Disc Information for Patients
This information is for reference use only, and should not constitute a diagnosis.
Introduction
If you are feeling lazy… just watch the lumbar disc video Dr. Carr made by clicking HERE, or clicking on the picture up at the top of this page…
If you go to your family doctor with low back and/ or leg pain and ask about seeing a chiropractor for it, they will often say, “Oh, no”, they’ll try to pop it back into place, which will not only be painful, but make matters much worse.” Is this true? What is the chiropractic approach to treating a “slipped disc”? Drugs? Surgery? TL;DR: No.
Well, if you’re looking for conservative care (which means non-surgical and drugless), chiropractic is your best bet for this. In treating low back “slipped discs”, most spine experts agree that conservative care should be tried before surgery is considered, except in severe cases.
Not only that, but chiropractic care has a long history of successfully providing conservative care for disc conditions – and no, chiropractors don’t try to “pop a disc back in place”.
It’s our hope that when you’re done reading this, you will understand the lumbar spine discs’:
A: Anatomy
B: Symptoms
C: How doctors diagnoses the disc, and
D: What treatment options are available.
Anatomy
The human spine is formed by 24 spinal bones, called “vertebrae”. Vertebrae are stacked on top of one another to form the spinal column. The spinal column gives the body its form, and is the body’s main upright support.
The old chiropractic joke (not really funny) is that the spine has two functions: to support the body, and support the chiropractor… (See? Told you it wasn’t funny…) The section of the spine in the lower back is known as the lumbar spine.
The lumbar spine is made up of the lower five vertebrae, numbered 1 to 5. These five vertebrae line up to give the low back an forward “banana” curve. The lowest vertebra of the lumbar spine, L5, connects to the top of the sacrum, a triangular bone at the base of the spine that fits between the two pelvic bones.
Cool fact: Some people (about 5-10%) have an extra, or sixth, lumbar vertebra… This condition doesn’t usually cause any particular problems, but these people tend to be taller!
It’s easiest to think about the disc as a circle of ligament between each vertebra in the spine that acts as both a shock absorber and a shock distributor.
Without discs, the spine simply could not function. A disc is made of two parts. The center, called the “nucleus pulposis” (It means “pulpy center” in Latin) is spongy, a little like crab meat). It provides most of the disc’s ability to absorb shock. The nucleus is held in place by the annular rings… concentric rings (like those of a tree) of fibrous material surrounding the tough, gelatinous center. When cracks, or fissures, occur in the fibrous rings, the rubbery-like material in the center can begin to push out.
Discs don’t really “slip”. Instead, they bulge, herniate, protrude, or rupture. Saying a disc has “slipped” does, however, suggest that something has “slipped out” and is not where it’s supposed to be, which is what exactly happens in disc injuries.
The low back disc is almost always the result of a cumulative process, versus a single ‘event’. As is often the case with joint and back injuries, the problem starts small and then builds until it becomes symptomatic.
For example, a patient sneezes/ picks up a pen/ washes a dog/ just sat up out of bed/ had sex/ fell snowboarding, etc. and experiences sudden back pain, proceeding to leg pain.
However, the sneeze/ whatever itself didn’t cause the disc to “slip,” but represents the final “straw” in a much longer process. The real cause of disc injury include disc dehydration, unusual stress on the disc secondary to disturbed mechanics, and too much load on the disc.
Healthy discs work like shock absorbers to cushion the spine. They protect the spine against the daily pull of gravity. They also protect it during strenuous activities that put strong force on the spine, such as jumping, running, and lifting. Perhaps the most interesting feature about discs is that they have no blood supply. In fact, the discs are the largest avascular structure in the human body.
Instead of blood supply, the disc ‘sucks up’ water during sleep, and squeezes it out when loaded. Discs depend on water to keep their height and perform efficiently. When we’re young, discs have their own circulation that helps keep them hydrated. As we get older, this circulation ends and the spine must move so that water can be drawn into the discs. If discs become dehydrated and lose their height, they’re vulnerable to cracks and fissures. The loss of water in the discs is the primary reason why people get shorter as they age.
Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand this pressure. However, as the annulus ages, it tends to crack and tear. It is repaired with scar tissue. This process is known as degeneration.
Over time, the annulus weakens, and the nucleus may begin to herniate (squeeze) through the damaged annulus. At first, the pressure bulges the annulus outward. Eventually, the nucleus may herniate completely through the outer ring of the disc.
Chiropractors are especially interested in seeing how injuries in one part of the body relate to the mechanical system of the body as a whole. We look at injuries specifically, but they also try to determine in what way an injury is the outcome of disturbances elsewhere in the body.
The spine functions as a whole, so if we have mechanical disturbances in one part of the spine, even as far away from the low back as the neck, it can influence conditions in another area of the spine. Imbalances in the pelvis, problems in the sacroiliac joints, low back hinges, as even problems in the mid back and the neck, even the feet and ankles can contribute to the process of disc degeneration and eventual injury, and can explain why your chiropractor adjusts you, not only at the low back level, but elsewhere, as well.
A lumbar disc can also become herniated during an acute (sudden) injury. Lifting with the trunk bent forward and twisted can cause a disc herniation. A disc can also herniate from a heavy impact on the spine, such as falling from a ladder and landing in a sitting position.
Herniation causes pain from a variety of sources. These are mechanical pain, inflammation pain and neurogenic pain. Mechanical pain comes from the parts of the spine that move during activity, such as the discs and ligaments. Inflammatory pain occurs when the nucleus squeezes through the annulus. The nucleus normally does not come in contact with the body’s blood supply. However, a tear in the annulus puts the nucleus at risk for contacting this blood supply.
When the nucleus herniates into the torn annulus, the nucleus and blood supply meet, causing a reaction of the chemicals inside the nucleus. This produces inflammation and pain.
Neurogenic pain occurs when there is direct pressure against a spinal nerve. Pressure on an irritated or damaged nerve can produce pain that radiates along the nerve, in pretty regular patterns.
It’s interesting to note that disc damage is typically a problem of middle age… Young discs haven’t traumatized enough to have them herniate, and elderly discs are dried out to the extent that they don’t ‘goop’ anymore.
Symptoms
If you are actually reading this because Dr. Carr told you to… you probably already know.
Many cases of lumbar disc herniation result from degenerative changes in the spine. The changes that eventually lead to a disc herniation produce symptoms gradually. At first, complaints may only be dull pain centered in the low back, pain that comes and goes over a period of a few years.
Doctors think this is mainly from small tears in the annulus. Larger cracks in the lumbar annulus may spread pain into the buttocks or lower limbs.
When the disc herniates completely through the annulus, it generally causes immediate symptoms, with sharp pain that starts in one hip and shoots down part or all of the leg. Commonly, patients no longer feel their usual back pain, only leg pain. This is likely because painful tension on the annulus releases when the nucleus pushes completely through. This usually occurs in the morning, and often patients will say they got out of bed, and then “X happened” and it was like being hit by lightning”.
Disc herniations produce inflammation when the nucleus comes in contact with the body’s blood supply (mentioned earlier). The inflammation can be a source of throbbing pain in the low back and may spread into one or both hips and buttocks.
A herniated disc can press against a spinal nerve, producing symptoms of nerve compression. Nerve pain follows known patterns in the lower limbs. It can be felt on the side of the upper thigh, in the calf, or even in the foot and toes.
Pressure on the nerve can also cause sensations of pins, needles, and numbness where the nerve travels down the lower limbs. If this happens, a person’s reflexes slow. The muscles controlled by the nerve weaken, and sensation in the skin where the nerve goes is impaired.
Rarely, symptoms involve changes in bowel and bladder function. A large disc herniation that pushes straight back into the spinal canal can put pressure on the nerves that go to the bowels and bladder. The pressure may cause low back pain, pain running down the back of both legs, and numbness or tingling between the legs in the area you would contact if you were seated on a saddle. The pressure on the nerves can cause a loss of control in the bowels or bladder. This is an emergency!!. If the pressure isn’t relieved, it can lead to permanent paralysis of the bowels and bladder. This condition is called cauda equina syndrome.
Doctors recommend immediate surgery to remove pressure from the nerves… if you are feeling this, DIAL 911 NOW and go to the ER!
Diagnosis
How do doctors diagnose the problem?
Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities.
These will include questions about where you feel pain and whether you have numbness or weakness in your legs. Your doctor will also want to know what positions or activities make your symptoms worse or better. Doctors rely on your report of pain to get an idea which disc is causing problems and if a nerve is being squeezed.
Then the doctor examines you to determine which back movements cause pain or other symptoms. Your skin sensation, muscle s