
and MRI) your chiropractor can diagnose and treat most disc disorders.
Your chiropractor can also discuss with you any need for surgical
intervention, should your diagnosis warrant a more radical surgical
solution.
Conservative chiropractic care for disc conditions may involve the use
of ice and or ultrasound to reduce any initial swelling and
inflammation during the acute phase. Guarded stretching of certain
muscles groups may also be started. Also, manipulation may be used to
restore lost joint integrity, and traction to the disc can be done to
help reduce (suck back in) some of the migrating nucleus material.
Your chiropractor may also recommend and fit you with a special back
brace to prevent re-injury and reduce pain. Nutritional recommendations
should also be followed to aid in the healing process.. For instance, a
substance called glucose-amino chondroitin sulfate is lost from injured
discs and may be replaced to a degree with supplements. Remember
that disc injuries take approximately twelve weeks to heal. Patience is
required to cope with the expected ups and downs; however, with
successful treatment and time, the results can be a welcome alternative
to the use of drugs or back surgery.
Chiropractors also frequently treat degenerative disc conditions. With
manipulation and other supportive measures such as applications of
moist heat, stretching, massage therapy, and proper exercise, the pain
and discomfort of degenerative joint disease can be greatly eased. With
proper continued care, the arthritic process can be slowed or halted.
Remember that if you have suffered from a previous disc condition in
the past, it would be wise to take good care of your spine and see your
chiropractor as recommended. A disc can never heal as good as new but
with good care, strengthening and support to the surrounding tissue,
your back may be spared the early onset of joint arthritis, which so
commonly follows a disc injury.
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DISCLAIMER:
Articles posted on this site are for informational purposes only.
Articles are not intended for self-diagnosis or treatment. Users of
this site should consult with their doctors before making any decisions
regarding their health care.
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