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A close friend and colleague recently wrote this article on disc herniations. It is a great article and if you have ever been diagnosed or suspect you have/had a disc herniation this article will be very interesting to you!
So what exactly is a disc and what is its function?
Discs are located between each of the vertebra of the spine, with the exception of the top two. The disc is made up of three parts: nucleus pulposis, annulus fibrosis and end plate (Picture 1 @ left). The nucleus is a liquid material in the middle of the disc with the consistency of tooth paste or jelly. The annulus is a fibrous ring that contains the nucleus, and finally the end plate is cartilage that sits on top and below the nucleus to further contain it. Located directly behind the disc lies the spinal cord and the nerve roots that supply the arms and legs. The main function of the disc is to allow for mobility of the spine and transmit forces during these movements. They are not shock absorbers, but are better to think of as a fulcrum for spinal movement.
What is a disc herniation?
A disc herniation is when the nucleus inside the disc tears its way through the annulus and either applies pressure directly on the nerve roots and/or creates an inflammatory reaction that can irritate the nerves (Picture 2). These herniations can create low back pain, buttock, leg and foot pain, numbness, tingling or burning sensations. However, presence of a disc herniation does not guarantee symptoms. Research has shown that as much as 50% of 40 year old patient will have signs of disc herniation on MRI's without any symptoms!
How do you get them?
Clinical research has shown that the number one cause of disc herniations is repetitive forward bending with rotation of the spine. Countless studies by famed low back researcher Stu McGill PhD have taught us that it takes about 10,000 bends of the spine to create a disc herniation. This is why patients will commonly come in to our office embarrassed because they hurt their back simply bending over to lift a pencil or other small item. Well in all actuality it had nothing to do with what they were lifting, but rather the number of times they lifted with poor form. Sitting and sit-ups also play a tremendous toll on the low back. Prolonged sitting, particularly with a slouched posture, is the worst posture for the low back (picture 4). The only thing worse for the spine then sitting is sit-ups! Commonly patients will tell us that they have been doing sit-ups at home to try and strengthen the muscles around the spine, however they have no idea that every time they do a sit-up it puts 730 LBS OF PRESSURE ON THE DISC AND ACTUALLY CREATED THEIR DISC HERNIATION WITH THEIR EXERCISE!
How does a doctor know if I have a disc herniation?
Our physicians will begin our exam with a thorough history, physical exam and later imaging if necessary. The classic disc herniation history will show pain in the low back and leg that is worse in the morning and painful with sitting and bending. Physical examination will vary depending upon specifics of the case but will typically include watching the patient walk, checking spinal reflexes, and performing various orthopedic test to see if we can reproduce the chief complaint. As a rule of thumb, if we can change your pain, we can help your pain. Finally, after the physical exam IF we determine that imaging is required the patient will be sent for an MRI (Picture 3).
How are disc herniations treated?
We manage disc herniation cases by treating with biomechanically superior adjusting techniques. In addition these patients will receive a full workup with the McKenzie Technique to determine the required route of rehabilitation exercises that the patient warrants. With the combination of spinal adjusting and rehabilitation we can successfully treat the vast majority of patients with disc injuries. Although they may be painful, disc injuries are really not as scary as they sound and the research supports conservative management as the first approach to treatment. Clinical research has shown that less than 3% of disc herniations will require any surgical action. We are trained to recognize the patients that do require more aggressive action and will readily refer to our Medical colleagues when it is indicated.
So what exactly is a disc and what is its function?
Discs are located between each of the vertebra of the spine, with the exception of the top two. The disc is made up of three parts: nucleus pulposis, annulus fibrosis and end plate (Picture 1 @ left). The nucleus is a liquid material in the middle of the disc with the consistency of tooth paste or jelly. The annulus is a fibrous ring that contains the nucleus, and finally the end plate is cartilage that sits on top and below the nucleus to further contain it. Located directly behind the disc lies the spinal cord and the nerve roots that supply the arms and legs. The main function of the disc is to allow for mobility of the spine and transmit forces during these movements. They are not shock absorbers, but are better to think of as a fulcrum for spinal movement.
What is a disc herniation?
A disc herniation is when the nucleus inside the disc tears its way through the annulus and either applies pressure directly on the nerve roots and/or creates an inflammatory reaction that can irritate the nerves (Picture 2). These herniations can create low back pain, buttock, leg and foot pain, numbness, tingling or burning sensations. However, presence of a disc herniation does not guarantee symptoms. Research has shown that as much as 50% of 40 year old patient will have signs of disc herniation on MRI's without any symptoms!
How do you get them?
Clinical research has shown that the number one cause of disc herniations is repetitive forward bending with rotation of the spine. Countless studies by famed low back researcher Stu McGill PhD have taught us that it takes about 10,000 bends of the spine to create a disc herniation. This is why patients will commonly come in to our office embarrassed because they hurt their back simply bending over to lift a pencil or other small item. Well in all actuality it had nothing to do with what they were lifting, but rather the number of times they lifted with poor form. Sitting and sit-ups also play a tremendous toll on the low back. Prolonged sitting, particularly with a slouched posture, is the worst posture for the low back (picture 4). The only thing worse for the spine then sitting is sit-ups! Commonly patients will tell us that they have been doing sit-ups at home to try and strengthen the muscles around the spine, however they have no idea that every time they do a sit-up it puts 730 LBS OF PRESSURE ON THE DISC AND ACTUALLY CREATED THEIR DISC HERNIATION WITH THEIR EXERCISE!
How does a doctor know if I have a disc herniation?
Our physicians will begin our exam with a thorough history, physical exam and later imaging if necessary. The classic disc herniation history will show pain in the low back and leg that is worse in the morning and painful with sitting and bending. Physical examination will vary depending upon specifics of the case but will typically include watching the patient walk, checking spinal reflexes, and performing various orthopedic test to see if we can reproduce the chief complaint. As a rule of thumb, if we can change your pain, we can help your pain. Finally, after the physical exam IF we determine that imaging is required the patient will be sent for an MRI (Picture 3).
How are disc herniations treated?
We manage disc herniation cases by treating with biomechanically superior adjusting techniques. In addition these patients will receive a full workup with the McKenzie Technique to determine the required route of rehabilitation exercises that the patient warrants. With the combination of spinal adjusting and rehabilitation we can successfully treat the vast majority of patients with disc injuries. Although they may be painful, disc injuries are really not as scary as they sound and the research supports conservative management as the first approach to treatment. Clinical research has shown that less than 3% of disc herniations will require any surgical action. We are trained to recognize the patients that do require more aggressive action and will readily refer to our Medical colleagues when it is indicated.
~Originally posted by Dr. Clinton Daniels
Thanks for reading this blog on disc injuries. If you have had a disc injury in the past please share your experience or if you have any questions about this blog or suggestions for future blogs, please feel free to leave a comment or contact our office to speak with one of our physicians directly.
Thanks for reading this blog on disc injuries. If you have had a disc injury in the past please share your experience or if you have any questions about this blog or suggestions for future blogs, please feel free to leave a comment or contact our office to speak with one of our physicians directly.
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