The Sievert Clinic - Chiropractic

The discs within the spine are basically cartilage pads which separate, cushion, and help to bind together the twenty-four (24) vertebrae. These discs are part of a system much like the "suspension system" of your vehicle, in that they provide a cushioning effect and flexibility for your spine. It is these discs which allow you to move and bend your neck and back. It is important to remember that discs do not have a direct blood supply. They receive their nutrition by a pumping process called osmosis and diffusion resulting from the movement of vertebrae above and below the disc. When this "suspension" system is not working properly because of improper spinal motion, the nutrients are not supplied to the disc, and degeneration may result.

Without the discs, the spine would be an inflexible solid mass of bone. Spinal discs make up approximately one-fourth of the length of the spine. Throughout your entire life, these discs are constantly exposed to compression, torque, twisting and injury, resulting in stress to the disc mechanism.

2. How Does an Injury To The Discs Occur?

Disc injury occurs as a result of many factors such as genetics and the normal "wear and tear" process of aging. Subluxations (minor displacements or functional disturbances) of the spine which were discussed earlier are also a factor in the cause of disc injury. The most common manner in which these displacements of the spine occur are through sudden, forceful movements of the spine, such as falling, lifting, twisting, auto accidents, or perhaps an unexpected slap on the neck or back. Sometimes, the mere position that the spine is in while performing a minor task can cause a disc injury. This can occur even when lifting a very light object.

3. Facts About Herniated Discs.

Disc disease is the topic of considerable discussion today and terms such as ruptured, herniated, bulged, degenerated, and protruded are often used interchangeably; however, they are not the same. The spinal discs are constantly subject to gravity and torque from body movements and, therefore, are susceptible to degeneration from wear and tear. The terms "degenerative disc" or "degenerative joint disease" more accurately describe the "wear and tear" process which occurs. Derangements of the spine are a major contributing factor in back pain. Derangements (subluxations) or structural imbalances allow the disc to bulge, protrude, herniate, or impinge upon nerves. Sciatic pain is a common example of the possible irritation which can result from a degenerative or herniated disc.

4. Back Surgery, Will It Be Necessary?

Many leading authorities state that only a small percentage of disc herniations actually require surgery. However, of those individuals, who are carefully and properly selected to be treated by surgical methods, the percentage of satisfactory results is good. By all indications, too many individuals are misdiagnosed as having a "herniated disc." These cases are too often improperly and aggressively managed. Many of these cases have resulted in considerable unnecessary and costly surgery, often with no positive outcome or resulting in a failed back syndrome. There are indications for surgery, which should be thoroughly understood and carefully considered. Intractable pain (pain which is not able to be relieved), recurrent crippling attacks of pain and immobility, which affect the livelihood of the individual and his or her "quality of life," and any significant neurological deficit (loss) in ability to walk, properly balance, or the ability to control bowel or bladder functions, are signs of the need for a possible surgical consultation. After careful evaluation of your problem, your doctor of chiropractic may advise you to consider a short-term trial of conservative chiropractic care. In the event this does not produce satisfactory results, you and your doctor will decide on a recommendation for a second opinion consultation prior to determining the need for surgery. While it is difficult to generalize about disc herniations, you should inform your doctor of any changes in your condition.

5. What To Do For Disc Problems

Clinical evidence suggests that many "disc herniations" can be successfully treated, and the resulting pain and muscle spasms effectively alleviated through the application of conservative chiropractic care. This may include specific spinal adjustments and, if appropriate, the use of supportive therapy. A fact which is often overlooked is that muscle spasm and pain are your body's way of protecting you from further tissue damage. Often the conservative approach is not to attack the pain and spasm, but rather to determine and correct the reason for your pain and spasm. When this is accomplished, your pain and spasm will most likely diminish and eventually disappear. The doctor of chiropractic directs his or her efforts toward the skillful restoration of the vertebrae to their normal range of motion, thereby reducing inflammation, stress and pressure on the spinal discs and spinal joints.

The chiropractic profession is the leader in the field of manipulation and conservative management of disc injuries. The application of the principles of chiropractic spinal management can lessen the possibility of costly hospitalization, unnecessary surgery and its often negative after effects, and considerable pain.

There are thousands of unnecessary spinal surgeries performed each year in the United States, with sources estimating as many as 44,000. A recent government report from the Agency for Health Care Policy and Research (AHCPR), which developed Guidelines For Acute Low Back Pain in Adults, suggested that the treating clinician discuss all treatment options with the patient. Surgery should be considered if the condition is disabling, the symptoms persist without improvement, or there is progressive deterioration in the condition. The study suggests that at least a one-month trial of conservative care be considered as a first treatment option. Among the recommended "preferred treatments" for acute low-back pain, spinal manipulation is one of the conservative methods indicated. Doctors of chiropractic perform 94% of all spinal manipulation administered in the United States.

6. How Long Will A Disc Problem Take To Respond?

The length of time you have the condition can greatly affect your response time. If, for example, you have only been treated with physical therapy, muscle relaxants or pain medication, and your condition was the result of a spinal derangement, you will have allowed the condition to possibly become chronic, while you attempted to treat only the pain. Removal of the pain is not necessarily always beneficial; it is the body's "warning signal" to alert you to problems.

The chiropractic conservative approach to the management of disc herniations utilizes, if indicated, a careful and strict regimen of ice or heat when necessary, supportive therapy, special rehabilitative exercises and specific chiropractic adjustments (manipulations). Careful ongoing monitoring of your progress by your doctor of chiropractic, as well as your providing him or her with important information on your improvement, will be essential to the successful management of your condition.

Specific chiropractic adjustments may improve spinal mobility and unlock the facet joints (gliding joints of the spine which allow movement) helping to relieve the accompanying muscle, ligament and tendon contractions, as well as the mechanical or reflex irritation of the nerve roots. Some disc cases respond in one or two weeks. For some patients, however, it may take longer. In any case, it requires time to heal, even after the pain has been relieved.

Disc problems are "potential time bombs," which can go off at any time. You must use caution when lifting, bending or performing any task where extra physical exertion is required. The erect posture of the human spine, coupled with repeated minor trauma or injury, increases the susceptibility of the spine and discs to degeneration.

SYMPTOMS AND SIGNS
OF DISC PROTRUSION

Deep, dull ache in low back.
Deep, dull ache in buttocks and/or posterior thigh, calf and sometimes foot.
Splinting muscle spasm of low back (reflex spasm immobilizing lumbar spine in antalgic position).
Sharp pain in low back upon movement.
Pain, loss of sensation, numbness and/or tingling in leg and/or foot.
Muscle weakness.
Inability to stand on toes or heels.
Pain accentuated by forward bending, sneezing or straining.
Bladder and bowel incontinence.
Other symptoms may be present.
Limited flexion and/or extrusion of back.
Increased pain with prolonged sitting, standing or lying on stomach.
Pain relieved when lying on back or side with knees and hips flexed.
Difficult to rise from sitting or lying position.
Coughing, sneezing or straining increases low back and/or leg pain.
Pain and stiffness in morning (usually difficult to put on stockings and shoes).
Increased pain after walking short distances (relieved with rest).
Decrease or loss of knee or ankle reflexes.
Muscle atrophy.
Other signs may be present.