Everyone has heard of the term, ‘slipped disc’ that they or someone they know has been diagnosed with. This is old terminology, and is not what actually happens. Disc problems (or pathologies) are one of the more serious causes of back pain, so in this month’s article we will go into more depth about what is a disc, what problems can occur with it, and what will it mean for you if you have a disc problem.
What is a Disc?
Firstly let’s look at the anatomy of a disc, in the spine there is a column of bones called Vertebrae, and in between each of these there is a pad called the Inter-vertebral Disc. They are circular structures built to absorb impact yet still allow movement in between each spinal segment.
There are two parts to every disc, the outer Annulus Fibrosus and the inner Nucleus Pulposus. The Annulus Fibrosus is a ring like structure of very tough ligaments that connect the Vertebrae to each other. The Nucleus Pulposus is a gel like substance that fills the space in the middle of the annular ring. The Nucleus Pulposus provides the cushioning or shock absorption of the disc.
How bad is it?
When a problem occurs, it is damage or change to the Annulus Fibrosus from either trauma, or more commonly an imbalance in the hips and/or pelvis which puts increased pressure or loading on the discs in the lower back.
These changes are called disc herniations and are usually split into four categories.
Normal Disc: Annulus Fibrosis is intact and Nucleus Pulposus is centralized.
I - Annular Fissure: The inner part of the Annulus Fibrosus separates allowing the Nucleus Pulposus to move away from the centre.
II - Disc Protrusion: Annulus Fibrosis is stretched in one section of the disc allowing the Nucleus Pulposus to move further away from the centre of the disc.
III - Disc Extrusion: The Annulus Fibrosus has separated allowing some of the Nucleus Pulposus to push out into the spinal canal while still remaining attached to the main body of the disc.
IV - Disc Sequestration: The Nucleus Pulposus has separated from the main body of the disc and is floating freely in the spinal canal.
As you can see, the term ‘slipped disc’ is not correct, as the Annulus Fibrosus is firmly attached to the bone requiring fracture of the bone itself for it to be pulled free. Herniation of the disc is the correct term and it can then be graded by number or name as shown above.
The levels of change to the disc do not necessarily have any bearing on the type or severity of symptoms a patient may be experiencing.
Symptoms can vary from no symptoms at all, or they may experience some back pain, to the worst case scenario, back pain and pain radiating down the arm or leg depending on the location of the disc pathology.
One of the reasons for this variation in pain is that that only the outer third of the Annulus Fibrosus is pain sensitive.
The other, and more important reason, is the location of the disc herniation. The protrusion, extrusion or sequestration has to put pressure on either the spinal nerve root (where nerves exits the spine) or actually onto the spinal cord itself for it to cause radiating pain down the arm or leg.
Sometimes the symptoms the patient is experiencing can be misdiagnosed as being caused by the disc pathology, but the location of their disc pathology does not match the symptoms in the location or severity that they are experiencing.
There can often be more going on than just the disc herniation, so our treatment here at Spinal Symmetry tends to look into more than just the disc.
As disc herniations are clearly seen on an MRI, they are often the blame for the cause of the pain- which is true in that they are physically the final straw, however, when you investigate further to what has actually caused the herniation, you are able to go back to the root cause and address it.
What can be done?
If a trauma was involved then it is a matter of waiting for the inflammation to reduce and the tissues to heal.
However, if it is poor posture or altered biomechanics causing the disc herniation, correction through manipulative therapy can help to rectify this. Correcting the altered biomechanics- ie. in the hips and pelvis, will change the forces acting on the disc and this correction will allow the biomechanics to return to normal and therefore reduce the likelihood of recurrence.
Through the Spinal Symmetry method, your practitioner will not be treating the spinal segment that the disc is between. They will be dealing with the structures below it (hips and pelvis) so that the forces of gravity are spread more equally onto the damaged disc.
This allows the Nucleus Pulposus to return to the centre and the Annulus Fibrosus to heal. With the use of tractional adjustments to the hips, pelvis and lower back rather than rotational adjustments, this allows the joints space rather than putting undue stress on the disc tissues.
The use of the Dynamic Therapy strap is a long term solution to create stability in the hips and pelvis (Click here to read more about Dynamic Therapy). The use of Dynamic Therapy will alter the pressures on the discs over a period of time, allowing them to heal. This also potentially minimizes the risk of re-injury, as it keeps the hips and pelvis in their optimum state of symmetry- which is part of their genetic design.
As there is very little blood supply to the Annulus, it tends to slow down the healing process.
Depending on the severity of the disc herniation, the pressure on the nerve can be relieved on it’s own through improving the biomechanics as we discussed above, or in some cases surgery may be required, usually in the extrusion and sequestration stages.
Generally, a trial of conservative, non invasive care- which is what we can provide, is recommended before surgery becomes an option.
If you have a disc problem or you would just like further explanation or advice please ask one of our practitioners.