What is a disc herniation?
A disc herniation is also known as a disc bulge, disc protrusion, disc extrusion, slipped disc, pinched nerve, sciatica, and typically can result in pain within the neck, arms, shoulder blades, lower back and legs.
A disc injury or bulge may be accurate description but in many cases this term is used often in an attempt to explain what is going on with a patients case.
Spinal Disc Anatomy
There are two different layers of a disc. The first one is the outermost layer and it is called the annulus fibrosis. This layer is a thicker fibrous layer that has nerves on the outer 1/3rd. These ring like structures are very much like an onion and give the disc its firmness and toughness and also functions to maintain the nucleus within the center.
The inner layer is called the nucleus pulposus and it’s a gel like substance within the middle. This layer functions to help reduce torsion within the spine while also helping with cushion and movement. The inner layer makes up ⅔ of the entire disc and does not contain nerves. This means that if you injure this area or begin to injure this area wouldn’t even know and it’s causing you pain or a problem.
To break it down, when the inside layer starts to migrate out of the center is when you will start to feel the pain creeping in.
Here is the big takeaway picture about disc injuries.
Once the problem or injury begins to hit the outside ⅓ and beyond, that is when you will start to experience pain, discomfort, stiffness, and even nerve pain that goes into the arms or legs. This means that this has been going on for weeks, months, or years and has been a process in the making. The disc gets injured from inside out, but heals from outside in so be patient with your treatment.
What are the Primary Functions of the Disc?
Discs within the spine run all the way from the cervical spine to the thoracic spine and into the lumbar spine and they have two primary functions. The first function of a disc is to assist with movement as well as shock absorption from such movement. The second function is to help create space between each vertebrae within the spine so that the nerve that comes out of the spine does not get pinched off.
Discs are unique in that they do connect bone to bone and therefore are classified as a ligament. These unique structures allow dynamic movement to be accomplished on a daily basis.
How Do Discs Get Injured?
Most disc injuries occur in the lower neck and the lower back areas. This includes C5-C6, C6-C7 and L4-L5, L5-S1. The reason that these areas are the most common is because they are the areas with the greatest amount of forces and movement placed upon them.
Typically discs will get injured via flexion and loading such as picking up a heavy weight incorrectly, but can also occur from trauma, vertical compression (lifting too heavy), poor posture, and repetitive strain such as sitting long periods of time, incorrect exercises and techniques, etc.
When a disc gets injured, it is typically as a result of that improper loading and positioning that compresses the disc. These areas of the spine are designed to be more rigid and stiff but over time with improper use and mechanics (sitting, poor posture, bending, etc) we begin to move these areas too much and in the improper way.
With time, this can lead to an annular tear (outside layer), which is a tear within one of the rings in the disc. If this tear is allowed to tear more, it could compromise the disc further and allow the nucleus or gel like substance to leak out further.
The problem begins here! This compression then continues on within the spine and can then compress sensitive structures like the nerve. This can result in conditions like sciatica if it is in the lower back or numbness and tingling into the arms if it is in the neck.
Your discs are resilient!
Despite what a lot of doctors say, spinal discs are incredibly resilient and can heal well if you give it the right treatment. Think about it, your body wouldn’t make something that wouldn’t last for 90 years or more. Yes, things do wear down over time but a majority of discs can last you your entire life and be painless.
In addition to the lifetime approach of maintaining discs, spinal discs although do not have direct blood supply but hey still can heal. The way disc get their nutrition is through movement. This means with the correct movements you will give your body nutrition it needs to heal.
Finally, discs can adapt. Just just like training a muscle to get bigger or stronger, you can train your disc to get stronger and you can do this through proper strengthening programs and improving your joint mechanics.
4 Types of of disc injuries
The words that professionals use is very important at times as it gives us indications to what is actually happening within the disc itself. Not only is that, but it can provide value to a patient if you truly understand what is happening to your body. Doctors often use this complex words to describe the complex process but here we will simplify it using the “jelly donut example”
Spinal discs are much like a jelly donut in that it contains a jelly like substance in the middle. When we compress the top, side, or front of the jelly donut, the jelly within the middle can migrate.
- Disc Bulge – this is when the disc material has been compressed to the point where there is some overlap of the disc material over the bone. This is where we take jelly donut a give it a squeeze from the top down. This flattens the jelly and the donut itself (compression).
- Disc protrusion – this is where some of the disc material as moved from the middle towards one side of the spine. Imagine stepping on the front left side of the jelly donut. This would push some of the contents within the donut and spine backwards. In a disc protrusion, there is about 25% or less of this occurring.
- Disc herniation – Imagine taking that spine or donut and stepping on the front of it to the point where the jelly in the back starts to break through the donut and begins to leak out. This is classified as a disc herniation and can be very painful. Not only can the disc itself be painful but it can place pressure on the nerves that run along side of the spine. Now imagine, that the leaking jelly donut is left on the floor. Ants will come. This is your inflammation. Although inflammation is the beginning phases of healing, it is often painful.
- Disc Sequestration – Now take that jelly donut and compress it a bit more to the point where the jelly falls out of the back of the donut and onto the floor. This is when the inside material literally separates from the disc itself. This gives the inside material the ability to move within the spinal canal which is something that can increase your pain significantly.
How to Diagnose a Disc Injury?
Believe it or not a disc bulge or herniation is fairly easy to diagnose. It should include history, current pain, and a physical assessment. Typically, you can get a physical examination that is quality in about 15-30 minutes to see what is going on with your back or neck pain.
The gold standard for diagnosis of a disc herniation in the neck and lower back is via MRI. This test may not be necessary at first, however it can be a valuable tool to help see what and where the site of injury may be.
Typically in the office I prefer if patients go through a course of care for 6-12 visits prior to getting an MRI (unless there are some warning signs) because this often cuts patient expenses. In addition, patients often get results without the use of MRI so its a win-win situation.
How can I treat my disc injury and pain naturally?
Natural and holistic treatment of a disc injury can include everything from ointments, Chiropractic Care, Rehabilitation, mobility training, and other methods. The first goal of any treatment is to reduce the pain as quickly as possible and is known as the pain relief phase.
During the pain relief phase you may want to explore options like tens units, electrical stimulation, ice, gentle movements, and activity modification. well this is not ideal for most people, is it often necessary when patients are in pain and suffering a lot of nerve pain as a result of the disc injury. Typically you can expect to be in this phase between one and four weeks.
As your pain decreases you will be able to move and do more but that does not mean you are not subject to further injury or pain. Just because you are not currently experiencing pain does not mean the disc is not injured or vulnerable to injury. In order to make a long-lasting effort and treat this naturally, you’re going to have to consider exercise programs that are geared specifically for you.
Pain & Sleeping with disc injuries
Low back pain common neck pain, and disc injuries are often painful at night and in the morning. This is because during sleep a disc tents to swell naturally which can add extra pressure to the spine causing discomfort. The swelling is a natural way for your body to heal everyday and pump the disc with fluid and nutrition.
In today’s modern society we do not sleep enough and when we are injured, we do not get enough quality sleep. If your discs heal at night but you’re not sleeping well you need to find a way to not only get more comfortable, but to get the quality sleep you need to recover. Too many people look for cures but neglect the basics. I often tell patients to get an extra hour of sleep every day for the next two weeks when they’re suffering a disc injury.
To help gain some additional sleep at night you will likely want to do some pain control and gentle movement or mobility exercises before getting into bed.
Nutrition for disc injuries
Nutrition is also very important to help healing throughout the body. You should initially focus on whole foods that are rich in fruits and vegetables. We know that supplementation can help, but it should be a supplement to your quality diet. If you need a jump start, supplementation can also be helpful in your recovery process and as a result, I’m going to share with you a few things you can use to help jump-start your healing.
- Collagen is it important part of the the entire body and pretty much makes up every single cell. Collagen is extremely important in soft tissue healing, skin, hair, nails, and is a major component in discs. If you have a disc injury, this is necessary to have in your diet since some of the disc is already broken down and need repair.
- Vitamin C – most people tend to have enough vitamin C in their diet but you can also get extra from plants in the form of vegetables and fruits. vitamin C is absolutely necessary because it is a precursor to making collagen.
- Most people (even in sun stricken states) are deficient in Vitamin D. Although it is classified as a vitamin, it is actually a hormone and critical for immune health and vital for healing illness and injury. This is not only good for healing but a good vitamin/hormone for overall health.
- Boswellia & Turmeric are both very well known to help treat inflammation. With a disc injury, there is often pain and using herbs and proper diet is a great way to help flush the body with quality nutrition and reduce whole body inflammation which can help with pain reduction.
If you want most if not all of the ingredients listed above then here is an all in one supplement I recommend many disc patients I see.
If you have more questions or want to schedule an appointment with Dr. Jagoda please click here. We are located in Pacific Beach, San Diego.
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