Columbia Advanced Chiropractic Blog, Body at Work

I have been asked a lot recently about disc problems and other factors that cause low back pain. Although there are many causes, the most common one is due to mechanical causes.  This means pain due to joint problems and subsequent soft tissue (muscle and ligament) compensation.  Although research has shown that the disc is not always the cause of low back pain, disc problems are often times the greatest concern a patient has when experiencing low back pain.

The topic of disc problems is lengthy and it is possible only to briefly touch on this topic.

To begin, it is a good idea to understand what spinal discs are.  The discs of the spine separate one vertebra from another acting like shock absorbers and allowing for spinal movement.  A disc is made up of a tough jelly-like inner material (somewhat like toothpaste) known as the nucleus pulposus (inner 1/3 of disc).  Layers of strong fibers (fibrocartilage) called the annulus (outer 2/3 of disc) wrap the nucleus.  The nucleus is thicker than the annulus thereby allowing the vertebra that rests on top of a disc to basically teeter or “balance” on the nucleus.  The nucleus is under pressure from the weight of the vertebra above it and ultimately the weight of the remainder of the body above it.  The inner disc gets its nutrient supply from the vertebral bodies above and below (a process called imbibition).  Basically, spinal joint movement pushes nutrients into the disc.  The inner 2/3 of the disc (part annular and part nucleus) has no blood supply!  This is the reason why proper spinal joint movement is so important.  If the spinal joints do not move, then the discs do not get their nutrients, and degeneration occurs!  It is the jelly-like nucleus that is displaced through cracks or tears in the annular fibers that results in a disc bulge.  If the outer layers of the annulus tear and the nucleus leaks out, this is called a herniation.

Terms often used to describe a disc injury include herniation, rupture, bulge, prolapse, extrusion, protrusion, slipped, etc.  To simplify the confusion and use the correct terminology, it is better to describe a disc injury with respect to what has occurred to the nucleus.  For example, if the nucleus has come out of the disc, the injury is referred to as a non-contained disc injury (herniation or protrusion).  If the herniated portion of nucleus detaches from the disc itself and “floats” around in the spinal canal then it called a disc prolapse.  This is the most serious type of disc problem.  On the other hand, if the nucleus has only worked its way through some of the fibers and is still held inside the disc, it is called a contained disc injury (bulge).

Diagnosing a disc injury is not always black and white.  There is often uncertainty that goes along with the suspected diagnosis.  In regards to a lumbar disc issue, when there are obvious signs of sciatic nerve radicular pain (burning into the lower leg) or sciatic radiculopathy (tingling and/or numbing into the lower leg), it is a little easier to make the assumption that a disc is involved (but not always).  Again, this is only an assumption.  This is because there are soft tissue problems that can mimic disc problems!  There are even times when a disc can be injured but not have any signs of sciatic nerve compression.  Under this circumstance, determining if a disc is involved becomes more difficult.

X-rays generally do not help in the diagnosis of disc injuries.  This is due to the fact that x-rays do not show any soft tissue.  A MRI is much more helpful as it shows all the tissues.  But even a MRI is not an absolute test as studies have shown that MRI examinations of the low back for disc related injuries could have a thirty-percent false positive reading.  Therefore, the diagnosis of a disc injury is not made by utilizing any one test or procedure.  Instead, the diagnosis is made by carefully putting together all of the pieces of the puzzle (history, examination, diagnostic imaging, etc…).

Proper chiropractic treatment of disc injuries focuses on improving mechanical function of the joints in the area of the injured disc and then stabilizing the region.  By restoring normal joint function, proper mechanics are restored and wear and tear on the disc can be stopped.  This enables the body to begin the process of healing.  Chiropractic care is very effective as a form of treatment for disc injuries.  However, it is important to note here that no single treatment for disc injuries yields 100% success.  Many times a combination of chiropractic and medical care works best for disc problems.  It is also important to state that some cases of disc injury do require surgery.  A surgical emergency occurs when a disc fragment presses against the spinal cord and causes serious muscle function loss such as loss of bowel and/or bladder function.  Luckily, most disc injuries do not lead to this type of problem and they can be addressed through conservative means!

One of the keys to successful care of disc pathologies is early detection and treatment for the disc injury.  A particular technique, called Cox flexion/distraction (www.coxtechnic.com) has been researched and studies are in the literature showing its efficacy with disc pathologies.  It is important to note that only PROPER care for disc problems will yield positive results. Improper care can make the condition far worse.  When seeking care for disc problems (or potential disc problems), make sure the person you are seeking care from has the appropriate training to deal with disc issues as a specific protocol is needed for each individual case.