Hey guys, Dr. Lell here explaining another common condition in an easy-to-understand way along with a review of current treatment options.
Ever hear about someone’s slipped disc? Or about how they threw their back out? Uncle Stan’s bulging disc? Fortunately, none of these things sound as bad as a full blown disc herniation. There are a lot of names out there to describe the different injuries to and pains caused by the discs between the bones in your spine. Today we’re going to talk about herniated disks. What it feels like to have them, what caused them to happen, and what people can do about them. As a low back pain expert of the medical community, I can type volumes about this one subject. But I’ll try to keep it condensed and easy to digest. I’ve separated out a closely related condition that often precedes this into another blog, the bulging disc. I strongly recommend you read that as well to gain a more comprehensive understanding.
Who gets this injury?
Usually people between the age of 25-45 but especially between 35-45 years. It used to be predominantly men but as more women enter jobs requiring heavy lifting, those statistics are starting to even off.
What does it feel like?
The symptoms can greatly depend on severity. They include…
- Low back pain
- Pain, tingling, burning, or numbness into the butt, groin, or leg
- Weakness of the legs or feet
- Changes in your bathroom habits
- Sexual dysfunction
The pain is usually made worse with…
- Getting in and out of a car, a chair, or bed
- The pain is usually worse in the morning
What causes it?
The pain and herniation are usually caused by a singular event like lifting something heavy. But this event is usually the last thing in an accumulation of factors. It’s the last straw that broke the piano mover’s back. People can be pre-disposed to these injuries making them more likely than someone else to get it. These predispositions can include a weakened annulus (more on this later), a degenerative spine, being overweight, and smoking cigarettes just to name a few. There are even weird ones like working a night job or being depressed. Some people are even finding a genetic link.
To understand the ins and outs of what’s really going on, we need to cover some of the anatomy and how they interact with one another.
Take a look at this image from Rochester Medical Center. The disc is composed of two parts: the annulus and the nucleus. The nucleus is a thick jelly like material and it is surrounded by a thick outer covering (think of a tire or a wicker basket), the annulus. Around the disc are the nerve roots that help you walk, feel, and pee and the spinal cord is in the middle.
The jelly like nucleus moves and changes in reaction to what you’re doing with your body. It is supposed to cushion your lumbar vertebra throughout its range of motion and act like a shock absorber. If you bend forward, the nucleus gets pushed towards the back. If you bend backwards, it goes towards the front. Same idea with bending side to side. The flaw in our design is that the thick outer covering is weakest in the back (near the spinal cord) and off to the side (on top of the nerves).
Through abnormal wear and tear (and not helped by those dispositions), the thick annulus starts to break down – especially in those weak spots. Think about taking a rubber band and rubbing it across a sharp corner. Eventually, the band will start to fray and snap – it’s kind of the same thing.
So – the moment of injury. Traditionally, the injury occurs with bending over and/or lifting something. This builds up enough pressure in the disc to shoot the jelly like nucleus through the weakened outer covering (the annulus). Sometimes the nucleus hits up against a nerve or the spinal cord causing neurological involvement. This usually happens in the lumbar spine but can occur in the neck and mid-back too.
The broken annulus is painful. The nucleus is where it shouldn’t be (outside of the annulus) so the body treats it like an invader and sets up a local inflammatory response (this is also painful). The muscles in the low back and surrounding area sieze up and lock as a protective mechanism. And if the nerves are being pushed on, you may get radiation into the legs or some weakness.
I’ve got a herniated disc – what do I do about it?
Herniated discs are generally self limiting despite being painful. Waiting it out and hoping you don’t make it worse is an excruciating option but 75% of all herniated discs spontaneously resorb within six months and the larger they are, the faster they disappear. Now in some cases, emergent care is very necessary so it’s important to monitor the situation. Increasing muscle weakness, change in bowel or bladder, or tingling/pain in the upper inner thighs and pubic region call for a trip to the emergency room.
They can be debilitating so most people choose to get treatment. Treatment not only helps with the pain but also drastically cuts the healing time. The options are the traditional medical route, surgery, or conservative care like chiropractic medicine or physical therapy. The risks of each must be weighed against your specific situation and what you’re hoping to gain. Prescription painkillers and muscle relaxers will help with the pain but they won’t do anything for the underlying problems causing the pain and may even allow you to cause further damage by dampening your body’s warning system (that’s what pain is – just an alarm that something is going wrong). New surgical procedures today are an okay option because they’ve gotten less invasive but I’m inclined to try anything before going under the knife. A study was done comparing the effects of surgery vs chiropractic care. People who underwent either chiropractic care or surgery have the same pain levels months after treatment has ended. The surgery group got there faster but the group receiving chiropractic care maintained the gains for longer.
Once you’ve herniated a disc, you’re more likely to do it again. So post care rehab and education is very important.
I’ve got a herniated disk – what are you going to do about it?
My approach to this is three-fold. First, I tackle the pain and inflammation. Rehab begins day one so that I can show you exercises and stretches to relieve the pain and prevent further damage. After the pain is under control, we’ll work together on reducing the herniation and teaching the muscles to relax in order to restore normal motion. After that, I focus on teaching preventative measures to keep this from happening in the future.
In short, lumbar disc herniations can be a debilitating and painful injury to the low back. There are many options out there for treatment, but this condition responds very well to conservative care. This post has gotten pretty long so in future posts, I’ll talk about my favorite stretches and exercises to relieve pain caused by a lumbar disc herniation.