Disc problems require special attention. A proper examination and diagnosis is essential to determine the best treatment guidelines. Chiropractors have special training in the care of the spine and intervertebral disc. Your chiropractor can help you determine if you have a spinal disc condition. If so, a treatment plan that is right for you can then be established to help you recover.
The intervertebral disc is made up of two components, an outer ligamentous wound covering, called the annulus 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 pressure. In fact, under heavy lifting with the spine straight, you would fracture the vertebra before you would ever rupture a normal disc. However, the high load capacity of our discs do not do well when we subject them to shearing (twisting) force.
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, especially far away from the body, 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. Small tears may or may not exhibit pain. This is because the nerves that reach the disc are very small and do not cover a lot of the area. 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 causes the joint to function poorly. This in turn places the joint under added stress with during movement and makes the disc even more susceptible to repeated stress injuries.
If annular tearing continues slowly, a condition called degenerative disc disease may result. This is a disc condition where the disc slowly looses its elasticity through a repeated process of wear and tear. The result is a thin disc that functions poorly as part of the joint complex and also functions poorly as a shock absorber for the spine.
If annular tearing occurs quickly, or if a weakened disc receives enough stress to tear through an already compromised area, the result will be a shift of the nucleus from the center towards the outside of the disc. This condition is referred to as a disc bulge or herniated disc (slipped disc.) A small migration of nuclear material, 3mm outside the disc or less, may be called a disc bulge or protrusion. A disc herniation is generally larger. If disc material actually escapes and separates from the outer edge of the disc a prolapsed disc is the correct diagnosis.