A herniated disc is a common, often painful condition that affects millions of people annually. It is most common in people aged 25-40, and is slightly more common in men than women. We will take a look at the factors that underlie herniated discs, the mechanism of pain, how to get symptomatic relief and what is done in order to allow the disc to heal. First, in order to understand what a herniated disc really is, and what it means, let’s take a look at some basic spinal anatomy.
An intervertebral disc is a shock absorber between a pair of adjacent vertebrae. It consists of a tough, fibrous outer covering, called the “Annulus Fibrosus”, which is made up of many layers of rings of the fibrous material. Inside the annulus, is a soft, jelly-like material, with the consistency of toothpaste, called the “Nucleus Pulposus”. The disc, as well as the adjacent vertebral bones make up a canal, through which pass the spinal cord and the nerves that come off of the cord. The “peripheral nerves” coming off of the spinal cord pass through an opening between the two adjacent vertebrae and the disc called the “intervertebral foramen,” which means the canal between the vertebrae. There are a number of other structures that pass through this foramen, such as arteries, veins, nerves and fat.
Grade 0 – Internal Disc Derangement
When the intervertebral disc herniates, it means that the nuclear material has pushed itself through cracks in the annular ring that holds the disc together. Depending on your anatomy, this can be extremely painful, or completely asymptomatic. Before any of that happens however, there is a first stage that must occur, during which pain is often felt, but no actual tissue damage is present. This is called “Internal Disc Derangement.” In this first stage, the nucleus pulposus moves from the center of the disc, off to one side. This puts additional pressure on some part of the annular material – usually towards the back and to one side or the other.
At this stage, chiropractic adjustment, along with some easy-to-do exercises should completely resolve the problem with no long term effects whatsoever. More often than not however, we do not see patients at this early stage, because most people experience this as some mild to moderate back pain that responds to a pain pill like ibuprofen or acetaminophen.
Grade 1 – Disc Protrusion
The next step towards a herniated disc is protrusion of the nucleus through the annulus. It doesn’t have to penetrate all the way through, but it does open tears in the annulus, and tissue damage has occurred. This is the most common stage in which a chiropractor will see a patient. For someone who is under the age of about 35 years old, it is usually possible to correct this problem, and it may or may not heal depending on a number of factors, such as age, sex, nutritional status, physical fitness and other health problems that you may have.
Grade 2 – Disc Extrusion
The next step is called disc extrusion, in which the nucleus penetrates all the way through the disc and is exposed to the internal body environment. This is a true herniated disc. The nucleus, thus exposed, may be putting pressure on a nerve, or because of the way in which the body’s immune system reacts to the nucleus, the immune system may be eliciting a powerful immune inflammatory response. Safely inside the disc, the nucleus, from development through birth, and into adulthood, is never exposed to the immune system, and so the immune system never gets to learn that it is “self.” Thus, when the immune system comes into contact with the disc, it sees it as foreign and attacks it ferociously. This immune attack releases many chemical mediators that cause inflammation, swelling, pain and heat, and if not brought under control, frequently results in extreme pain.
At this point, the appropriate protocol is to institute an anti-inflammatory diet, along with additional nutritional anti-inflammatory supplementation, in order to get the inflammation under control. This will be coupled with exercises to be performed at home and in the office, along with chiropractic adjustment in order to try to pull the nucleus back into place and allow the disc to heal. Again, in those patients under the age of 35, this is still a possibility. However, due to the extent of the damage to the annulus at this point, the possibility of the disc herniation becoming a chronic problem is increasing.
Grade 3 – Disc Sequestration
The final step in a herniated disc, if untreated, is disc sequestration. This means that a portion of the nucleus has actually broken off inside the spinal canal and is floating free wreaking havoc. This is almost always surgical and only an MRI can tell whether this has occurred. If in fact this is what you have, we will make the appropriate referrals to ensure that you get the therapy that you require.
Because of the way in which herniated discs occur, and depending on where they have occurred, you may experience a range of symptoms including arm pain, leg pain (also called sciatica), localized back pain, headache, neck pain, mid-back pain, pins and needles with or without pain, or a wide range of other possible symptoms. It is very important that you tell the doctor about any and all symptoms that you are experiencing, including any weakness or difficulty controlling your bladder or bowels.
Using a combination of natural anti-inflammatories, nutritional modifications, dietary supplementation, and physical medicine, it is usually possible to fix disc herniations non-surgically and prevent them from re-occurring. Why wait? Give us a call at 201-569-1444 for an appointment!