Disc herniation: causes, symptoms and treatment.
What is Disc herniation:
Disc herniation is a condition of the spine where a nucleus pulposus is displaced from
intervertebral space. Nucleus pulposus is the inner space of the vertebral disc. It is made up
of jelly like material that consists of mainly water, as well as loose network of collagen
fibers. Spinal discs act as a shock absorber present between the vertebra, the specialized
bones that make the spinal column. Intervertebral disc simply means the disc between the
two vertebrae. Discs act as a tough ligament that hold the vertebra together, allow mobility
and helps for weight bearing. Between 60% and 80% of people will experience low back
pain at some point their lives. Some of these people will have low back pain and leg pain
caused by a herniated disk.
Causes of disc herniation:
There are many causes of a herniated disc. It can often the result of daily wear and tear on
the spine, called degeneration. When the weight carried by back distributed to the
intervertebral discs due to the movement such as walking, twisting and bending, the
vertebras disc can become worn out over the course of time. Other cause includes a sudden
traumatised injury to the spine either a jerking movement that can put too much pressure
on the disc, lifting a heavy object incorrectly and/or twisting the body inappropriately.
Stages of disc herniation:
There are four stages of disc herniation:
First stage is disc bulging or early degeneration where the nucleus pulposus weakens due to
the chemical changes in the disc. The disc become less able to absorb the shock of the
movement and leads to instability in the intervertebral joint. Second stage is Prolapse, the
position of the disc changes. Protrusion or bulging of the nucleus pulposus begins to form. It
may or may not affect the spinal cord and nerves depending on the bulging and protrusion.
Third stage is called extrusion, in this stage gel-like nucleus pulposus breaks through the
annular fibrosis (outer layer of the disc) but it still remains within the disc. Fourth stage is
Sequestration, in this stage, the nucleus pulposus breaks through the annulus fibrosus and
affect the spinal cord and nerve.
Risk factors of disc herniation:
Carrying excess weight is an important risk factor for disc herniation due to the extra
pressure on the spine, causing disc to bulge and irritating the nerve roots. Standing or sitting
for prolonged period of time can increase the chances the wear and tear on your spine and
increase the risk of disc herniation. Sedentary lifestyle can increase the risk of back
problems due to inappropriate pressure added on the spine. Previous history of herniated
disc can also increase the risk of recurring.
Signs/Symptoms of disc herniation:
Disc herniation can be present in any part of the spine either cervical, thoracic or lumbar
spine. The lumbar spine (lower back) is one of the most common areas for disc herniation.
It can add extra pressure on the nerves and muscles attached to the area of the spine. The
symptoms of disc herniation involve:
Pain and numbness( most common on one side of the body), pain that extends to the arms
or legs (depending the spinal nerve impinged), pain worsens at night or with sudden
movement, pain that worsens after prolonged sitting or standing, unexplained muscle
weakness, tingling, aching or burning sensation in the affected nerve area.
Diagnosis:
To diagnose the disc herniation, health care provider will review the history and perform
physical examination. The test may involve orthopaedic and neurological testing. The
function of the nerve and muscle testing will be examined. Radiography Imaging will be
utilised to view the bones and muscles of the spine and look for any affected areas. These
imaging modalities include X-rays, CT scans, MRI scans and Discograms.
Complications:
Untreated or severe disc herniation may cause permanent nerve damage. It can lead to
condition such as cauda equina syndrome. In this condition, nerves supplying to the legs and
pelvis can get interfered and lead to loss of control for bowel or bladder. Another
complication may include saddle anaesthesia which can cause sensation loss in the inner
thighs, back of the legs and around the rectum.
Treatment:
Treatment for a disc herniation can range from conservative to surgical procedure. People
usually consider physiotherapist, Chiropractic or acupuncturist treatment to resolve the
complaint initially. The goal of care mainly depends to stretch or strengthen the back and
surrounding muscles. Avoiding the activity such as heavy lifting, prolonged sitting or
standing helps to alleviate the symptoms. Doing regular, moderate-intensity exercise is also
vital for strengthening the structures that support the spine and for keeping the spine
healthy. Getting at least 150 minutes of physical activity each week helps maintain the
integrity of the musculoskeletal system. Maintaining proper hydration and staying flexible
also keep your body strong and healthy and slows wear and tear on your body. Muscle
relaxants, narcotics and nerve pain medications can also be prescribed. If the symptoms do
not subside between 8 weeks, surgery would be recommended which remove the damaged
or protruding portion of the disc. In other cases, laminectomy and spinal fusion can also be
performed to add stability to the spinal column.
Chiropractic management:
Chiropractic care helps to address pain and other associated symptoms. Chiropractors
utilise orthopaedic, neurological exams and radiography imaging to check the reflexes,
muscle strength and loss of any nerve function. Chiropractors evaluate the functioning of
the spine as one area of the spine can influence other part of the spine and/or body. The
treatment will involve chiropractic spinal adjustment and other techniques to ease the
muscles and symptoms of herniated disc. A gentle low force technique is usually applied on
the herniated disc. Chiropractic care is safe and effective for most patients. So, if you know
someone who is suffering from herniated disc, do not hesitate to visit your chiropractor and
ask any further questions.
