Approximately 19-27% of everyone over the age of 20 has a herniated disc, with 95% of these in the Lumber (low back) area. However, just because one has a herniated disc does not immediately mean it is symptomatic or the cause of their back pain or sciatica. Most of the people who have them do not even know it. Chiropractors can detect and treat the potential for one to form long before the disc bulges and becomes symptomatic. We often do not need an MRI for this. These cases are the most severe and painful for the patient and often the most costly to our insurances (when not handled by a Chiropractor), misunderstood and mistreated by the healthcare profession.
What is a herniated disc? There are different types, but lets begin with what the disc does and what is made of. The disc material is meant to be a cushion between two vertebrae. There are two parts of the disc, the nucleus pulposus: the gelatinous middle section, which is surrounded by the annulus fibrosis. The annulus is made up of concentric layers of cartilage. All of these are held between the vertebrae firmly with a ligamentous joint capsule and lined by other ligaments. Chronic subluxation can lead to the annulus fibers beginning to break down. The nucleus will start to travel and "push" through usually towards the back of the disc. At this point it is called an "internal disc disruption." Once that material hits the outer third of the annulus it hits pain receptors and triggers an inflammatory response. There can be much pain depending on the individual BEFORE it shows up on an MRI. The next stage is the actual bulge, where some of the annulus "bulges" from the nucleus pushing towards the end of the disc material. When the nucleus breaks through the annulus and fatigues the posterior longitudinal ligament it is called a protrusion. When part of the nucleus breaks off it is called a sequestration. It is important to note that these herniations do not just "happen." They are slow degenerative processes from chronic joint inflammations and subluxations. By the time there is disc tissue involvement there have been permanent arthritic changes to the vertebrae and chiropractic serves to keep this condition under control with maintenance visits, nutritional support and certain types of strengthening exercises. This disc herniation itself is NOT CURABLE but the symptoms are very manageable and 86% of the time can be cured.
The pain from an acute disc is actually from the inflammatory chemicals leaking from the damaged disc material into the nearby nerves. At this point the condition is getting serious and the brain may start immobilizing the patient's body to stop further trauma to the spine by begining to put pain down the distribution of the nearby nerves. Sometimes exercises are recommend at this point to and serve to further aggrevate and go against what the body naturally does to stop this process! These should be saved for later when the patient's spine is less inflammed and movable. We call this pain sciatica if in the leg and brachial radiculitis if in the arm. In severe cases the disc material itself can compromise the nerve roots. The spinal cord itself can be impinged upon in extreme cases. An MRI will show the extent of the bulge, but not how or why it got there. Understanding how and why it got there leads to proper treatment, not simply identifying it on an MRI after an exam. Chiropractors will use an MRI to give statistical analysis of the outcome of our services depending on the extent or classification of the disc bulge.
When is it safe for chiropractic? When will it respond to chiropractic? A chiropractor can ALWAYS treat an acute or herniated disc UNLESS: there are red flags such as cancer, fracture, an infection or severe neurological compromise such as loss of bowel/urinary control, balance issues and/or severe compression on the cord resulting in similar symptoms. The latter we refer out to an orthopedist and statistics show only 1-3% of all spinal pain falls into these categories. If the patient does not show 50% improvement in 12 visits again the patient will be referred out to a surgeon. If chiropractic can treat so many of these cases then one might wonder why so many cases are sent to an orthopedist first then? The short answer is ignorance of Chiropractic, nervous patients, and lack of communication between Medical Doctors and Chiropractors. This is important because many patients (and primary care physicians) think a surgeon is necessary right away.
Sciatica and low back pain, even cervical pain and radiculitis down an arm(s) from a disc irritation are conditions Chiropractic treat successfully and safely every day. We are perfectly qualified to determine if the case will need a surgical referral. It is estimated most people only do a half hour of research on the web to decide about spinal surgery. Some studies have shown up to 65% of spinal surgeries fail (called failed back surgery syndrome) and strong evidence for successful outcomes is still lacking to this day.
We use the latest low force, gentle techniques for herniated and acute discs at this office and we have an extremely high success rate. Then for optimal outcome we also use specific nutrition and supplementation to facilitate the body to rebuild the disc material. Lastly, we prescribe stability exercises to strengthen the involved areas of the spine.
If you have any other questions please call us we will be happy to answer them.