Vertebral discs have a fairly straightforward anatomy. There are two parts. The first is the annulus fibrosus. This is the tough outer ring of the disc. It is composed mostly of collagen fibers with some cartilage cells. This outer ring is very strong and holds up to most of the tensile movements, stresses, and compression that help to move the spine as well as act as a cushion or shock absorber. The outermost portion of the ring is the only tissue within the disc that is innervated, meaning that nerves are located here. This is the reason that when disc problems occur that there is a high probability of producing pain. The annulus also helps to contain the much softer inner portion of the disc.
The soft, gelatinous inner portion of the disc is called the nucleus pulposus. Think similar to a jelly doughnut. This inner part has a very high water content. The annulus surrounds the nucleus and really helps to keep the spine mobile in many different directions. The nucleus also expands and contracts based on how much downward pressure is applied to the spine. During the day gravity weighs us down and the water content in our nucleus decreases and the disc loses a very small amount of height. Movement and bending also tend to squish out a little water from the nucleus. At night when we sleep we don’t have gravity pulling on us nor is there a lot of bending and movement so the disc actually absorbs more fluid and increases in height. These two portions of the disc work to help the spine move fluidly while also helping to support body weight. Something fun to know is that we are usually taller in the morning than we are at night.
Now that we know the basic anatomy of the disc let’s talk about ways which can damage the discs. You have probably heard stories of people who bent down to tie their shoes and all of a sudden had severe low back pain. Or someone had been working the yard all weekend and on Monday couldn’t get out of bed because of back pain. Or someone has had back pain for months or even years and the pain ebbs and flows in getting better and worse in a repetitive cycle. Sometimes these issues can be as simple as muscle strains or ligament sprains in the spine but oftentimes people don’t know that they can have disc issues without even realizing it. Every time we bend or twist we place stress and strain on spinal discs. All of these scenarios can be the start of an ongoing problem involving a spinal disc.
Disc herniations, disc bulges, and slipped discs refer to very similar problems within the discs of the spine and these terms are sometimes interchangeable. There are also subtle differences between these terms. Let’s start with a slipped disc. This term is somewhat misleading. A spinal disc cannot slip out of place. It is attached to the vertebra above and below by the fibers of the annulus actually being interwoven in the bone of the vertebrae. If discs were as loose as this term seems to dictate then the spine would be very wobbly and not structurally sound. Your spine would essentially be sloppy like a bobblehead. So the term slipped disc is generally not a good term to use even though it is commonplace.
Let’s compare a disc bulge and a disc herniation. These two terms are very closely related but have distinct differences. First, disc bulges are older and more chronic, and disc herniations are newer and more acute. Another difference is that a disc bulge is commonly wider in relation to a herniation which is more narrow in nature. Lastly, a disc herniation tends to have the part of the nucleus protrude outside of the annulus or outer ring of the disc because of a tear in the annulus. A bulge typically doesn’t have any part of the nucleus extending beyond the annulus. If you want to make a comparison, a disc bulge is similar to eating a sandwich or hamburger and when you take a bite stuff slides out the back of the burger or sandwich. A disc herniation can be likened to another kind of herniation, a hernia. Hernias are when abdominal contents are pushed out through the abdominal wall. Using this imagery we can see a difference between the two.
How do disc bulges and herniation occur? There are typically two ways in which discs can herniate or bulge. One way is constant load or stress on the discs. This would be something like sitting for long periods throughout the day at a desk or bending forward for long periods like doing yard work. If we look back at the analogy of the sandwich or hamburger you can see that constantly bending forward or sitting in a flexed position can push the nucleus out on the annulus. When the stress builds it stretches and expands the annulus enough to cause a bulge in the disc. This is why bulges are chronic and tend to be very broad and large. Now, herniations can be considered an extension of a bulge, meaning that if there is enough pressure and stress on the disc then the nucleus can be pushed through the annulus because the annulus has become overly stretched and weakened. The nucleus has found the path of least resistance and pushed its way out from the outer ring of the annulus. This is why most times a herniation is new and acute. If we remember too that the outermost portion of the annulus is still highly innervated then a disc herniation can cause significant pain. Typical disc bulges and herniations will push toward the back side because of the forward flexion of the spine. Again go back to the hamburger analogy.
So what about degenerative disc disease (DDD) that my doctor told me about? DDD is a term used to identify the aging process that is occurring within spinal discs. Just like with many other tissues within the body, the disc degenerate and become brittle. Discs don’t have the pliability and flex and give that they once had in earlier years. Stiffness and loss of range of motion are common complaints with those who have DDD. Think about a rubber band. New rubber bands are very flexible and can stretch a lot. Old rubber bands that have been used over and over and have even sat tend to look cracked and brittle. This is the challenge of aging and continuing to move like when we were younger.
Disc derangement is an umbrella term that is used to describe all of these issues. It is used when imaging, such as an MRI, has not been done or an extensive physical exam hasn’t been performed.
How can these problems be addressed? More than often people will seek care from a medical physician and after imaging has been taken then the usual next step is surgery to either remove part of the disc or to fuse the spinal segments above and below the disc to eliminate and further damage. These two approaches are incredibly invasive and can sometimes not fully resolve the problem.
Chiropractors have extensive training and knowledge about discs and the spine in general. Chiropractic adjustments can help significantly with these types of issues. Encouraging movement in the spine that does not invoke pain can help the body regulate itself and turn off pain signals for a short time so that there can be some pain relief. With pain relief, the body has the chance to heal in a more functional way because you can move better in greater ranges of motion without pain. As the spine moves better and easier without pain the disc can heal over a period of three to four weeks and continues to get better with routine and functional adjustments. There is a caveat, however, not everyone is the same, and not everyone will respond to traditional chiropractic care. There needs to be more without being invasive like surgery.
So what is less invasive than surgery but can do more for a disc problem that isn’t chiropractic care? Spinal decompression enters the conversation. Decompression is fairly intuitive when it comes to the concept. We experience compression every day due to gravity which can further a disc problem. By doing the opposite of compression the disc can actually vacuum back into its original location leading to healing and repair of the disc.
If decompression is the answer why not use an inversion table? An inversion table can be helpful when it comes to disc problems. However, too much pull can cause more pain and discomfort because the disc can be overloaded with fluid and when the compression comes back from standing it can lead to debilitating pain again. Utilizing spinal decompression in a clinical setting in a chiropractic office is safer and easier to replicate than an inversion table. Slow and steady decompression with low loads is more effective. Combine the therapy with consistency and it is a powerful non-invasive solution to disc herniations and bulges.
The use of decompression in our office is highly successful and virtually painless. More than often patients walk out of our office with less pain than when they walked in. Conservative care of disc problems should be a first step for almost everyone. Unfortunately, when people are in pain the first response is to seek immediate attention from urgent care or even the emergency room. This is where the breakdown occurs for people getting great care for their disc issues because the next step after an urgent care or emergency room visit is an appointment with an orthopedic surgeon or neurosurgeon. The opportunity to get care that is conservative and non-invasive isn’t even presented unless a person already visits a chiropractor. Now this isn’t to say that every disc issue will be resolved with chiropractic care and decompression. There are times when surgical intervention is necessary. In those rare cases, we humbly refer patients to the right providers to address the issue to its extent and be fully resolved.
We would love to help you or a loved one with these types of disc problems. Our office is happy and willing to help. We enjoy seeing patients get back to feeling themselves again after treatment. Call our office today to schedule your appointment and get feeling better and more like yourself.
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