Disc Injury | Discogenic Disease

Pain in the neck or back (upper or lower) can be the result of a disc injury or degenerative disc disease, both involving the discs of the spine.

Chiropractic for Disc Injury

“Manipulation has been shown to be an effective treatment for some patients with lumbar disc herniation.” (J Manipulative Physiol Ther. 1993 Jun;16(5):342-6)

“Chiropractic distraction manipulation is an effective treatment of lumbar disk herniation.”

(J Manipulative Physiol Ther. 22(1):38-44)

“Management of post-surgical lumbar disc herniation with chiropractic and active rehabilitation is discussed…Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.” (Journal of Chiropractic Medicine, 3(3):108-115)
In another study, this one published in the Journal of Neurology in 2003, 55 patients with lumbar disc injuries who after an initial (5-day) favorable response to chiropractic methods (“mechanical physiotherapy”), reported “at a median follow-up of 55 weeks, there were high rates of patient satisfaction, recovery from neurological deficits, employment, and a low rate of surgical interventions.” (Journal of Neurology, 2003; 250(6):746-749)

How Can Chiropractic Therapy Help My Injured Disc?

Your chiropractic physician will start with a medical history and physical exam.  The physical exam often includes orthopedic and neurologic testing during which the doctor may come to suspect that you have a disc injury.  If a disc injury is suspected, the doctor may order imaging studies, such as an x-ray, to assess any changes in your bone structure. The doctor may also recommend an MRI, which is the best way to see the actual disc and the extent of any disc injury that may be present.

Once a determination of the injury and extent of injury is made, a chiropractic care plan can be developed.  The first stage of this care plan will be acute care aimed at reducing the pain and inflammation. Modalities such as joint manipulation, physiotherapy, ice, ultrasound therapy, traction, interferential electrical stimulation, nutritional supplements and even acupuncture may be recommended. Another treatment that may be recommended is special stretching on a flexion distraction table. This is done to manually decompress the disc, by creating a negative vacuum in which the disc bulge or herniation can be sucked back inside the disc space.

“Nonsurgical spinal decompression provides a method for physicians to properly apply and direct the decompressive force necessary to effectively treat discogenic disease.” (J Manipulative Physiol Ther. 1989 Jun;12(3):220-7)

According to the study from which this quote came, spinal decompression helped 92% of patients previously thought to need disc-related surgery to restore mechanical function of the related disc(s) and helped 86% of them to alleviate their symptoms of pain related to the disc injury or degeneration.

“Treatment was successful as defined by: pain reduction; reduction in use of pain medications; normalization of range of motion, reflex, and gait; and recovery of sensory or motor loss.”
Patients with disc injuries report great relief when pressure is removed from the disc.  Sometimes pain reliever injections may be deemed necessary as a temporary measure to alleviate pain during the healing process. Surgery to repair the disc is sometimes also recommended.

At our office we will discuss all your options for care. Most important is to get an accurate diagnosis as soon as possible after your injury. Some disc injuries may lead to permanent nerve damage if not treated promptly and appropriately.

Common Types of Disc Injuries We See in Our Office

Before proceeding with this partial list of disc injuries seen in our office, there is a caveat that for many people may come as a long-awaited explanation: there is, unfortunately, no consensus among medical and health care professionals as to the exact definitions of these terms. In the following descriptions we aim, as always, to be as anatomically precise as possible.

Although not a comprehensive list of every type of disc injury by any measure, the following is an overview of some of the most common types of disc injuries we see in our office.

Disc Derangement: This is an all-encompassing term used to indicate any injury to the disc; the injury can occur with or without nerve compression or pain.

Intervertebral Disc Syndrome: This is a non-specific term used to indicate pain coming from the disc without indicating specifically where or why.

Bulging Disc (aka Disc Prolapse, Disc Protrusion): This is when the nucleus of the disc starts to bulge and then, most often, tears one-by-one through the disc’s 18 layers of annular fibers. Sometimes this bulging (or out-pouching) places pressure on surrounding nerves or on the spinal cord itself, but this is not always the case. It is quite common for people to have bulging discs on MRI but no pain because the bulge hasn’t broken through to the layers of the disc that contain nerves. Once the bulge passes through into the other layers, however, it can potentially cause shooting pain down the arm if the injured disc is located in the neck or down the leg, as in cases of sciatica, if the injured disc is in the low back. Usually, bulging discs are caused by trauma that has built up over time from lots of repetitive stress to the area. Then something as simple as bending over to pick up a pencil may be the “final straw” that causes the disc to herniate.

Disc Herniation (aka Herniated Disc, Disc Extrusion): This is when the nucleus of the disc has broken through all of the layers of the disc beyond the vertebral margin while the outer region (or annulus) remains intact. As the word “extrude” means to thrust or force out, the term “disc extrusion” is often used to describe a disc herniation. A disc herniation (or extrusion) may result in nerve compression and sometimes  spinal cord compression. Most of the time a disc herniation will cause pain, and it can cause numbness, tingling, and weakness too.

There are 3 types of disc extrusion:

1. Subligamentous Disc Extrusion in which the disc herniates and tears the outer annulus but does not go beyond the ligament.
2. Transligamentous Disc Extrusion in which the disc herniates and tears the outer annulus beyond the ligament, but without any disc debris breaching the intervertebral foramen (or opening).
3. Disc Extrusion with Sequestration in which the disc herniates and tears the outer annulus beyond the ligament and has leaked disc debris into the intervertebral foramen.

Other terms commonly used interchangeably for both Disc Herniation and Disc Extrusion include:

• Slipped Disc
• Disc Tear
• Ruptured Disc
• Disc Lesion

Specific symptoms of a herniated disc include:

• a pain often described as an electric shock
• numbness and tingling
• muscle weakness
• gastrointestinal difficulties (bladder or bowels)

Sadly, people often mistake pain of disc injury and degenerative disc disease for common “minor” back pain (as from over-exertion or a muscle sprain or strain), which is one cause of many disc injuries and cases of degenerative disc disease going undiagnosed and therefore untreated for far too long.

What is a Disc?

Discs, also known as intervertebral discs due to their relationship to the spine, are the separators between each of the vertebrae (or bones of the spine).

The human spine has 23 discs. Their primary purpose is to act as shock absorbers to cushion the impact on adjacent vertebrae (or bones of the spine). But that’s not their only purpose. To summarize simply, a disc serves the following three roles:

1. as separator – creating space between the vertebrae and keeping them from rubbing against one another
2. as shock absorber – cushioning the vertebrae from impact and compression
3. as spinal mobility – allowing the vertebrae a limited range of movement

As for the physical structure of spinal discs, they are made up of two parts:

1. nucleus pulposus – the soft interior portion
2. annulus fibrosus – the hard exterior portion

The nucleus of a disc is made up of loosely meshed fibers suspended in a gel-like substance. It is surrounded by the 18 concentric layers of resilient collagen fibers that comprise the annulus. This tough but pliant and elastic fibrous exterior seals in the gel in the nucleus, and constantly shifts and adjusts itself so as to evenly distribute the pressure being placed upon it. These two portions are connected to one another with plates made of cartilage that fit them together like two cylinders, one inside the other. A popular (and sometimes helpful) visual analogy for this is a jelly doughnut.

Interesting to note is that a person could actually tear through the innermost 8 layers of a disc and not even experience any pain, since no nerve parts or blood supply pass through them.

Degenerative Disc Disease

To start with, the name “Degenerative Disc Disease” is actually a misnomer and not really a disease at all. Nor is it always progressive, as the term “degenerative” implies. Everyone will experience disc degeneration as they get older. However the symptoms individuals experience will vary with some experiencing no symptoms at all and others experience pain from disc injuries intermittently.
Not all practitioners agree on what the definition of degenerative disc disease encompasses. Generally there are two contributing factors to degenerative disc disease:

1. the natural “wear and tear” of time and age that causes discs to dehydrate
2. tears or ruptures in the discs through which inflamed proteins in the ordinarily-sealed disc space are allowed to leak out and cause the surrounding nerve roots and related nerve structure to become inflamed as well; these tears, unfortunately, never fully heal and eventually lead to the disc dehydrating

In both these scenarios, dehydration is the penultimate stage in the process of disc degeneration, the final one being the disc space increasingly narrowing and the disc itself becoming increasingly stiff and incapable of effectively doing its job of protecting the vertebrae anymore (in turn, a contributing factor to arthritis).

Speaking of which, you may sometimes hear degenerative disc disease referred to as arthritis, spondylosis, or osteoarthritis, but these are all inaccurate analogues. That’s because degenerate disc disease describes a condition of and directly impacting the discs, while arthritis, spondylosis, and osteoarthritis refer to changes in and of the bone (albeit in this instance, the bones of the spine – or the vertebrae). What accounts for the common mix-up in terminology is that degenerative disc disease is usually accompanied by arthritis, spondylosis or osteoarthritis. Sometimes degenerative disc disease is discovered before the arthritic changes occur, and in some instances (as mentioned above) could be a contributing factor to the development of arthritis.

The gradual stiffening of the discs over time and in response to injury causes them to become less pliable, less able to adjust to pressure, impact, friction, and compression. In terms of tears in the discs, the absence of a blood supply to the discs subverts any efforts the body could make to fix the tears, leading to the condition becoming progressively degenerative.

Whether it’s due to the natural process of aging or a sudden injury, the pain of degenerative disc disease can be intense. This is due to the inflammation caused to the nerves and related structures surrounding the discs.
Interestingly, as people age, there are fewer and fewer inflammatory proteins in the discs. After the age of 60 pain from degenerative disc disease (or “discogenic pain”) are practically nil.

To learn more about what is causing your back pain and your options for treatment, call 773.878.7330 today to schedule an appointment at our office, Ravenswood Chiropractic Center located in Andersonville, Chicago.  Pain lasting more than one week is not normal and not good.  We accommodate same day emergency appointments for back pain.