Of
all the biomechanical (structural) ailments of the spine, a disc
condition can be one of the hardest to treat. It requires the longest
amount of healing time, approximately twelve weeks. In contrast, a
muscle strain will usually heal in two to four weeks and a ligament
strain in four to six weeks.
The
lack of a
direct source of blood supply is the main reason the disc takes so long
to heal. A disc only receives nutrients when the motion of the bones
above and below the disc causes some blood within that bone to be
pumped into the disc. However, this pumping action actually becomes
hindered due to the attendant back muscle spasms, which develop to
protect the back from further injury.
Disc
problems
require special attention. A proper examination and diagnosis is
essential to determine the best treatment guidelines. Chiropractors
have special training in the care of the spine and intervertebral disc.
Your Doctor of Chiropractic can help you determine if you have a spinal
disc condition. If so, a treatment plan that is right for you can then
be established to help you recover.
The
intervertebral
disc is made up of two components, an outer ligamentous wound covering,
called the annulus and an inner jelly-like substance called the nucleus
pulposus. The nucleus provides the main cushioning effect while the
annulus acts as the container that holds the disc between the vertebrae
and keeps the jelly-like nucleus in place.
The
design of intervertebral disc is such that it can withstand a
tremendous amount of compressive pressure. In fact, under heavy lifting
with the spine straight, you would fracture the vertebra before you
would ever rupture a normal disc. However, the high load capacity of
our discs do not do well when we subject them to shearing (twisting)
force.
Bending while lifting and
twisting is the most
difficult stress for the disc to handle. When a person bends forward,
the pressure in the discs of the lower back is nearly doubled. When an
object is lifted, especially far away from the body, this stress is
multiplied even more. If the person begins to turn as the object is
lifted, shearing force is transferred into the disc and the fibers that
make up the outer covering of the disc may begin to tear.
Tearing
of the annular fibers (outer covering) of the disc can happen slowly
and gradually or abruptly in a traumatic situation. Small tears may or
may not exhibit pain. This is because the nerves that reach the disc
are very small and do not cover a lot of the area. Sometimes when minor
tearing occurs, the pain will be described as a twinge. On the other
hand, severe tearing almost always results in sudden, prolonged, and
worsening pain, which is accompanied by muscle spasm and possibly
referred pain into an extremity (arm or leg, depending on where the
disc damaged occurs.)
When tearing
becomes extensive
enough that the nucleus pulposus can no longer be contained within the
center of the disc, the jelly-like substance that makes up the nucleus
begins to migrate out. This shifting of the nuclear material causes the
joint to function poorly. This in turn places the joint under added
stress with during movement and makes the disc even more susceptible to
repeated stress injuries.
If annular
tearing
continues slowly, a condition called a degenerative disc disease may
result. This is a disc condition where the disc slowly looses its
elasticity through a repeated process of wear and tear. The result is a
thin disc that functions poorly as part of the joint complex and also
functions poorly as a shock absorber for the spine.
If
annular tearing occurs quickly, or if a weakened disc receives enough
stress to tear through an already compromised area, the result will be
a shift of the nucleus from the center towards the outside of the disc.
This condition is referred to as a disc bulge or herniated disc
(slipped disc.) A small migration of nuclear material, 3mm outside the
disc or less, may be called a disc bulge or protrusion. A disc
herniation is generally larger. If disc material actually escapes and
separates from the outer edge of the disc a prolapsed disc is the
correct diagnosis.
Acute injuries can
happen from any
sudden tearing of the disc fibers. Common activities and situations
that injure discs are bending, lifting, or twisting the spine, falls,
or automobile accidents. The symptoms will vary due to level, location,
and size of the disc injury. A herniation can happen in any part of the
spine cervical (neck) thoracic (middle back) or lumbar (low back)
region. Of these, herniations in the thoracic region are very uncommon.
Disc injuries to the lower back are more common from lifting and
cervical disc injuries are an all too common in severe whiplash
injuries. A little known fact is that lifting a heavy can actually
cause a cervical disc herniation if the disc was already weakened.
Chronic
disc conditions can be the result of a poorly healed injury or from
excessive and repetitive stress. As more wear occurs, the disc becomes
dehydrated (dries out) and becomes thin. Calcium salts may try to
invade the disc and the surrounding tissue. This is the way the body
tries to stabilize the weakening disc. The result over time is joint
spurs (arthritis) and a poorly functioning back joint. Stiffness and
dull aching pain are usually reported in these classic cases of chronic
disc disease.
Discs that are
bulging, herniated, or
prolapsed often create sharp pain, which may radiate into the
extremities. A cervical disc herniation may cause pain down and arm.
Likewise, a lower back herniation may send pain down a leg. The area
the pain travels to is an important clue as to the level of the disc
injury. For instance, if the last lumbar disc is herniated, pain may
travel down the back of the right leg and into the little toe. If the
middle of the lumbar spine is damaged at the third lumbar disc level,
the pain will travel more towards the front of the leg.
In
the lower back, the position of the herniation also determines the
symptoms. For instance, if the disc herniation is near the center of
the spine, the pain may only be experienced in the back. The pain with
this type of herniation gets a bit better when you lean into the side
of pain and worsens when you lean away from the side of pain. A disc
herniation on the lateral side (away from the center of the spine.) may
only cause leg pain. The pain from this type of herniation decreases
when you lean away from the side of pain and worsens when you lean into
the side of pain.
Your Doctor of
Chiropractic is
specially trained in the treatment of the spine and through careful
history, examination, and imaging (x-ray and MRI) your chiropractor can
diagnose and treat most disc disorders. Your chiropractor can also
discuss with you any need for surgical intervention, should your
diagnosis warrant a more radical surgical solution.
Conservative
chiropractic care for disc conditions may involve the use of ice and or
ultrasound to reduce any initial swelling and inflammation during the
acute phase. Guarded stretching of certain muscles groups may also be
started. Also, manipulation may be used to restore lost joint
integrity, and traction to the disc can be done to help reduce (suck
back in) some of the migrating nucleus material.
Your
chiropractor may also recommend and fit you with a special back brace
to prevent re-injury and reduce pain. Nutritional recommendations
should also be followed to aid in the healing process.. For instance, a
substance called glucose-amino chondroitin sulfate is lost from injured
discs and may be replaced to a degree with supplements.
Remember
that disc injuries take approximately twelve weeks to heal. Patience is
required to cope with the expected ups and downs; however, with
successful treatment and time, the results can be a welcome alternative
to the use of drugs or back surgery.
Chiropractors
also frequently treat degenerative disc conditions. With manipulation
and other supportive measures such as applications of moist heat,
stretching, massage therapy, and proper exercise, the pain and
discomfort of degenerative joint disease can be greatly eased. With
proper continued care, the arthritic process can be slowed or halted.
Remember that if you have suffered from a previous disc condition in
the past, it would be wise to take good care of your spine and see your
chiropractor as recommended. A disc can never heal as good as new but
with good care, strengthening and support to the surrounding tissue,
your back may be spared the early onset of joint arthritis, which so
commonly follows a disc injury.