Spinal disc herniations, often referred to as a “slipped disc”, are common yet often misunderstood sources of back pain and discomfort. While spinal disc herniations can occur at any age, understanding the causes, symptoms and treatment options for disc herniations are vital for effective management and long term spinal health. In this article we will also discuss a specific case of a person who injured a disc in their low back, fully recovered, but then had another injury that caused similar symptoms but did not injure the disc again.
A spinal disc herniation is a condition where the soft jelly-like inside pushes out through a crack or tear of the tough exterior called the annulus. Having a crack or a tear in the annulus can be a source of pain. Some individuals may have a tear or crack and not experience pain. Other individuals may have the jelly-like interior, called the nucleus, get pushed out through the tear which causes pain in the back as well as pain to radiate into the legs or arms, depending on where the problem is occurring. And, in some cases a person may have a full blown disc herniation and not experience any pain, a lucky few.
Because disc herniations are common it is important to know how they occur. In most instances a disc becomes problematic through repetitive overuse of the back or neck, or less than ideal sustained postures. In overuse injuries of a spinal disc there are repetitive movements, usually into forward flexion, that stresses the disc until there is a failure in the outer fibers of the annulus. Think of bending a paperclip over and over at the same point until eventually the paperclip breaks at the weak point of over bending. This is the exact same way a disc can be injured. Patients inevitably ask, “how did this happen?”. More often we find that patients respond, “I didn’t do anything out of my normal routine” or “all I did was bend forward to tie my shoes”, which is metaphorically speaking the straw that broke the camel’s back. In these cases when we dig a little deeper we find that people have labor intensive jobs that require a lot of bending forward. Sometimes it is even just people who have desk jobs where they sit for most of the day in a sustained posture. What ends up happening is the disc is on the verge of failing and given other factors like less sleep the night before or fatigue from a workout can be a catalyst for what pushes things over the edge when someone simply bends forward and the disc finally gives out. In some cases it may be a little more obvious where there was a specific incident where a person may be lifting something heavy and they feel their “back give out” or feel a “pop”. There are also the cases of people having traumatic disc injuries like falling on their butt from a height or even a car accident. These injuries share the commonality of such extreme pressures within the disc that the inner portion, the nucleus, finds the path of least resistance and ruptures through the annulus.
Of course a disc injury or herniation can cause pain in the back or neck, but that can be just the start of other symptoms that can be associated with a disc injury. The anatomy of the spine is designed to protect the spinal cord while also providing support and stability for the human frame. As the spinal cord travels down the spinal column nerves exit the spine to innervate organs, muscles, skin and other parts of the body. Where these spinal nerves exit are in close proximity to the spinal discs. When a disc herniates or bulges outward it can place pressure on these nerves and cause pain to radiate into the legs or arms and even cause numbness, tingling or burning sensations. The nerve doesn’t have to have direct contact with the disc in order for the nerve to be irritated. Inflammation caused by the injured disc is enough to cause a chemical irritation and produce the same symptoms. Most of the time people will say that the leg pain and numbness or tingling is worse than the back pain. All of these clues point toward a true disc herniation when a patient comes into the clinic.
How are disc related injuries treated? More often patients treated with conservative care have better outcomes and longer lasting results than jumping right into surgery. Conservative care for disc herniations consists primarily of spinal decompression with other therapies included to provide a broad spectrum of healing and recovery. Spinal decompression is pain free and done in a manner of making a patient as comfortable as possible and even eliminating pain and other symptoms while treatment is being performed. Decompression is done with a belt placed around the waist of the patient and then hooked to a machine via a cable that gently decompresses the spine with increased tension up to a specified weight that is different for every patient. The traction will then vary between a higher tension and a lower tension over a period of about 15 minutes. This slow pulsing higher and lower tension provides fluid and nutrient transfer through the disc to produce a vacuum effect as well as helping the injured tissue to heal. We incorporate laser therapy as well to provide increased cellular activity to speed the recovery process. Over time the disc heals, symptoms decrease and people return to a normal active life. However, this does not mean that reinjury will not occur because returning to a lifestyle that is no different than before will inevitably reproduce the same injury. In addition to treatment and therapies we include exercises and stretches that will empower a patient to help stabilize the injured area and prevent future injuries from occurring.
In a recent case in our clinic a 44 year old male patient had just finished treatment for a lower back disc herniation. He was experiencing low back and leg pain as well as numbness and tingling. He was treated just how it was described above with decompression and laser therapy for a total of 15 treatment sessions. He experienced a complete improvement of no pain and no numbness and tingling into his leg. One week later he was on vacation and was out on a wave runner and landed very hard on his backside from the wave runner being launched into the air going over a large wave. Over the course of a month his symptoms returned to the same as before being treated with decompression. His initial thought was that he re-injured his disc in his lower back. He was also experiencing new symptoms than before. His hip and the muscles surrounding his hip became very tight and his range of motion decreased dramatically. He was also noticing that the same side of his lower back was beginning to get tighter and starting radiating pain outward around his flank. He decided that trying physical therapy and even having some epidural injections of his low back would fix the problem. Both failed. He even tried dry needling in his low back and hip and that gave him some relief of the muscle tension and tightness he was feeling, but he was still having pain in his leg. He returned to our clinic in hopes of doing more decompression to fix the issue. It turns out that his previously injured disc was not the problem even though the mechanism of his injury would indicate that that is likely the case. Instead he sprained some ligaments of his low back and pelvis as well as strained some muscles of his lower back and hip. This translates to why the low back epidural injections did not help his pain because that wasn’t what he needed. Now he is being treated for those injuries with other therapies that have made a bigger impact on his symptoms.
This case is significant. Significant in a way that not all lower backs that are hurt are caused by a herniated disc and necessitate an MRI. Knowing what we know as spinal experts, as chiropractors, we know that there are a myriad of things that can go wrong in the spine that aren’t always disc injuries. Specialists who are trained to identify disc injuries will inherently have the ability to know when an injury will not be disc-related. MRIs are helpful when a specialist is not available to evaluate the injury. This patient who went to other providers went through the gambit trying to identify the cause of the pain hoping that it was a reinjury of the disc that was treated. Unfortunately, he tried other methods with providers that did not address the real problem when the initial thought was another disc-related injury. It is easy to see that similar symptoms would lead this patient to believe that he had reinjured his lower back and his disc. We were able to step in and evaluate and examine him and because of the knowledge and expertise that we have we were able to treat him precisely for what he needed instead of basing his treatment solely on his recent history. This is what sets us apart and why we have the best outcomes and successes in our clinic.