A Disc Injury can be acute, where the pain starts quickly but then reduces after a few days or weeks, or chronic, where pain might last on and off for several weeks or even months and years.
The Structure of an Invertebral Disc
The bones of the spine are cushioned by small discs, which are round and flat with a tough, outer shell (capsule or annulus fribrosis) that surrounds a jelly-like material (nucleus). When discs are healthy, they act as shock absorbers for the spine, keeping the spine flexible.
Mechanism of Disc Injury
Disc injury occurs when the pressure inside the disc exceeds the strength of the outer shell.
Since the front wall of the shell is a third thicker than the back wall, most fissures, protrusions and slipped discs occur at the back.
The typical mechanism consists of the following sequence of movements:
- Forward flexion of the spinal column: More load is placed on the back part of the disc. Because of its consistency, the nucleus is pressed against the back wall of the shell.
- Lifting heavy weights: This tends to press one vertebra against another, increasing the pressure inside the disc.
- Stretching the spine with the heavy weight: The increased pressure on the disc caused by bearing the weight “squeezes” the nucleus back more strongly. If there is enough pressure against the posterior wall of the fibrous envelope, this tears (disc fissure), swells (disc protrusion), or breaks (disc rupture).
- A similar effect can be produced by repeated flexion-stretching movements with a lighter load or even with no load. Every such movement generates small impacts on the back wall of the shell.
These processes occur much more readily when the muscles of the back are weak. If they are sufficiently developed, these muscles protect the disc by various means.
Symptoms of a Disc Injury
Many people who have a herniated disc are not aware of it because they have no symptoms of leg or back pain. Symptoms that do appear vary greatly, depending on the position of the herniated disc. If the herniated disc is:
- Not pressing on a nerve, there may be a low backache or no symptoms at all
- Pressing on a nerve, pain or numbness can occur in the area of the body leading from the nerve
- Located in the neck, pain or numbness may be felt in the shoulders, arms or chest
Located in the lower back, sciatica may occur and cause leg pain and other nerve-related symptoms, such as weakness, numbness or tingling in one leg. Pain from a herniated disc in the lower back (sciatica) may be felt in the buttock and down the back of the leg to the ankle or foot. There may be low back pain, but it is usually not as severe as leg pain
Nerve-related symptoms of a herniated disc include:
- Tingling (“pins and needles” sensation) or numbness in one leg that can begin in the buttock or behind the knee and extend to the ankle or foot
- Weakness in certain muscles in one or both legs
- Weakness in both legs and the loss of bladder and/or bowel control, which are symptoms of a specific and severe type of nerve root compression called cauda equina syndrome. This is a serious problem that requires immediate medical help. If you have symptoms of this syndrome go straight to A and E.
- Other symptoms of a herniated disc may include severe deep muscle pain and muscle spasms.
Treatment at The City of London Chiropractor Clinic
Most herniated discs heal on their own over time (one to six months). The goals of treatment are to:
- Relieve pain, weakness or numbness in the leg and lower back
- Prevent further injury by teaching the patient techniques and exercises for care of the back
More than 90% of patients who have a herniated disc will improve within six months after nonsurgical treatment. For this reason, nonsurgical treatment is usually tried before surgery is considered. Nonsurgical treatment usually includes:
- Rest, followed by a gradual increase in activity
- Medication to control pain and inflammation
- Physical treatment by your chiropractor including massage, stretching, electrotherapy and gentle adjustments.
- Exercises recommended by your chiropractor to help reduce pain and strengthen the muscles that support the back
In some cases, herniated discs heal on their own by a process called resorption. During resorption, the body absorbs parts (fragments or tissue) from a herniated disc that has ruptured.
Surgery may become necessary in only a small number (less than 10 percent) of people who have herniated discs. Surgery may be considered for people who have progressive nerve damage or severe weakness or numbness or for those whose pain has not been relieved by other methods.
Infection in a Disc (Discitis)
Discitis is inflammation of the vertebral disc space. It is usually associated with infection and can co-exist with vertebral osteomyelitis (spondylodiscitis). Discitis most commonly affects the lumbar spine. The thoracic spine is least commonly affected with the cervical spine between the two. Discitis can occur in children but most commonly affects males aged in their 50s.Risk factors include any cause of immunosuppression (including diabetes) and intravenous drug use. Discitis may rarely follow surgery involving the disc space.
Symptoms of Discitis
Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population.
An insidious onset is common, with neck or back pain and localised tenderness. Pain is worse on movement. Mobility may be restricted.
There may be associated fever and weight loss.
Neurological deficit may be present. This is more likely in the cervical spine.
Age Related Disc Injury (Degenerative Disc Disease)
Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region). Degenerative Disc Diseases involves the drying up of the nucleus of a disc and the reduced flexibility and ability to absorb shock.
The changes in the discs can result in back or neck pain and/or:
- Osteoarthritis, the breakdown of the tissue (cartilage) that protects and cushions joints.
- Herniated disc, an abnormal bulge or breaking open of a spinal disc.
- Spinal stenosis, the narrowing of the spinal canal, the open space in the spine that holds the spinal cord.
These conditions may put pressure on the spinal cord and nerves, leading to pain and possibly affecting nerve function as described earlier.