When talking about a ‘herniated disk’ it usually stirs up nothing but confusion and fear of having a “bad back”. There are also many different terms used to describe a herniated disk. The understanding of this diagnosis often tends to be as clear as mud. We will try to help you understand the diagnosis and the different treatments available to you. And in the process we will make our best attempt to NOT bore the heck out of you. Let’s get started.
There are many different terms used for a herniated disk. These terms include: slipped disk, ruptured disk, collapsed disk and disk bulge. We will use the term herniated disk throughout this article for clarity.
The ‘disk’ sits between each vertebra in the spinal column. It is technically called the intervertebral disk. The disk has 2 distinct parts: (1) annulus fibrosus and (2) nucleus pulposus. The outer annulus fibrosus is a strong cartilaginous structure. The inner nucleus pulposus is a more watery, jelly-like structure. When the disk is healthy, it acts as a shock absorber and permits normal range of motion throughout the vertebral (spinal) column. In order to maintain a healthy disk, normal motion through the joints of the spine (facet joints) is crucial. The only way for a disk to get its nutrition is through movement. This process is called imbibition. (Remember for later).
When the disk begins to degenerate (or if there is significant trauma), tears can develop in the outer annulus. When this happens, the inner nucleus is able to squeeze through those tears and make its way to the outside. This is a ‘herniated disk’. It looks something like this…
A herniated disk may cause different types of symptoms in different people. These symptoms often include burning pain, tingling, numbness, dull ache and weakness. If the herniated disk is in the neck (cervical spine) then these symptoms may be in the arms. If the herniated disk is in the lower back (lumbar spine) then these symptoms may be in the legs. If you develop any of these symptoms, it is important to have them evaluated by a medical professional (this includes medical doctors, doctors of osteopathy and doctors of chiropractic).
2 primary pain syndromes arise due to herniated disks: (1) radicular pain from a pinched nerve or (2) discogenic pain which is pain stemming from the disk itself. Pain from a pinched nerve typically leads to pain in the upper or lower extremities. Discogenic pain is typically localized to the neck or lower back. This type of pain is also called axial pain.
At our office we evaluate the cause of your pain through…
- Complete and thorough medical history
- Thorough physical examination
- Diagnostic testing (if indicated) may include:
- Blood work
- CT scan, etc.
This allows us to come up with an accurate diagnosis, accurate prognosis and proper treatment plan designed specifically for you. Just as importantly, we rule out more sinister causes of back pain through the history and exam. Again, this leads us to providing an accurate diagnosis, prognosis and treatment plan.
The majority of people suffering from symptomatic herniated disks will benefit from conservative (non-surgical) treatment. These treatments consist of chiropractic and physical therapy treatment, over-the-counter and/or prescription medications and minimally invasive techniques such as epidural steroid injections. The main goal of conservative treatment is to reduce the pain and help to prevent future occurrences. A conservative course of care is typically 6-8 weeks long and may consist of a combination of the above mentioned therapies. Often times, co-management between different specialists offer the patient the best chance of full recovery. If conservative treatment is successful at reducing the patient’s symptoms, then it is usually recommended that they continue with the conservative therapies for management of the condition. Spinal surgery is typically a last resort treatment for herniated disks. However, there is a small subgroup of people who require immediate surgical intervention. One example of an urgent surgical condition is called cauda equina syndrome. This syndrome is characterized by loss of normal bowel/bladder function, progressive leg weakness and numbness along the inner thighs (saddle anesthesia). Cauda equina syndrome and other pathologies requiring surgical intervention are typically suspected after taking a thorough medical history and performing a physical examination and confirmed through diagnostic imaging (e.g. MRI).
If you think you may be suffering from a herniated disk, contact our office for an evaluation of your symptoms. We promise to perform a thorough evaluation and recommend the proper course of treatment. If we feel that your condition requires another specialist we will not hesitate to make the necessary referral. We are here for you.
Village Center Chiropractic healthcare team