Vertebral discs are the cartilaginous pads or cushions that lie between vertebrae in the spinal column. Each vertebral disc is composed of a fibrous outer layer that holds a gel-like substance in the middle, sort of like a jelly donut. Discs function as shock absorbers for the vertebrae and help protect the central nerves that run up and down the spine. Damage from trauma or chronic dysfunctional movement patterns can erode the outer layer of the disc, causing it to tear or “herniate.”
A Herniated Disc
When a disc herniates, the outer fibrous layer becomes weak or ruptures causing the inner “jelly” to bulge out (1). Herniated discs can be due to altered mechanics in the spine, trauma, or injured spinal ligaments. They are more common in the lower back -the lumbar spine- and may lead to symptoms of lumbar radiculopathy, or “sciatica.” The bulged part of the disc can compress nearby nerve roots, irritating them and causing pain to radiate down that nerve.
What is important to know about disc herniations is that they do not always hurt. Not every patient who has a herniated disc experiences pain. In fact, herniated discs can be a sign of injured or lax spinal ligaments that alter the mechanics of the spine thereby damaging the disc and causing it to bulge (2).
Spinal Instability
An unstable spine exerts excess pressure on the discs and causes hypermobility of vertebrae- possibly pinching nearby nerves. This hypermobility leads to the abnormal movement which slowly degrades the disc’s outer fibrous layer and makes it prone to herniation. Instability and hypermobility can cause the facet joints of the spine to touch and irritate nearby nerves thereby eliciting symptoms. If left untreated, an unstable spine can degrade the discs until invasive procedures are required.
Signs and Symptoms
If symptoms are present, they can be a result of the herniated disc itself, injured ligaments, or pinched spinal nerves. Symptoms can include back pain in the affected region, pain radiating down the leg and buttocks, numbness, tingling, and muscle weakness (1). In severe cases, a person can lose bowel and/or bladder control (1)(2).
Available Treatments
Conservative (non-invasive) treatments are always the first choice when it comes to disc herniations. This may include pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or muscle relaxants. Other treatments include rest, corrective exercise or physical therapy, chiropractic and osteopathic manipulations, massage therapy, acupuncture, and prolotherapy. Cases unresponsive to conservative treatments may be candidates for surgical intervention.
Corrective Exercise and Physical Therapy: Prolonged inactivity can lead to the weakening of muscles and soft tissue structures that support the spine. This weakness is an added risk of the deterioration of vertebral discs and can speed up the degenerative process. It is important to make exercise part of treatment to ensure that the supportive structures of the spine remain competent.
Manipulative Treatments: Chiropractic and Osteopathic manipulative treatments can help correct mechanical dysfunctions that may be damaging the disc, irritating nerves, or compressing neurovascular structures. Proper alignment and movement of the spine are needed to allow proper healing and for alleviating pain symptoms.
Massage and Acupuncture: Both massage therapy and acupuncture can help a patient relax and reduce stress levels. Stress is known to amplify pain symptoms which may interfere with sleep and lower an individual’s quality of life.
Regenerative Medicine: Regenerative Medicine is an injection-based treatment that leads to the repair of soft tissues such as tendons and ligaments. This is ideal for repairing and strengthening any injured ligaments in the spine that are causing instability and hypermobility. When combined with Osteopathic Manipulative Treatments (OMT), prolotherapy can correct the root cause -spinal dysfunction and laxity- of the herniated disc.
References-
- Harvard Health Publishing. (2018, November). Herniated Disk. Retrieved from https://www.health.harvard.edu/a_to_z/herniated-disk-a-to-z
- Hauser, R. (n.d.). Caring Medical. Retrieved April 23, 2020, from https://www.caringmedical.com/prolotherapy-news/non-surgical-treatment-herniated-disc/