The intervertebral disc is made up of two components, an outer ligamentous covering, called the annulus fibrosis and an inner jelly-like substance called the nucleus pulposus. The nucleus provides the main cushioning effect while the annulus acts as the container that holds the disc between the vertebrae and keeps the jelly-like nucleus in place. The design of intervertebral disc is such that it can withstand a tremendous amount of compressive and shearing forces. In fact, under heavy lifting with the spine straight, you would fracture the vertebra before you would ever rupture a normal disc.
Bending while lifting and twisting is the most difficult stress for the disc to handle. When a person bends forward, the pressure in the discs of the lower back is nearly doubled. When an object is lifted, this stress is multiplied even more. If the person begins to turn as the object is lifted, shearing force is transferred into the disc and the fibers that make up the outer covering of the disc may begin to tear.
Tearing of the annular fibers (outer covering) of the disc can happen slowly and gradually or abruptly in a traumatic situation (car accident, slip and fall, sporting injury, etc.) Small tears may exhibit pain because the nerve supply to the disc can become irritated. Sometimes when minor tearing occurs, the pain will be described as a twinge. On the other hand, severe tearing almost always results in sudden, prolonged, and worsening pain, which is accompanied by muscle spasm and possibly referred pain into an extremity (arm or leg, depending on where the disc damaged occurs.)
When tearing becomes extensive enough that the nucleus pulposus can no longer be contained within the center of the disc, the jelly-like substance that makes up the nucleus begins to migrate out. This shifting of the nuclear material is what we commonly refer to as a disc herniation.
Discs that are bulging, herniated, or prolapsed often create sharp pain, which may radiate into the extremities. A cervical disc herniation may cause pain down the arm. Likewise, a lower back herniation may send pain down a leg. The area the pain travels to is an important clue as to the level of the disc injury.
Your Doctor of Chiropractic is specially trained in the treatment of the spine and specifically disc conditions. Your chiropractor can also discuss with you any need for surgical intervention, should your diagnosis warrant a more radical surgical solution.
Conservative chiropractic care for disc conditions may involve the use of ice to reduce any initial swelling and inflammation during the acute phase. Stretching and physiotherapy exercises are often prescribed to help stabilize the core and guarding muscles. Also, chiropractic adjustments (manipulation) may be used to restore lost joint integrity in addition to traction to the disc to help reduce (suck back in) some of the migrating nucleus material.
