Spinal disc deterioration from aging is normal, but health issues or injuries can advance the degenerative process. Disc protrusions are related to herniated discs but are the mildest form of the condition and are a common form of spinal disc deterioration that can cause neck and back issues. However, individuals may have a small protruding disc that can go undetected unless it irritates or compresses the surrounding nerves. Chiropractic care, decompression, and massage therapy can realign the disc back into position, relieving discomfort and pain.
Disc Protrusion
A disc is like a sturdy soft rubber shock absorber/cushion with added gel inside. The gel acts as a shock absorber. When the gel begins to protrude out slightly, this is a disc protrusion. Once a protruding disc begins to develop, it usually remains in that position. The disc can sometimes reabsorb on its own and realign back into position, but there is no way of knowing that will happen or how long it will take. With age and/or injuries, the body’s parts change. The spine’s discs dehydrate and lose elasticity weakening the discs and making them more vulnerable to herniation stages:
First Stage
Following natural weakening can be classified as a disc protrusion when the disc’s core begins pushing into the spinal column.
Disc protrusions can be tiny or push out an entire side of the disc.
Second Stage
Disc deterioration often consists of a bulging disc when the core pushes out farther around the circumference beyond the disc’s outer layer, called the annulus fibrosus, creating the telltale bulge.
A bulging disc involves more than 180 degrees of the disc’s circumference.
Third Stage
The third stage is a herniated disc, meaning the disc’s outer wall has torn, allowing the inner gel to leak out, usually irritating the surrounding nerves.
Fourth Stage
The fourth stage is sequestration, a herniated disc in which a piece of the nucleus breaks free of the vertebral disc fragments and falls into the spinal canal.
Types
A disc protrusion is one type of disc herniation that pushes out but remains connected. Different types compress and irritate the discs differently and produce various symptoms, including:
Paracentral
This is the most common, where the disc protrusion jams the space between the central canal and the foramen.
Central
This is where the disc protrusion impinges into the spinal canal, with or without spinal cord compression.
Foraminal
The disc intrudes into the foramen, the space through which nerve roots branch off the spinal cord and exit the vertebrae.
Symptoms, Diagnosis, and Chiropractic Care
Individuals with a disc protrusion can have symptoms similar to sciatica, which includes back, buttock, and leg discomfort, numbness, and pain sensations.
Treatment for disc protrusion will be based on the individual’s symptoms.
A chiropractor will take a detailed medical history and perform a physical examination.
A spinal MRI test could be ordered depending on the injury or condition.
A customized treatment plan will be developed to fit the individual’s medical needs.
Most disc protrusions improve after a few weeks of rest, avoiding strenuous activities, activity modification, an anti-inflammatory diet, and gentle exercises that the chiropractic team will provide.
True Spinal Decompression
References
Fardon, David F et al. “Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology.” The spine journal: official journal of the North American Spine Society vol. 14,11 (2014): 2525-45. doi:10.1016/j.spinee.2014.04.022
Mysliwiec, Lawrence Walter, et al. “MSU classification for herniated lumbar discs on MRI: toward developing objective criteria for surgical selection.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 19,7 (2010): 1087-93. doi:10.1007/s00586-009-1274-4
A sports hernia is a soft tissue injury that happens in and around the groin area. It is a strain or tear of any soft-tissue muscles, tendons, or ligaments in the lower abdomen or groin area. It usually happens during physical sports activities that require fast, quick, sudden changes of direction and/or intense twisting movements. Despite its name, a sports hernia is not a hernia in the classic sense. The condition’s proper term is athletic pubalgia. However, a sports hernia can lead to an abdominal hernia. The condition can happen to both men and women.
Anatomy
The soft tissues most affected by sports hernias are the oblique muscles in the lower abdomen, along with the tendons that attach the oblique muscles to the pubic bone, are the most at risk. In many cases, the tendons that attach the thigh muscles to the pubic bone or adductors are also stretched or torn.
Core Muscle Injury
A core muscle injury is when the deep layers of the abdominal wall weaken or tear. This can cause nerve irritation and contribute to uncomfortable symptoms of numbness or tingling. The most common causes include:
Planting the feet and turning or twisting with maximum force.
Constant repetitive hip and pelvic twisting motions.
Imbalances between the hip and abdominal muscles can also, over time, cause overuse injuries.
Weakness in the abdominals and improper or no conditioning can also contribute to injuries.
Chronic groin pain is the primary symptom of a core muscle injury.
Sharp groin pain with exertion.
Basic movements like sitting down or getting out of bed can also present with pain or discomfort.
Pain on one side of the groin.
Pain or numbness that radiates into the inner thigh.
Pain when coughing or sneezing.
Tenderness or pressure on the lower abdominal area.
Pain decreases with rest.
Diagnosis
A doctor will discuss symptoms and how the injury occurred. They will run a series of strength tests like a sit-up or trunk flex against resistance. If it is a sports hernia, there will be tenderness in the groin or above the pubis, along with discomfort and pain. Further tests will include MRI, ultrasound, or X-rays to rule out hip, low back, or pelvis injuries to confirm a core muscle injury.
Non-Surgical Treatment
Rest
In the first 7 to 10 days after the injury resting and icing the area is recommended.
If there is a bulge in the groin, compression or a wrap can help relieve symptoms.
Chiropractic and Physical therapy
Two weeks after the injury, chiropractic adjustments and physical therapy exercises are recommended to improve strength and flexibility in the abdominal and inner thigh muscles.
For most cases, 4 to 6 weeks of chiropractic and physical therapy will resolve any pain and allow the individual to return to their exercise or sports activity.
Anti-inflammatory Medications
A doctor could recommend non-steroidal anti-inflammatory medications to reduce swelling and pain.
If the symptoms persist over a prolonged period, a doctor may suggest a cortisone injection.
If the pain comes back when resuming the physical activities, surgery could be needed to repair the torn tissues.
Surgical Treatment
Repairing the torn tissues can be done with a traditional open procedure that involves one long incision or a minimally invasive endoscopic procedure. In an endoscopy, the surgeon makes smaller incisions and uses a small camera, called an endoscope, to see inside the abdomen. The results of traditional and endoscopic procedures are the same. Most individuals can return to sports and physical activities 6 to 12 weeks after surgery.
Body Composition
Muscle Gain
Individuals can’t lose fat forever. At some point, they need to work on developing muscle or work to preserve the muscle that is already present. This requires a different diet and exercise plan than one designed for fat loss. Instead of getting the body into a catabolic state, the body needs to be in an anabolic state where the body builds tissue instead of breaking it down. To build muscle, the body needs resources meaning proper nutrition and sufficient protein intake to increase muscle mass. Maintaining an energy surplus of around 15% is appropriate for developing musculature, meaning a moderately active individual with a BMR of 1,600 calories would want to their intake to about 2,852 calories a day.
References
Hoffman, Jay R et al. “Effect of protein intake on strength, body composition and endocrine changes in strength/power athletes.” Journal of the International Society of Sports Nutrition vol. 3,2 12-8. 13 Dec. 2006, doi:10.1186/1550-2783-3-2-12
Larson, Christopher M. “Sports hernia/athletic pubalgia: evaluation and management.” Sports health vol. 6,2 (2014): 139-44. doi:10.1177/1941738114523557
Poor, Alexander E et al. “Core Muscle Injuries in Athletes.” Current sports medicine reports vol. 17,2 (2018): 54-58. doi:10.1249/JSR.0000000000000453
Thorborg, Kristian et al. “Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management.” The Journal of orthopedic and sports physical therapy vol. 48,4 (2018): 239-249. doi:10.2519/jospt.2018.7850
Tyler, Timothy F et al. “Groin injuries in sports medicine.” Sports health vol. 2,3 (2010): 231-6. doi:10.1177/1941738110366820
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