For many decades, most back pain was believed to be caused
by “slipped” or “torn” discs. We now know this not to be true. Disc problems
constitute only a small portion of the causes of back pain and rarely require surgery
for pain relief. Talk to your patients about disc problems.
What are spinal discs?
• Spinal discs are thick ligament-like outer rings, also
known as annuli fibrosis, that attach to the top and bottom of each vertebra.
The discs provide shock absorption, protecting the spinal cord and ensuring
flexibility of the spine.
• An annulus fibrosis contains a jelly-like substance called
the nucleus pulposis, which is primarily made up of water. The nucleus provides
shock absorption and acts as a fulcrum to direct the movement of the vertebrae.
What are the most common disc problems?
• A disc “bulge” results from slight tears in the outermost
fibers of an annulus fibrosis. These small tears can be painful for a short
period of time.
• A disc protrusion/extrusion, also called “herniation,” is
a more significant injury, when the fibers of an annulus are completely or
significantly torn and some of the nucleus leaks through. A herniation can also
be painful and may even cause nerve compression. In the most severe cases, the
spinal cord can become compressed.
• The most common disc problem is degenerative disc disease.
This occurs when the nucleus loses water and small tears develop in it. The
body then forms osteophytes (bone spurs) along the edges of the vertebrae, and
the disc space narrows. If you have family members who have degenerative disc
disease, you are more likely to develop it yourself, although the condition can
also be caused by trauma or injury.
What are the common signs and symptoms of disc problems?
Common signs of disc problems include, but are not limited
to:
• Back or neck pain
• Leg or arm pain
• Stiffness
• Tenderness of the spine and spinal muscles
If you experience any of the following, seek immediate care
for a spine problem:
• Loss of bowel or bladder control
• Inability to urinate and/or defecate
• Acute loss of feeling in both buttocks and/or both arms
• Inability to walk or use your arms (often from severe
acute weakness)
• Fever along with your back pain
How are disc problems diagnosed?
• Disc problems are most often diagnosed through a thorough
history and physical examination, including assessment of your nervous and
musculoskeletal systems. Your doctor of chiropractic will likely move your back
and arms and legs into various positions while applying pressure to your
joints.
• Plain film x-rays are helpful in some forms of disc
problems.
• Magnetic resonance imaging (MRI) has become the mainstay
for the diagnosis of disc problems, as it images the discs quite nicely.
How are disc problems treated?
• Most disc problems are easily treated with conservative
interventions. Early in the course of an acute injury, your doctor of
chiropractic will likely use several different physical modalities to control
pain.
• Both ice and heat have shown effectiveness in managing the
pain of acute low-back injury.
• Getting back on your feet and moving is critical.
Typically, the less time you spend in bed, the better off you are. If you
“baby” your back, in most cases, the long-term results will be worse.
• Chiropractic spinal manipulation has been demonstrated to
be a safe and effective tool in the management of disc problems, especially
when combined with therapeutic exercise. Your doctor of chiropractic will
likely prescribe both for you.
• In most circumstances, spine surgery and injections are
not necessary in the management of disc problems—and they often cause more
problems than they’re worth.
Can disc problems be prevented?
• Stay physically active and exercise regularly. This
generally means performing general fitness exercises, such as walking, running,
and swimming. Your doctor of chiropractic can design a specific exercise
regimen to fit your needs.
• Make a conscious effort to maintain correct posture when
you sit, stand, lie down, work and exercise.
• When lifting objects, bend your knees, keep the object
close to your body, keep your back straight and lift with your legs. Never lift
an object by bending over and twisting. You’ll only invite a back injury.
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