Disc Bulge / Herniation : Your Treatment Options
There are a variety of terms used interchangeably with a spinal disc injury including disc herniation, pinched nerve, bulging disc, disc prolapse, ruptured disc or slipped disc. Chances are if you’re suffering a spinal disc injury then you’re experiencing burning, shooting, electrical pain or aching pain accompanied with numbness, tingling and muscle weakness. As well as this characteristic signs of a disc injury include abnormal posture (referred to as antalgic posture), altered gait or walking pattern, reduced movement and generalised stiffness.
If serious enough, disc pathology may cause nerve root entrapment at any area of the spine. Nerve root entrapment is when a ‘disc bulge/herniation/prolapse’ directly presses upon the nerve that is in close proximity to it. Most commonly these types of problems occur in the lower neck and lower back region leading to referred nerve pain.
WHAT IS THE ROLE OF A DISC?
The interveterbral disc’s primary role is to act as a ‘shock absorber’ for forces that are placed upon the body and spine. In combination with this, each disc allows the spine mobility and flexibility to bend. There are a total of 23 discs that separate each vertebrae of the spinal column except for between the top two bones in the neck.
Each disc is divided into two components, a soft spongy inner (nucleus pulposes) and hard outer (annulus fibrosis) layer. Damage to either of these layers can contribute to pain in any area of the spine. Interestingly, when we are born each disc has a relatively high water content which decreases as we age leading to a more rigid, firm and less flexible disc. Unfortunately this leads to disc degeneration but this process can be prevented if properly managed and the spine is looked after from a young age.
ARE YOU EXPERIENCING THESE SYMPTOMS?
- Neck pain & stiffness
- Shoulder, arm and hand pain
- Numbness, tingling and muscle weakness
- Lower back pain & stiffness
- Buttock, thigh, leg and foot pain
- Inability to straighten your posture
- Pain the worsens when bending, lifting or straining
PREDISPOSING RISK FACTORS OF DISC INJURY
There are a variety of predisposing risk factors including being overweight or obese, inadequate supporting muscular strength, ageing, poor posture (rounded shoulders, forward head position, pelvic tilt, pelvic unleveling, scoliosis), incorrect lifting techniques as well as occupations that require prolonged sitting that may enhance your chances of suffering disc injuries.
If you’re also suffering additional symptoms including saddle paraesthesia, bowel/bladder dysfunction, neurological deficit, suddent onset of pain following a traumatic event or presence of significant muscle atrophy (weakness and wasting) than it is recommended for you to consult immediate medical attention.
DISC BULGE TREATMENT OPTIONS
Depending upon the exact cause of you pain, location and pathophysiology there are a variety of techniques available to sufferers. Specific details are listed below:
Specific Manual Spinal Manipulation is the most commonly used therapeutic tool for Chiropractors and is commonly referred to as an ‘adjustment.’ This technique involves repositioning a joint which may assist with improving overall spinal curvature, flexibility, improving joint alignment, muscle relaxation, reduce pressure on the nerve and reduce pain amongst other things.
Flexion-Distraction / Traction Therapy (stretching of the thoracic and lumbar spine) is favoured in many cases of lumbar disc bulges and as another form of joint mobilisation that involves gently stretching joints of the spine opening restricted spinal joints to improve spinal movement and reduce pressure on the disc
Joint mobilisation (gentle stretching) is a more gentle therapy that is often used during acute phases to open up joints to improve overall movement and assist tissue healing
Activator Technique (hand held instruments) used to facilitate enhanced joint movement and is suitable for all individuals and different level of severity
SOT pelvic blocking (mobilisation of pelvic joints) to facilitate the joint movement in the pelvis, and sacrum joints
MEDICATION - ANTI-INFLAMMATORIES
In particular circumstances anti-inflammatory medications may be advised to assist with reducing your pain. Unfortunately such medications do not assist in healing, but in the short-term they will assist with making life a little easier.
MEDICATION - CORTISONE INJECTIONS
Cortisone injections are a particularly useful way of relieving pain associated with disc injuries. Cortisone is a potent anti-inflammatory and can be injected directly into the site of injury. It is important to recognize that like all treatment, some individuals do not respond successfully so be sure to look at all other treatment options before considering this approach
In certain cases we may recommend a combination of injection and manual therapy.
Flexibility & Strengthening Exercise prescription is sometimes beneficial. Specific exercises depend on the nature of the severity and must only be recommended by a trained professional
If all other options have been exhausted and you have not responded to treatment, surgical intervention may be clinically indicated to remove your injured disc or fuse surrounding vertebrae. It is important to recognise that clinical risks exist with any procedure so be sure to discuss these with your doctor beforehand.
RESEARCH ON DISC BULGE AND CHIROPRACTIC?
Given majority of patients suffering disc pathology will improve following non-operative therapies such as Chiropractic, a trial of conservative management is warranted before examining operative techniques. Daffner, S (2010). Cost and use of conservative management of lumbar disc herniation before surgical discectomy. The Spine Journal, 10(6); 463-468
A large percentage of acute and chronic lumbar disc bulge treatment patients using Chiropractic care demonstrated clinical significant improvements, with no adverse events. Leeman, S (2014). Outcomes of acute and chronic patients with magnetic resonance imaging – confirmed symptomatic lumbar disc herniations receiving high-velocity, low amplitude spinal manipulative therapy: A prospective observational cohort study with one year follow up. Journal of Manipulative Physiological Therapeutics, 37(3); 155 – 163