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
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.
The goals of the chiropractic treatment of a thoracic disc herniation are to reduce pain and dysfunction while the body heals itself.
Since most disc extrusions naturally regress in a few months, chiropractors will attempt to reduce the pain and pressure caused by the disc herniation. Chiropractic treatment of a thoracic disc herniation may include one or a combination of the following:
Some chiropractors will recommend nutritional support, such as proteolytic enzymes, to reduce the pain and swelling associated with a disc herniation.
More Chiropractic Treatments for Upper Back Problems
In addition to joint dysfunction, myofascial pain syndrome, and thoracic herniated disc, which have already been reviewed in this article, chiropractic care may be a treatment option for additional upper back problems, such as thoracic joint dysfunction, thoracic outlet syndrome, and shoulder dysfunction related to the upper spine.
Will your back pain become chronic?
Joint dysfunction
The thoracic spine is a marvel of joint interaction and complex motion patterns. Composed of a total of 220 separate joints,1 it makes up the lion�s share of the 313 total joints in the entire spine. With this many interactive articulations it is easy to see that maintaining normal joint function, motion, and position is important. Chiropractors treat thoracic joint dysfunction with chiropractic adjustments.
There are a variety of chiropractic-adjustment techniques that can be used to adjust a dysfunctional joint:
Most chiropractors employ manual adjusting techniques that utilize precise thrusting adjustments to help normalize joint function.
Chiropractors can also use softer directional adjusting techniques or adjusting instruments to accommodate the needs of the patient.
Thoracic outlet syndrome
Thoracic outlet syndrome (TOS) is a disorder in which the nerves of the brachial plexus and blood vessels are compressed. This compression can cause great pain and altered sensations such as a �pins and needles� sensation in the hands.
Treatment of thoracic outlet syndrome can include stretching, manual trigger-point therapy, and myofascial anchor-and-stretch release techniques to the affected muscles. Chiropractors may also include adjustments and postural instruction.
Thoracic/shoulder dysfunction
The function of the shoulder and the upper back are interrelated. Studies have shown that thrusting manipulations applied to the thoracic spine and ribs have reduced shoulder pain and dysfunction. Chiropractic adjustments to the thoracic region can be beneficial to certain types of shoulder dysfunction.
There are many causes and treatment options for thoracic spine disorders. Chiropractors have a wide range of treatment options for treating these conditions. Chiropractors are increasingly joining collaborative spinal care teams as a drug-free option for treating spinal and musculoskeletal conditions.
The thoracic spine is a marvel of joint interaction and complex motion patterns. Composed of a total of 220 separate joints, it makes up the lion�s share of the 313 total joints in the entire spine. �It’s easy to see that maintaining normal joint function, motion, and position is important. Chiropractors treat thoracic joint dysfunction with chiropractic adjustments.
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