Explaining the Herniated Disc

  Many people have either heard of or experienced the pain associated with a 'blown disc', but what does that mean and how can chiropractic help.  Today we will discuss all of this and answer some commonly ask questions while giving you a good foundation of knowledge about disc degeneration.  Let's start by explaining the anatomy of a vertebral disc.  The disc itself is like a cushion for the vertebrae that are stacked on top of one another in our back.  They help to create a space for the exiting nerve roots at each level that come off of the spinal cord (see below).  When we are young the disc is similar to a jelly donut with a soft, pliable inside called the nucleus pulposus and a harder outside called the annulus fibrosis.  The disc itself doesn't have any direct blood supply like the bones and muscles in the rest of our body.  Instead the disc relies on the surrounding vertebrae for its nutrients and hydration.  Most often this occurs at night when our body is relaxed and we are laying down, allowing the disc space to open and the nutrients to flow between the bone and into the disc.

  When a disc herniation occurs this can be from an acute trauma or from chronic abuse and degeneration over the years.  A bulging disc is one of the most common disc problems that people encounter.  This is not a true disc herniation as the annulus fibrosis is still fully intact.  This may or may not cause pain for an individual (usually 50% do, 50% don't) and is a symmetric bulging of the entire disc.  A disc protrusion is a true herniation, with a tear in the annulus fibrosis and part of the nuclues pulposus goes beyond the borders of the vertebrae.  A protrusion differs from an extrusion in that an extrusion can travel up or down the vertebral segment adjacent to the disc.  There is also something called a sequestration (not shown) in which a part of the nucleus actually breaks off and is a free fragment.  Most people with protrusions, extrusions, and sequestrations do experience local and radiating (pain into the arm/ leg) pain.  Herniations are most common at L5/S1 which is the transitional segment between the last lumbar vertebrae and the start of the tail bone or sacrum. 

  So how can chiropractic care help prevent disc herniations?  Remember when we talked about how the disc does not have its own blood supply and relies on the vertebrae for its nutrients?  When a chiropractor manipulates a joint they are creating motion in that area.  In the back these joints are restored with proper mobility, enabling the disc to get what it needs from the surrounding tissues (and it decreases pain of course!).  This is why I always tell my patients that even if we don't get a 'pop' or 'crack' during a manipulation, we are still getting the motion into the joint and that is more important.  Just like a nut and bolt need oil and motion to keep from rusting, our back needs to be adjusted to keep everything moving easily and functioning properly. 
  What if you already have a disc herniation?  Chiropractic care can help to treat disc herniations.  With a tailor made treatment plan a chiropractor can help get the nucleus back where it's supposed to be as the body heals itself and the annulus repairs on its own.  Herniations are normally harder to treat and therefor take longer to treat, but the success rates have been equal to, if not higher than that of back surgery.