Diagnosed With a Herniated Disc?

By: Dr. Robert Duvall, DPT, ATC, MGFI

You've probably heard people say they have a "slipped" or "ruptured"
disc in the back. Sometimes they complain that their back "went out".
What they're most likely describing is a herniated disc. This
condition is a common source of back and leg pain.

Discs are soft cushions found between the vertebrae that make up the
spinal column (your backbone). In the middle of the spinal column is
the spinal canal, a hollow space that contains the spinal cord. The
nerves that supply the arms, leg, and torso come from the spinal
cord. The nerves from the neck supply the arms and hands, and the
nerves from the low back supply the butt and legs. The discs between
the vertebrae allow the back to move freely and act like shock
absorbers.

The disc is made up of two main sections. The outer part
(the annulus) is made up of tough cartilage that is comprised of
series of rings. The center of the disc is a jelly-like substance
called the nucleus pulposus. A disc herniates or ruptures when
part of the jelly center pushes through the outer wall of the
disc into the spinal canal, and puts pressure on the nerves. A
disc bulge is when the jelly substance pushes the outer wall but
doesn't completely go through the wall.


What do you feel?

Low back pain will affect four out of five people during their
lifetime. The most common symptom of a herniated disc is "sciatica".
Sciatica is best described as a sharp, often shooting pain that
begins in the buttocks and goes down the back of one leg. This is
most often caused by pressure on the sciatic nerve that exits the
spinal cord. Other symptoms include:

* Weakness in one leg or both legs
* Numbness and tingling in one leg (pins & needles)
* A burning pain centered in the low back
* Loss of bladder or bowel control (seek medical attention
immediately)
* Back pain with gradually increasing leg pain. (If you have
weakness in both legs. Seek immediate attention.)

How do you know you have a herniated disc?

Your medical history is key to a proper diagnosis. A physical
examination can usually determine which nerve roots are affected
(and how seriously). A simple x-ray may show evidence of disc or
degenerative spine changes. An MRI (magnetic resonance imaging) is
usually the best option (most expensive) to determine which disc
has herniated.

Why do discs herniate?

Discs are primarily composed of water. As we become older (after
the age of 30), the water content decreases, so the discs begin
to shrink and lose their shape. When the disc becomes smaller the
space between the vertebrae decreases and become narrower. Also, as
the disc loses water content the disc itself becomes less flexible.

While aging, excess weight, improper lifting and the decrease in
water in the discs all contribute to the breaking down of discs, the
primary cause of a herniation or bluge is uneven compression and
torsion that's placed on the discs.

This uneven pressure is caused by imbalances in muscles that pull
the spine out of its normal position and then your body is forced to
function in what I call a physical dysfunction. Every human being
develops these dysfunctions over time and eventually they cause
enough damage to create pain.

The best treatment options

When it comes to treating a herniated disc, there are traditional
treatments such as ice/heat, ultrasound, electrical stimulation,
cortisone injections, anti-inflammatory medications and even surgery.
While these may deliver some relief, it will usually be temporary
if at all.

But the major problem with these traditional treatments is that they
can't fix or heal a herniated disc as they do not address the actual
cause of the problem. For example, even if you were to have a surgery
and get some pain relief, the fact is the dysfunctions that caused
the disc to herniated in the first place are still there and if not
addressed, they will continue to place uneven pressure and strain on
the discs and sooner or later you will likely have another problem
with that disc, or others.

Without identifying and addressing the underlying cause of the problem,
which is the physical dysfunctions caused by imbalances in muscles,
you will likely continue to suffer with this condition and the
continuous flare ups for years.
Unfortunately, most doctors, chiropractors and physical therapists
don't spend time or focus on identifying the physical dysfunctions that
are responsible for the condition so most people end up jumping from
one useless traditional treatment to the next and suffer for months or
years unnecessarily.

If you have been diagnosed with a herniated disc, or are wondering if
your back pain may be caused by a herniated disc, either way you must
identify and address the physical dysfunctions that are causing your
pain as part of your recovery.

Dr. Robert Duvall is a Doctor of Physical Therapy and Certified
Athletic Trainer.  He has helped Thousands of people identify and
cure their back pain by educating them with articles such as this one.
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