Low back pain with pain radiating into the legs is one of the most common injuries in the United States. Many of the patients with these symptoms along with lower extremity weakness may have a herniated disc. Herniated discs are also called protruding, bulging, ruptured, prolapsed, slipped, or degenerated discs. A disc herniation occurs when the cushion that sits between the spinal bones, or vertebrae moves from its normal position and enters the spinal canal. This is a problem because this is where the spinal cord and nerve roots are located.
What is the spinal disc?
The soft structure that sits between the each vertebrae is referred to as the spinal disc. The disc is composed of a soft center similar to the center of jelly donuts and referred to as the nucleus pulposus. The nucleus is surrounded by several layers of connective tissue that is composed of material similar to ligaments and tendons called the outer annuls and looks like concentric rings, like the annular growth rings of a tree. This spinal disc becomes more rigid with age. In a young individual, the disc is soft and elastic, but like so many other structures in the body, the disc gradually looses its elasticity and is more vulnerable to injury. As early as 30 a disc may show signs of deterioration and on MRI about 30% of people demonstrate deterioration.
What happens with a ‘herniated disc’?
As we age and the spine becomes less flexible and when this happens the disc may rupture. When a disc ruptures a portion of the nucleus pushes outside of its normal borders and may be completely extruded, outside the disc, this is called a herniation. When this herniation enters the spinal canal pressure can be put on the spinal cord and nerve roots, often referred to as a pinched nerve. There is normal some extra space around the spinal cord but if there is not enough to accommodate the herniation then the nerves are compressed.
What causes herniated disc symptoms?
Once the herniation occurs and a nerve is pinched that is when symptoms arise. A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine. Often times when a disc is herniated the person may already have spinal stenosis or a narrowing of the spinal canal. This leads to less space for the herniation and increased pain due to further irritation of the nerve.
What are the symptoms of a herniated disc?
When the spinal cord becomes compressed it does not function properly and may lead to a range of symptoms. Abnormal signals may get passed from the compressed nerves, or signals may not get passed at all. There are several common symptoms of a herniated discs. The pressure on the nerve will cause abnormal sensations, commonly experienced as electric shock pains. When the compression occurs in the cervical (neck) region, the shocks go down your arms, when the compression is in the lumbar (low back) region, the shocks go down your legs. Tingling, numbness or pins and needles are often abnormal sensations associated with disc injuries. These symptoms may be experienced in the same region as painful electric shock sensations, but may not be in the area of the actual injury. Because of the nerve irritation, signals from the brain will be interrupted causing muscle weakness. Nerve irritation can therefore be tested by examining reflexes, testing muscle strength, and assessing sensory input. Of all of the symptoms associated with disc problems the most serious is bowel or bladder problems. These symptoms are important because they are signs of cauda equina syndrome, a possible condition resulting from a herniated disc. This is a medical emergency, and your should see your doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals. These symptoms are all due to compression of the spinal nerves but that may not be the full extent of the damage, as seen in the cauda equina syndrom organs can also be effected leading to issues with breathing, digestion, or even heart problems..
How is the diagnosis of a herniated disc made?
Most often, your physician can make the diagnosis of a herniated disc by physical examination performed by a chiropractor. By testing sensation, muscle strength, and reflexes, your chiropractor can often establish the diagnosis of a herniated disc.
Often this diagnosis will be confirmed using MRI and other advanced imaging. The MRIs is only useful in conjunction with the physical examination and should not be performed by itself. It is normal for a MRI of the lumbar spine to have abnormalities, especially as people age. Patients in their 20s may begin to have signs of disc wear, and this type of wear would be expected on MRIs of patients in their 40s and 50s. This is the reason that your physician may not be concerned with some MRI findings noted by the radiologist.
The diagnosis and treatment of disc issues are dependent on the physical findings and symptoms. Your chiropractor will also take into account the patients experience and asses the imaging studies. Only once this information is put together can a reasonable treatment plan be considered.
Chiropractic care is an excellent treatment choice for the management of herniated disc problems. Chiropractic is safe, non-invasive and non-toxic and it also works! Chiropractic care is a modern treatment approach for herniated discs. Typically chiropractic care involves spinal adjustments, physiotherapies, muscle therapies, such as massage and trigger point work, nutritional support and active care rehabilitation.
What is Lumbar Flexion Distraction technique?
Lumbar flexion distraction technique is, a chiropractic treatment, used in our clinic. It is often referred to as Cox flexion distraction. Cox Technic is non-surgical, doctor-controlled, hands-on spinal manipulation used to help treat herniated disc symptoms. It is performed with the patient lying on The Cox Table a specially designed chiropractic instrument. This table permits an effective decompression adjustment and manipulation. This is a widely used approach to treating symptomatic disc injuries involving back pain and accompanying leg pain. During the treatment the spine is gently distracted or stretches which allows the chiropractor to isolate the area of disc involvement while slightly flexing the spine in a pumping rhythm. There should be no pain involved in the treatment.
The tractioning or distraction of the disc combined with isolation and gentle pumping of the involved area allows the central area of the disc, the nucleus pulposus, to assume its central position in the disc. Flexion distraction is also thought to improve disc height. Well-researched and documented, flexion distraction and decompression help relieve spinal pain and return patients to their desired quality of life by dropping intradiscal pressure, widening the spinal canal foraminal area, reducing pressure on the spinal nerves, and returning motion to the spinal joints. Cox Technique is appropriate for conditions causing low back and leg pain as well as neck and arm pain. It also reduces pain attributable to disc herniation, a slipped disc, a ruptured disc, facet syndrome, stenosis, spondylolisthesis, and other conditions.
The surgical approach to treating a herniated disc is removal of the disc (discectomy), surgically fusing two vertebrae together with hardware, or cutting away part of the vertebrae (laminectomy) in order to decompress the spine. Spinal surgery has a very poor track record, a 50% failure rate. It is also the most invasive treatment option. Because of this, surgery should only be considered as a last resort not a first choice. You should try everything else available to you before allowing anyone to operate on your spine. Most surgeon would never even consider operating on you until you have first tried all the conservative treatment choices. This would include chiropractic care, physical therapy, massage therapy, medications, acupuncture, etc. Is surgery ever the right choice? Yes, absolutely, there are certain times when the problem is so severe that it is no longer treatable via conservative methods. That being said, you should still always start with the least invasive approaches first and progress from there.
If you have been suffering with a herniated disc call me to schedule a free, no-obligation consultation.By: Paul R. Mahler Jr. DC Mahler Family Chiropractic Center 1144 wyoming Ave. Kingston, PA. 18704 http://mahler-chiropractic.com May be reproduced in whole only. We can treat herniated discs and back injuries and pain including sciatica, disc, herniation, slipped disc, stenosis, and much more.