Disc Buldges and Herniations
If you think surgery is the only option for herniated disc you would be wrong. Did you know there was a study released in 2010 that found people with herniated discs in their lower back that received chiropractic care had the same results as those who underwent surgical intervention? This study was done by JMPT, and it was titled “Manipulation or Microdiscectomy for sciatica: a prospective randomized controlled study.”
What Are Disc Injuries?
There are a few terms for different degrees of disc problems. They are all varying degrees of injury to the disc. Lets go over a few terms you may have heard:
1. Degenerative Disc Disease – This is basically arthritis of the disc. This is caused by wear and tear or an old injury to the disc. This can cause limited motion, stiffness and a dull achy pain. If it becomes severe enough it can pinch a nerve.
2. Annular fissures -These are injuries directly to the disc The invertebrate disc is composed of an outer layer of consecutive rings and a jelly center portion. When there are tears in the ring, this is called an annular tear. These can cause pain, muscles spasms and discogenic referred pain. These do heal up without any surgery.
3. Disc bulges or protrusions – With repetitive injury and annular tears, the disc looses its normal shape and can sag out into the spinal canal. These can cause nerve root irritation but they don’t always. Acute disc bulges are usually symptomatic but many people have several disc bulges that show up on an MRI but are asymptomatic. Old disc bulges are more like arthritis of the disc. Without nerve irritation, these usually do not require surgery.
4. Disc Herniations or Prolapse- This is a more serious injury of the disc where the annular fibers tear so much it allows the center portion of the disc to herniate out into the spinal canal region. This usually causes pain down the leg (back) or arm (neck). These can heal up on their own but treatment can be extensive. Surgery may be an option but conservative care usually should be tried first.
Do Disc Injuries Require Surgery?
If you have been diagnosed with or think you may have a disc injury, you may not need surgery. If you do not have any warning signs such as loss of bowel or bladder movements, significant weakness in an arm or leg, loss of muscle size or complete loss of reflexes, than you should likely try conservative care first. Surgery is a permanent change to your musculoskeletal system and has it’s own risk. There is also no garentee that it will end back pain. It does do a good job at relieving nerve pressure though. But again, trying conservative care may work just as well.
Is It Safe To Adjust Disc Injuries?
In most cases adjusting a disc problem is not only safe but very effective in revealing pain. Once a disc is herniated, the damage has already been done and further injury is unlikely. Many primary care doctors may be hesitant to send you to a chiropractor but this is most likely due to not understanding chiropractic or bias against it.But what about the dangers of adjusting someone with a disc injury The vast majority of chiropractors (who perform the majority of manipulations in this country) consider this in the presence of herniated disc to be safe and appropriate. While no large-scale studies have been conducted regarding the complication rate of manipulation in the presence of a herniated disc several cases have been reported in the literature describing patients having been treated in this manner without aggravation of the condition, let alone serious complication. In one study,(BenEliyahu DJ. Chiropractic management and manipulative therapy for MRI documented cervical disk herniation. J Manipulative Physiol Ther:1994:17(3):177-185. ) patients with cervical herniated disc were treated with an approach that included spinal adjustments; nine of them were able to return to their previous occupations. No complications were reported. Certainly, as someone who has treated scores of patients with disc injuries over the years, my experience with the relative safety of manipulation for this condition is consistent with that suggested by the literature.
Still, care needs to be taken when applying manipulation to a segment in which disc injury is present, as an acutely inflamed nerve root can be quite sensitive and it is easy to provoke pain. The maneuvers should be gentle (this applies to any manual adjustments) and the segment should be carefully taken to the point of physiologic restriction before thrust is applied. Extension should be avoided, as this increases nerve root pressure. It is often helpful to apply long-axis traction while carrying out the spinal adjustment, as this has been shown to decrease pressure in the disc.
What Kind Of Treatment Do We Offer For Disc Injuries?
Special care should be given to disc injuries, especially acute disc herniations. We will usually change our techniques in these situations. Here are some examples how care can be modified to treat a patient with severe pain from a disc injury:
- Use less force – Most patients that have a severe injury it just hurts to move. So if a manual manipulation is applied, care is taken to use as little as force necessary to get a movement of the vertebrae. Getting a joint to tension is the key to this.
- Use lighter techniques – we offer less aggressive techniques as well when an aggressive manipulation cannot be done due to pain or muscle spasms. These could be Thompson table assisted drop techniques, pelvic blocking, activator or an impulse adjusting instrument.
- Traction – one of the best treatment for disc injuries is long axis traction. By stretching the spine, there is a suction like force drawing in any inflammation.
- Soft Tissue work – If the pain is so severe most movements cannot be tolerated, we can use soft tissue massage, trigger point work, fascal work, electrode therapy or ultrasound to start the healing process.
- Rehabilitation – Once the disc has calmed down, core stabilization may be needed to stabilize the injury.
