Back Clinic Herniated Disc Chiropractic Team. A herniated disc refers to a problem with one of the rubbery cushions (discs) between the individual bones (vertebrae) that stack up to make your spine.
A spinal disc has a soft center encased within a tougher exterior. Sometimes called a slipped disc or a ruptured disc, a herniated disc occurs when some of the soft centers push out through a tear in the tougher exterior.
A herniated disc can irritate the surrounding nerves which can cause pain, numbness, or weakness in an arm or leg. On the other hand, many people experience no symptoms from a herniated disk. Most people who have a herniated disc will not need surgery to correct the problem.
Symptoms
Most herniated disks occur in the lower back (lumbar spine), although they can also occur in the neck (cervical spine). Most common symptoms of a herniated disk:
Arm or leg pain: A herniated disk in the lower back, typically an individual will feel the most intense pain in the buttocks, thigh, and calf. It may also involve part of the foot. If the herniated disc is in the neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into the arm or leg when coughing, sneezing, or moving the spine into certain positions.
Numbness or tingling: A herniated disk can feel like numbness or tingling in the body part served by the affected nerves.
Weakness: Muscles served by the affected nerves tend to weaken. This may cause stumbling or impair the ability to lift or hold items.
Someone can have a herniated disc without knowing. Herniated discs sometimes show up on spinal images of people who have no symptoms of a disc problem. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
A common cause of lower leg and back pain is a ruptured disc or herniated disc. Symptoms of a herniated disc may include muscle spasm or cramping sharp or dull pain, sciatica, and leg weakness or loss of leg work. Sneezing, coughing, or bending intensify the pain.
Rarely, bowel or bladder control is lost, and when this happens, seek medical attention at once.
Sciatica is a symptom often associated with a lumbar herniated disc. Stress on one or several nerves that contribute to the sciatic nerve can lead to pain, burning, tingling, and numbness that extends from the buttocks into the leg and into the foot. Normally one side (left or right) is affected.
Anatomy of Lumbar Spine Discs
First, a brief overview of spinal anatomy so that you can better understand the way the lumbar herniated disc may lead to lower back pain and leg pain.
In between each of the 5 lumbar vertebrae (bones) is a disc, a tough, fibrous shock-absorbing pad. Endplates line the endings of every vertebra and help hold discs in place. Every disc includes a tire-like outer ring (annulus fibrosus) that encases a gel-like material (nucleus pulposus).
Disc herniation occurs when the annulus fibrous breaks open or cracks, permitting the nucleus pulposus to escape. Though you may have heard it be called a ruptured disc or even a bulging disc, this is called a herniated nucleus pulposus or herniated disc.
When a disc herniates, it can press on the spinal cord or spinal nerves. All along your spine, nerves are branching off from the spinal cord and travelling to various parts of your body. The nerves pass through small passageways between the vertebrae and discs, so if a herniated disc presses into that passageway, it can compress (or “pinch”) the nerve. This can result in the pain associated with herniated discs. (In the case below, you can observe a close-up look at a herniated disc pressing on a spinal nerve.)
Lumbar Herniated Disc Risk Factors
Many factors can increase the risk for disc herniation, including:
Lifestyle choices like tobacco use, lack of regular exercise, and insufficient nourishment significantly contribute to inadequate disc health.
As the body ages, natural chemical modifications cause discs to slowly dry out, which can impact disc strength and resiliency. To put it differently, the aging process can make your discs less capable of absorbing the shock from the body’s movements, which is one of their most important jobs.
Poor posture combined with the habitual use of incorrect body mechanics stresses the lumbar spine and influences its usual ability to take the bulk of the body’s weight.
Combine these factors with the eeffects from daily wear and tear, injury, incorrect lifting, or twisting and it is simple to comprehend why a disc may herniate. For example, lifting something incorrectly may lead to disc pressure.
Disc Herniation Phases
A herniation may develop suddenly or slowly over weeks or months. The four phases to a herniated disc are:
1) Disc Degeneration: Chemical modifications related to aging causes discs to weaken, but with no herniation.
2) Prolapse: The form or position of the disc changes with a few small impingement into the spinal canal and/or spinal nerves. This stage is also referred to as a bulging disc or a disc that was protruding.
3) Extrusion: The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
4) Sequestration or Sequestered Disc: The nucleus pulposus fractures throughout the annulus fibrosus and can then go outside the intervertebral disc.
Lumbar Herniated Disc Diagnosis
Lately, not every herniated disc causes symptoms. Some people discover they have a ruptured disc or herniated disc after an x-ray for an unrelated reason.
Most of the time, the symptoms, notably the pain, prompt the patient to seek medical attention. The trip with the doctor includes a physical exam and neurological exam. He or she will examine your medical history, and inquire about what remedies you have tried for pain relief and what symptoms you’ve experienced.
An x-ray may be needed to rule out other causes of back pain like osteoarthritis (spondylosis) or spondylolisthesis. A CT or MRI scan verifies the extent and location of disc damage.These imaging tests can show the soft tissues (including the disc).
Sometimes a myelogram is essential. In that evaluation, you will receive an injection of a dye; the dye will appear on a CT scan, so allowing your physician to readily see problem areas.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
Various injuries can be caused by automobile crashes. One of the most frequent car accidents is the collision in which a vehicle is hit from behind. If you have been in these events you may be receiving neck pain therapy for a accident called whiplash that occurs when an occupant of this vehicle is thrust forth and back.
This injury may cause a herniated disc in the cervical (neck) area, in addition to a variety of other symptoms. A whiplash injury can include neurological impairment in mobility, joint aches, problems with concentration and chronic pain. Besides damaging the delicate tissues (muscles, tendons, and ligaments) that maintain the neck, it may also harm the cervical spine (the neck region of the backbone), inducing a herniated disc in the neck. The herniation can compress the nearby nerves, causing pain. Symptoms of a herniated disc in the neck may include tingling, numbness, and muscle weakness.
Pain from Previously Existing Conditions
In a study published in the journal Spine, doctors found that disabling pain in the back following whiplash may be due to a previously disc in the spine. These conditions may present no symptoms that are apparent before the accident. The researchers further concluded that pain was successfully treated following microdiscectomies for these discs.
Symptoms from whiplash injuries cannot be necessarily resolved with neck pain treatment, and can be tricky to diagnose since the pain lower back and even in the shoulder region can radiate to other regions of the body. It can be especially challenging for the physician when symptoms are vague and non-localized.
When the natural reactions of the body don’t operate properly, injuries occur. In the normal state, a C-shape is maintained by the cervical spine. On an S-shape as the portion extends and the upper portion of this area flexes, the individual’s cervical spine takes upon impact from behind. This phenomenon risks herniating a disc or tearing a ligament. If the human body’s protective response is working correctly, it will recognize the impact and signal the cervical muscles and make a supportive scaffold for the cervical spine and ligaments.
Although pain can heal on its own it may often require therapy. A treatment program for a herniated disc in the neck may consist of anti-inflammatory pain medication, rest, and physical therapy. With these conservative treatments, the symptoms generally improve over time. But if imaging tests find out that the damaged disc is compressing nearby nerves and/or the spinal cord, or if symptoms persist despite the treatment, neck surgery may be considered.
There are a few things you can do in order to stop whiplash injuries requiring neck pain treatment and increased risk for pain . These include maintaining fitness and good posture. You can start focusing on those goals.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.
If given the opportunity, a herniated disc can occur as a consequence of trauma and can create a plethora of problematic symptoms which might become chronic pain conditions. Whiplash is most frequently associated with car collisions, but can actually happen from any injurious procedure that snaps the neck forward or back beyond its normal selection of movement.
This informative article will detail the prevalence of herniated discs related to whiplash events. We’ll investigate how whiplash occurs and how the process can enact disc injury in the cervical or upper thoracic spinal regions.
Whiplash Herniated Disc Incidents
Whiplash happens because of abrupt acceleration, or more commonly, sudden deceleration. Inertia is the force which can create harm to the spinal structures and the throat muscles at the neck and back.
The head is a really heavy weight that is supported by the slightly thinner and weaker vertebrae and intervertebral discs in the cervical spine. When inertia is applied to the entire body, the head will snap backwards or forward, causing both and typically hyperflexion or hyperextension. As it whips about causing an assortment of injurious events that are possible, including a herniated disc, this heavy weight places stress on the cervical spine.
Herniated Disc Pain and Discomfort
Whiplash typically occurs from severe trauma, such as an automobile accident, slip and fall, sports injury or act of violence. Any situation which causes the head to jolt abruptly back-and-forth, can cause whiplash.
Whiplash is a condition which sometimes occurs after an accident, but could also take some time to become apparent. The reasons for this time delay response vary, but are commonly linked to three possible causations:
First, it’s the pain relieving quality of adrenaline, which often fills the bodily systems during a crash. This can diminish the severity symptoms which might otherwise be debilitating when they occur. Second, is the psychological nocebo effect of the trauma, which could take some time to infiltrate and to come up within the subconscious mind. Finally, the secondary gain principle enacted by legal action having to do with the accident might causes time delay. It’s no coincidence that people begin to experience pain right around the time they seek professional help.
Whiplash & Herniated Disc Consequences
The vast majority of whiplash complaints are due to muscular injury, not damage to the spinal column. Neck muscle pain can be extremely severe, but is not a significant worry and should resolve with symptomatic treatment.
Extreme trauma or highly focused trauma can cause a bulging disc or even a ruptured disc in the neck or upper back. Symptoms are very likely to be painful for a number of weeks, but should resolve within 2 months, as is typical for practically any disc injury condition with the proper treatment and care.
Other less common effects of severe whiplash might incorporate a change in the natural curvature of the spine, a fractured or shattered vertebra or a torn ligament or tendon.
Whiplash Herniated Disc Guidance
A lot of men and women suffer whiplash traumas on a daily basis. These types of injuries are an inherent part of the fear we have towards spinal damage and are an integral component of litigation. Both of these factors make judging the actual degree of any whiplash neck injury complicated.
Pain is often worsened or perpetuated through psychosomatic or secondary gain factors, instead of structural anatomical problems. It is crucial, as a patient, to look past the psychological and legal implications of your injury and concentrate on your recovery.
The neck, like every other area of the human body, was made to heal, but will only do so in the event that you give it the mental and emotional support and trust it requires.
There isn’t anything more important than your health. Unfortunately, this is a lesson for those who endure a plethora of herniated disc treatments and eventual disc surgery simply to bolster a case that is legal. When the case is over, you might have some money, but is it really worth it to lose your freedom and functionality for the remainder of your life?
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Automobile Accident Injuries
Whiplash, among other automobile accident injuries, are frequently reported by victims of an auto collision, regardless of the severity and grade of the accident. The sheer force of an impact can cause damage or injury to the cervical spine, as well as to the rest of the spine. Whiplash is generally the result of an abrupt, back-and-forth jolt of the head and neck in any direction. Fortunately, a variety of treatments are available to treat automobile accident injuries.
Title: Spinal Adjustments are Safe in the Presence of Herniated disc with the Absence of Cord Compression
Abstract: The objective was to explore the use of MRI to increase the efficacy and safeness of adjusting the cervical spine in the presence of a disc herniation when there is no evidence of cord compression on MRI.
Introduction: A 30 year old male patient presented to the office on 1/8/14 with injuries from a motor vehicle accident. The motor vehicle accident had occurred 3 weeks prior to his first visit. The patient was the restrained front seat passenger. The car he was travelling in struck another car and the patient�s car was flipped over onto its roof. While the car remained on its roof the patient was able to crawl out and awaited medical attention. The patient was taken by ambulance to the hospital where he was examined and testing was ordered. The patient had multiple CT scans of the head and X-rays of the cervical and lumbar. The CT of the head revealed a nasal fracture and the patient underwent immediate surgery to repair his broken nose.
Safe and Effective Chiropractic Adjustment Study
The patient presented three weeks post-accident with persistent and progressive daily occipital headaches, neck pain into the shoulders bilaterally, upper back pain and lower back pain that radiates into the legs and down into the feet bilaterally. He has swelling at the left anterior knee and bandages around the right elbow and two black eyes.
The patient states that he was having difficulty with regular activities of daily living including walking for more than 15-20 minutes, long periods of standing, more than an hour of sitting, any bending or lifting and any regular daily chores. The patient also states he was having difficulty getting a restful night�s sleep due to the pain. The patient�s visual analog scale rating was 10 out of 10.
History: The patient denied any prior history of neck or back pain. No reported prior injuries or traumas.
Objective Findings: An examination was performed and revealed the following:
Range of Motion:
Cervical Motion Studies:
Flexion: Normal=60 Exam- 25 with pain with spasm
Extension: Normal=50 Exam- 20 with pain with spasm
Left Rotation: Normal=80 Exam- 35 with pain with spasm
Right Rotation: Normal=80 Exam- 35 with pain with spasm
Left Lat. Flex: Norma=-40 Exam- 15 with pain with spasm
Right Lat. Flex: Normal=40 Exam- 15 with pain with spasm
Dorsal-Lumbar Motion Studies:
Flexion: Normal=90 Exam- 35 with pain with spasm
Extension: Normal=30 Exam- 10 with pain with spasm
Left Rotation: Normal=30 Exam- 10 with pain with spasm
Right Rotation: Normal=30 Exam- 5 with pain with spasm
Left Lat. Flex: Normal=20 Exam- 5 with pain with spasm
Right Lat. Flex: Normal=20 Exam- 5 with pain with spasm
Orthopedic Testing
The orthopedic testing revealed the following positive orthopedic tests in the cervical spine: Valsalva�s indicating the presence of a disc at L4-S1 and the lower cervical region, foraminal compression indicating radicular pain in the lower cervical region, Jackson�s compression , shoulder depressor and cervical distraction all indicating pain in the lower cervical region. The lumbar testing revealed a positive Soto-Hall with pain at the L4-S1 level, Kemps positive with pain from L4-S1, Straight Leg raiser with pain at 60 degrees, Milgram�s with pain at the L5-S1 level, Lewin�s with pain at L5-S1, and Nachlas eliciting pain in the L5-S1 region.
Neurological Testing
The neurological exam revealed bilateral upper extremity tingling and numbness into the shoulder on the left and down the right arm into the hand. The lower extremity revealed tingling and numbness into the gluteal�s bilaterally with left sided radicular pain in to the leg into left foot. The pinwheel revealed hypoesthesia at C7 bilaterally and L5 bilaterally dermatome level. The patient was unable to perform the heel-toe walk
The chiropractic motion palpation and static palpation exam revealed findings at C 1,2 , 5, 6, 7 and T 2,3,4,9, 10 and L 3,4,5 as well as the sacrum.
X-Ray Result Study
The hospital had cervical x-rays and a CT of the head on the day of the accident. Thoracic and lumbar studies were needed as a result of the positive testing and the patients history and complaints The x-ray studies revealed a reversed cervical curve and misalignment of the C1,2,5,6,7 and the lumbar studies revealed a mild IVF encroachment at L5-S1 with rotations at L3,4,5.
The results of the exam were reviewed. The patient�s positive orthopedic testing, neurological deficits coupled with the decreased range of motion and positive chiropractic motion and static palpation indicated the necessity to order both cervical[1]and lumbar[2] MRI�s4.
MRI Results
The MRI images were personally reviewed. The cervical MRI revealed a right paracentral disc herniation at the level of C5-6 with impingement on the anterior thecal sac. There is also a C6-7 disc bulge impinging on the anterior thecal sac. The lumbar MRI revealed an L5-S1 disc herniation. There are disc bulges at from L2-L4.
CERVICAL MRI STUDIES
LUMBAR MRI IMAGES
Safe and Effective Treatment Plan
After reviewing the history, examination, prior testing, x-rays, MRI�s and DOBI care paths3 it was determined that chiropractic adjustments6 wereclinically indicated
The patient was placed on a treatment plan of spinal manipulation with modalities including intersegmental traction, electric muscle stimulation and moist heat. Diversified technique was used to adjust the subluxation diagnosed levels of C1,2,5,6,7 and L3,4,5. Although there were herniated and bulging discs present in the cervical and lumbar spine there was no cord compression. Therefore; there was no contraindication to performing a spinal adjustment. As long as there is enough space between the cord and the herniation or bulge then it is generally safe to adjust.5
The patient responded quite favorably to the spinal adjustments and therapies over the course of 6 months of treatments. Initially, the patient was seen three times a week for the first 90 days. The patient demonstrated subjective and objective improvement and his care plan was adjusted accordingly and reduced to two visits per week for the next 90 days of care. His range of motion returned to 90% of normal:
Range of Motion:
Cervical Motion Studies:
Flexion: Normal=60 Exam- 55 with no pain
Extension: Normal=50 Exam- 40 with mild tenderness
Left Rotation: Normal=80 Exam- 75 with mild tenderness
Right Rotation: Normal=80 Exam- 75 with mild tenderness
Left Lat. Flex: Norma=-40 Exam- 35 with no pain
Right Lat. Flex: Normal=40 Exam- 35 with no pain
Dorsal-Lumbar Motion Studies:
Flexion: Normal=90 Exam- 80 with tenderness
Extension: Normal=30 Exam- 25 with tenderness
Left Rotation: Normal=30 Exam- 25 with no pain
Right Rotation: Normal=30 Exam- 25 with no pain
Left Lat. Flex: Normal=20 Exam- 20 with no pain
Right Lat. Flex: Normal=20 Exam- 20 with no pain
The patient had decreased spasm, decreased pain, increased ability to perform ADL�s and his sleep had returned to normal. The patient states that he was no longer having the same difficulties with regular activities of daily living. He was now able to walk for 45 minutes to 1 hour before the lower back pain flared up, he is able to stand for 1-2 hours before the lower back pain begins, he is able to sit for an hour or more before the lower back pain flares up. When the patient bends or lifts he has learned to use his core and lifts less than 20-30 pounds to avoid exacerbating his low back. The patient also states he was no longer having difficulty getting a restful night�s sleep. The patient�s visual analog scale rating was 3 out of 10.
Conclusion
The patient presented 3 weeks post trauma with cervical and lumbar pain as well as headaches. The symptoms were progressing and the pain was radiating into the upper and lower extremities. The history and exam indicated the presence of a herniated disc in the lower lumbar and cervical region. Cervical and lumbar MRI�s were ordered to identify the presence of the herniated disc as well as to determine whether or not the patient should be adjusted. The MRI results of both the cervical and lumbar MRI revealed herniated discs, however, because these discs were not causing cord compression it was safe to adjust the cervical and lumbar spine5.
Competing Interests: There are no competing interests in the writing of this case report.
De-Identification: All of the patient�s data has been removed from this case.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
References
New England Journal of Medicine; Cervical MRI, July 28, 2005, Carette S. and Fehlings M.G.,N Engl J Med 2005; 353:392-399MRI for the lumbar disc, March 14 2013, el Barzouhi A., Vleggeert-Lankamp C.L.A.M., Lycklama � Nijeholt G.J., et al., N Engl J Med 2013; 368:999-1000 www.state.nj.us/dobi/pipinfo/carepat1.htm -16.7KB
New England Journal of Medicine; Cervical-Disk HerniationN Engl J Med 1998; 339:852-853September 17, 1998DOI: 10.1056/NEJM199809173391219
Is It Safe to Adjust the Cervical Spine in the Presence of a Herniated Disc? By Donald Murphy, DC, DACAN, Dynamic Chiropractic, June 12, 2000, Vol. 18, Issue 13
Treatment Options for a Herniated Disc; Spine-Health, Article written by:John P. Revord, MD
Additional Topics: Chiropractic Helps Patients Avoid Back Surgery
Back pain is a common symptom which affects or will affect a majority of the population at least once throughout their lifetime. While most back pain cases may resolve on their own, some instances of the pain and discomfort can be attributed to more serious spinal conditions. Fortunately, a variety of treatment options are available for patients before considering spinal surgical interventions. Chiropractic care is a safe and effective, alternative treatment option which helps carefully restore the original health of the spine, reducing or eliminating spinal misalignment which may be causing back pain.
El Paso,TX. Chiropractor Dr. Alex Jimenez looks examines a�herniated disc.
Herniated disc is a somewhat common condition that can occur anywhere along the spinal column, but most commonly affects the lower back or neck area. Also known as ruptured disk or a slipped disc, a herniated disc develops when one of the pillow-like pads between the vertebrae moves out of position and presses on nerves that are adjacent.
Herniated discs are usually caused by overuse injuries or injury to the back; however, disc conditions may also develop as a result of the standard aging process. It’s also known that there is a genetic factor that leads to the evolution of herniated disc and disc degeneration. As the size of herniation shrinks with time via resorption, typically, a herniated disc in the lower back will heal within six months. If physical therapy, drugs along with other treatments fail, operation may be needed.
What’s A Disk?
Spinal discs are cushion-like pads located between the vertebrae. Without these �shock absorbers,� the bones in the spinal column would grind against one another. Along with giving the backbone flexibility and making movements like twisting and bending potential, discs protect the spine by absorbing the effect of trauma and body weight. Each disk has a strong outer layer called annulus fibrosus and a soft, gel-like center, called nucleus pulposus. There are fibers on the outside of each disc that attach to adjoining vertebrae and hold the disc in position. A herniated disc occurs when the gel as well as the outer layer tears or ruptures -like middle leaks to the spinal canal.
The spinal canal has only enough space to place spinal fluid and the spinal cord. When a disc herniates and spills to the spinal canal, it could cause compression of spinal cord or the nerves. Alterations in sensation and intense, debilitating pain often happen. Furthermore, the gel-like substance inside the disk releases chemical irritants that bring about pain and nerve inflammation.
What Causes A Herniated Disc?
As we get older, the spinal disks gradually lose fluid volume. This process progresses slowly and begins at about age 30, over time. As the disks dry out, tears or microscopic cracks can form on the outer surface, causing it to become weak, fragile and much more susceptible to injury. The most common causes of herniated disc are:
Wear and tear: Disks dry out and aren�t as adaptive as they were.
Repetitive�movements: Work, lifestyle, and certain sports activities that place stress on the spine, especially the lower back, further weaken an already vulnerable area.
Lifting the wrong way: Never lift while bent at the waist. Proper lifting entails lifting with a straight back and your legs.
Injury: High-impact trauma can create the disk to bulge, tear or rupture.
Obesity: Carrying excess weight places an undue amount of strain on the back.
Genetics: There are a few genes which might be more typically present in individuals with disc degeneration. More research is necessary to investigate the role of those genes�they could be targets of biological treatment in the future.
Which Are The Symptoms Of A Herniated Disc?
Pain from a herniated disc can fluctuate, determined by severity and the place of the harm. It is typically felt on one side of the body.
Little or no pain could be felt in case the injury is minimal. Pain might be severe and unrelenting, in the event the disk ruptures. If significant nerve impingement has occurred pain may radiate to an extremity in a certain nerve root distribution. For instance, sciatica is often resulting from herniated disc in the low back. Herniated disc can manifest itself with a variety of symptoms, including:
Dull ache to severe pain
Numbness, tingling, burning
Muscle weakness; spasm; altered reflexes
Loss in bowel or bladder control (Note: These symptoms constitute a medical emergency. When they occur, seek medical attention immediately).
How Is A Herniated Disc Diagnosed?
History and physical examination point to some diagnosis of herniated disc. A herniated disc is likely if low back pain is accompanied by radiating leg pain in a nerve root distribution with positive straight leg raising test (ie, elevating the leg while lying down causes radiating pain down the leg), as well as other neurologic deficits for example numbness, weakness, and altered reflexes.
Imaging studies usually are ordered to confirm a diagnosis of herniated disc. X rays are not the imaging medium of choice because soft tissues (eg, discs, nerves) are hard to capture with this specific technology. However, they might be used as an initial tool to eliminate other illnesses such as for instance fracture or a growing. Confirmation of the feeling of herniated disc is generally achieved with:
Magnetic Resonance Imaging (MRI): This technology shows the spinal cord, surrounding soft tissue and nerves. It really is the best imaging study to support the identification of a herniated disc.
Nerve Conduction Studies (NCS) and Electromyogram (EMG): These studies use electric impulses to measure the level of harm to the nerve/s brought on by compaction from a herniated disc along with other conditions that cause nerve impingement may be ruled out. NCS and EMG are not routine evaluations to diagnose herniated disc.
Herniated discs occasionally heal independently through a process called resorption. This means the disk fragments are consumed by the body. Most people suffering from herniated disc do not need surgery and react well to conservative treatment.
What is a Herniated Disc?
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber).
A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body’s weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.
The progression to an actual HNP varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
Progression of Herniated Disc
The extremities affected are dependent upon the vertebral level at which the HNP occurred. Consider the following examples:
Cervical – Pain in the neck, shoulders, and arms Thoracic – Pain radiates into the chest Lumbar – Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation and is serious requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.
Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation of a spinal nerve) may increase when pressure is applied to the affected spinal level.
A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed.
Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.
Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance Imaging (MRI) provides more detail. The MRI is the best method enabling the physician to see the soft spinal tissues unseen in a conventional x-ray.
Radiographic Evidence of HNP
The findings from the examination and tests are compared to make a proper diagnosis. This includes determining the location of the herniation so treatment options can be reviewed with the patient.
Athletes are at higher risk of experiencing injuries or aggravating a previously existing condition due to the constant exposure to rigorous training and competitions. Although the lower extremities most frequently result in damage or injury, lower back complications have only been increasingly reported among the wide majority of athletes alike.
Among the young college athletes and professional athletes alike, low back pain is considered to be one of the most common complaints, estimated to affect more than 30 percent of athletes at least once in their career. A wide number of back injuries can affect the athlete, including muscle spasms and stress fractures, spondylosis, spondylolisthesis, disc degeneration, facet joint arthropathy and disc issues, such as lumbar disc herniation.
Lumbar disc herniation is a well-known type of injury which often causes impairing low back pain, however, it can also compress the nerve roots in the area and generate radicular pain and other symptoms along the lower extremities, such as altered sensations and muscle weakness. Furthermore, this type of injury will not only affect the athlete�s ability to perform during their specific sport or physical activity, it may also become chronic and affect the athlete in the future.
Conservative treatments are frequently utilized when managing lumbar disc herniation in athletes, although surgical options may be considered if the injury is too severe. Many elite athletes often request faster recovery methods for their type of injuries and symptoms in order to minimize their time spent away from training and competition. As a result, a wide number of athletes will seek surgical alternatives earlier than recommended, provided they meet the criteria for lumbar spine surgery. The most popular surgical procedure for athletes with a low back disc herniation is the lumbar disc microdiscectomy.
Anatomy & Biomechanics of the Lumbar Spine
The intervertebral discs of the lumbar spine perform an essential biomechanical role within the spine. These function to provide mobility between the segments of the spine while distributing compressive, shear and torsional forces. These discs are made up of a thick, outer ring of fibrous cartilage, known as the annulus fibrosis, which surround the gelatinous core of the disc, known as the nucleus pulposus, which is contained within the cartilage end plates.
Each intervertebral disc consists of cells and substances, such as collagen, proteoglycans and scattered fibrochondrocytic cells, which function to absorb and conduct increased forces from body weight and muscle activity. In order to effectively perform its function, the disc depends immensely on the structural condition of the annulus fibrosis, nucleus pulposus and the vertebral end plate. If the disc is healthy, it will evenly spread the forces being applied against the spine. However, disc degeneration caused by cell degradation, loss of hydration or disc collapse, can decrease the disc�s ability to withstand external forces and these will no longer be absorbed and conducted evenly across the spinal structures.
Tears in the annulus fibrosis of the disc along with extrinsic loads may ultimately cause the disc to herniate. Alternatively, applying a large, biomechanical force against a normal disc, such as a heavy compression on the spine due to a fall on the tailbone or strong muscle contraction from heavy weight lifting, can also damage the healthy structures of the disc and cause a rupture.
Disc herniation is characterized when the nucleus pulposus, the soft, jelly-like material in the center of a disc, pushes through a tear in the annulus fibrosis, the fibrous exterior of the disc. If the protrusion does not compress the nerve roots that travel along the spine, the individual may only experience back pain. But, if the herniated disc pushes against the lumbar nerve roots or other structures within the lower back, the individual may experience radicular pain along with neurological symptoms, such as numbness and paresthesia.
The pain and other symptoms associated with lumbar radiculopathy occurs due to a combination of nerve root ischemia from compression and due to inflammation caused by the chemicals released from a ruptured disc. During a herniation, the nucleus pulposus places unnecessary pressure against the weakened areas of the annulus, protruding through these weakened sites in the outer structure of the disc, ultimately forming a herniation. It�s important to note that when a lumbar disc herniation occurs, in a majority of cases, some form of disc degeneration may have existed before.
The Process of Lumbar Disc Herniation
Unlike other musculoskeletal tissues of the body, intervertebral discs generally degenerate sooner than other structures. Some studies have shown adolescents between the ages of 11 to 16 with signs of degeneration. As people age, the discs will naturally degenerate further. In a research study conducted using normal, healthy subjects between the ages of 21 to 30, more than one third of the individuals presented degenerated discs.
While the spinal discs may be at risk of injury in practically all fundamental planes of motion, these are often more susceptible to damage or injury during constant and repetitive flexion or hyperflexion along with lateral bending or rotation. Trauma from an injury caused by an excessive axial compression can also harm the internal structure of the discs. This can commonly result after the individual has suffered a fall or due to strong muscular forces being placed against the spine during specific activities, such as heavy weight lifting.
When it comes to athletes, they are frequently exposed to conditions of higher loading. A herniated disc can be categorized according to its location: central, posterolateral, foraminal or far lateral. Herniation varieties can also be classified as: protrusion, extrusion or sequestered fragment. Finally, disc herniation may be identified according to the level where they occurred on the spine. Most develop along the lumbar spine, often affecting the lumbar nerve roots which may lead to symptoms of sciatica. Upper lever herniated discs are rare, but when they do occur along with radiculopathy, they generally affect the femoral nerve.
Disc Herniation in Athletes
Athletes who participate in sports or physical activities which utilized combined trunk flexion and rotation have an increased chance of experiencing herniated discs. Individuals between 20 to 35 years of age are the most common group to herniate a disc, most likely as a result of the nature of the nucleus pulposis and due to behavior. This age group is most likely to be involved in sports which require higher loads of flexion and rotation or they may practice improper postures and positions when carrying weight.
The sports most at risk of disc herniation include: hockey, wrestling, football, swimming, basketball, golf, tennis, weight lifting, rowing and throwing activities, because these sports involve either high loads or high exposure to combined flexion and rotation mechanisms. Additionally, athletes who engage in more intense, continuous training routines appear to be at an increased risk of developing spinal injuries or conditions, similar to those involved in impact sports.
Signs and Symptoms Indicating Discectomy
An athlete is generally driven by motivation and goals when they choose to undergo surgery to treat a lumbar disc herniation. Rather than waiting for the symptoms to decrease over a period of rehabilitation, athletes prefer a relatively simple microdiscectomy.
A conservative period of management for symptoms of a lumbar herniated disc may involve: medication therapy, epidural injections, relative rest and trunk muscle rehabilitation, acupuncture and chiropractic care with massage. However, athletes who experience low back pain with pain radiating down one or both legs, neurological signs and symptoms, mild weakness of distal muscles, such as extensor hallucis longus, peroneals, tibialis anterior and soleus and those who demonstrated positive on the straight leg raise test, may meet the criteria to follow through with a surgical intervention for their lumbar herniated disc.
Generally, elite athletes have a shorter time span in which to allow conservative rehabilitation to be effective. For a majority of the population, medical practitioners often prescribe a minimum 6-week conservative period of treatment with a review at 6 weeks to decide whether they should extend the rehabilitation or to seek treatment from a specialist. This particular healthcare professional may then offer other alternative interventions to treat the issue.
For athletes, however, these time frames are compressed. Epidural injections are often offered to athletes to assess the issue quicker, and if there are no results within a determined period, an immediate lumbar spine microdiscectomy may follow.
Imaging
Magnetic resonance imaging, or MRI, are considered to be the preferred method for identifying lumbar disc herniation, as these are also very sensitive when detecting nerve root impingements. Because abnormal MRI scans can occur in otherwise asymptomatic individuals, it�s essential to establish a clinical correlation of symptoms before any surgical considerations. Additionally, individuals may present clinical signs and symptoms suggesting the presence of a lumbar herniated disc but they may lack sufficient evidence on MRI to meet the criteria to follow through with surgical interventions. Accordingly, it�s been proposed that a volumetric analysis of a lumbar herniated disc on MRI may be potentially valuable for assessing an individual�s and athlete�s suitability to receive surgery.
MRI Lumbar Spine Disc Herniation
Chiropractic and Massage
Fortunately, before considering surgical intervention, although more time and patience may be required, there are several effective, alternative treatment options that can help reduce and eliminate the symptoms associated with a lumbar herniated disc. Chiropractic is a healthcare profession that focuses on injuries and conditions of the musculoskeletal system and the nervous system as well as the effects of these on general health. Chiropractic care emphasizes the treatment of the body as a whole rather than focusing on a single injury or condition. Through the use of spinal adjustments and manual manipulations, two of the most common techniques used in chiropractic, a chiropractor can carefully re-align the spine, helping to restore and reduce the pain and swelling caused by a lumbar herniated disc.
Along with a combination of massage, chiropractic care can ultimately help rehabilitate an injured athlete or individual. A massage, best referred to as myofascial release, is a hands-on technique that involves applying gentle, sustained pressure into the myofascial connective tissue restrictions, to eliminate pain and restore function. Massage can increase blood flow, which delivers more oxygen and nutrients to the muscles surrounding the affected region of the spine. The increased blood flow may also help carry away unnecessary substances which may have accumulated through time. Chiropractic care and massage are safe and effective treatments that can help rehabilitate athletes with lumbar disc herniation without side effects.
Sports injuries can become a difficult situation for any athlete, especially if the symptoms become more severe, leading to further complications. When recovering from an injury, an athlete’s main concern involves them returning to play as soon as possible. Chiropractic care and the use of physical therapy as well as other types of treatment methods and massage can help individuals effectively recover from their injuries.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
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