You may have been told at some point that you had a slipped disc. This can feel legitimate. That said, discs don’t “slip”. They are anchored in place to the vertebrae by very strong ligaments. What this term is actually usually referring to is a bulging, or more correctly, herniated disc. So what is a disc bulge/herniation and what can we do about it?
Between each of the vertebrae in your spine (aside from the very top of your neck) is one of these discs, 23 in total. They have two main parts, a complex of multiple cartilage rings on the outside called the annulus fibrosus and a gelatinous center called the nucleus pulposus. You could visualize it a bit like a jelly donut. These discs are strong, flexible and aid it movement and shock absorption. The discs can deteriorate over time from injuries, bad posture, poor movement patterns, and simple wear and tear. This deterioration is often referred to as degenerative disc disease and tends to progress with age. As the cartilage deteriorates, sometimes the gelatinous nucleus starts to push out against and distend the disc. This is called a bulging disc. If the nucleus breaks through to the outside of the disc, we call that a herniation. Herniations come in two basic varieties, extrusions and sequestrations. Simply put, with extrusions, the disc material has come out of the disc, but is still contiguous with the remainder of the nucleus. With sequestrations, a portion of disc material has separated itself from the rest and worked its way into the layers of the annulus or even into the spinal canal.
Symptoms (if present) of a disc bulge and herniation are similar. Commonly, patients experience pain, numbness, weakness and tingling in the extremities when the spinal cord and/or any nearby nerve roots are compressed or impinged by the disc or disc material. In the image above, you can see the areas affected by nerve compressions at various parts of the spine. Contributing factors include excess body-weight, physically demanding jobs and genetics. Ok, so that’s what it is. But what do we do about it?
Treatment for disc injuries has a few basic components to it:
- 1. Get the breath working for you. Proper breathing mechanics are crucial for creating the intra-abdominal pressure necessarily to stabilize the spine. Proper breathing also allows for appropriate activation of the other core muscles.
- 2. Get the core firing properly. The core, especially the muscles of the deep core such as the transverses abdominis (TVA), multifidus, pelvic floor muscles, respiratory muscles and deep spinal muscles, if not firing properly will promote compression and spasm of the low back and neck. Planks won’t cut it. You need to train these muscles to activate automatically during exercise. Click HERE to read a blog article I wrote on the subject.
- 3. Work on improving your posture. Poor alignment, especially spinal alignment, increases stress to the discs and slows or prevents healing. A focus on flexibility of restricted areas and strengthening of lengthened areas can help.
- 4. Treatment of peripheral nerve entrapments. When the spinal cord or nerve roots become entrapped and inflamed, the nerves often become adhered to neighboring structures creating additional tension on the nerve. This leads to increased pain and disability. Spasmed muscles can also contribute to nerve entrapments. Active Release Techniques (ART) is terrific at resolving nerve entrapments. Cold laser is also very helpful.
- 5. Decompression. Decompressing the spine can help the discs heal, even when herniated. The negative pressure created inside the disc during decompression can draw the annulus and any extruded disc material back in, improve circulation to the disc, and allow the cartilage to begin to heal. Decompression includes devices such as the Spinal Stretch device on the low end, on up to inversion tables, all the way up to machines such as the DRX-9000. Consult your doctor before trying decompression. There are certain contraindications. If your back has any hardware in it from previous surgery or your herniation is of the sequestered variety, you’ll want to steer clear of spinal decompression. This is not a comprehensive list.
Left on their own, bulging/herniated discs DO usually heal. They just don’t necessarily heal well. As I said before, the discs play an important role in the mobility of the spine as well as shock absorption. Improperly healed, the affected segment will often exhibit reduced mobility which places additional strain on neighboring segments. It’s not uncommon for adjacent segments to become unstable over time and develop their own bulge or herniation. And on and on it goes. So even if your symptoms resolve on their own, that doesn’t mean any of the underlying causes went anywhere.
Some disc injuries simply won’t respond to conservative treatment and there are surgical options in those cases. That said, most can be effectively treatment non-surgically. If any of the above sounds familiar, please feel free to contact me.