Is it Back Pain or a Herniated Disc?

If you are one of 31 million Americans experiencing back pain, neck pain, or low back pain, a "slipped" disc or herniated disc may be the cause.

But what exactly is a herniated disc, and how does it become injured?

The spine consists of 24 blocky bones (vertebra) stacked on top of each other in a flexible column that allows our body to move. Between each vertebra sits a soft, rubbery cushion made of cartilaginous fibers and hydrated proteins known as an intervertebral disc.

Intervertebral discs help act as shock absorbers for our spine. Discs absorb the impact of numerous physical activities: running, bending over, sitting, jumping on a trampoline, and more. Intervertebral discs also absorb physical forces sustained in stationary positions like sitting at a football game or in front of a computer for long periods.

Intervertebral discs are located along the spine in our neck, mid back, and lower back. They also bend and twist with movements of the spine, allowing our bodies to be flexible.

How do they accomplish this? Intervertebral discs are shaped like jelly donuts with a tough, fibrous outer portion known as the annulus fibrosis and a soft, gel-like inner portion called the nucleus pulposus. This combination of a more rigid exterior and softer interior allows it to distribute the forces we encounter with our everyday activities and physical exertion.

How does an injury occur to an intervertebral disc?  Imagine dropping a jelly doughnut onto the sidewalk and stepping on it.

The term "slipped disc," more accurately known as a bulging or herniated disc, refers to some damage that has occurred to either the annulus fibrosis, the nucleus pulposus, or both.

The damage can be minor – think of a small papercut that heals just fine on its own. Sometimes, the outer portion of the intervertebral disc tears, resulting in large bulges in the annulus fibrosis.  If the tearing and damage to the annulus fibrosis are extensive, the nucleus pulposus may leak out. 

Damage to this tough exterior of the intervertebral disc can also irritate the nerves on the outer third of the annulus fibrosis, causing pain and other issues to occur.

Compromise to the disc structure is commonly thought to occur from accidents or traumas, but this is not always the case. Although injuries from traumatic accidents like sporting injuries, vehicle collisions, or slips and falls can cause damage to the disc, degeneration, or accumulated wear and tear on the body, it can also cause discs to become more susceptible to injury and damage! Sometimes degeneration occurs from age, but it also can occur naturally. Thankfully, the rubbery discs in our spine are a lot stronger than a jelly doughnut!

Although intervertebral discs can be injured, there may not be any symptoms.  Having a disc injury may not always be painful or even result in pain or a loss of function. 

If there is a disc bulge or herniation, surgery is not always necessary to relieve the problem, either. Why is this? Disc bulges can occur naturally in the body without producing any signs or symptoms that they exist. It's when signs and symptoms, such as pain and a decreased ability to perform regular activities, may indicate the need for some intervention.

The mechanism of a disc herniation

The vertebrae and intervertebral discs of the spine surround and protect the spinal cord: the information highway connects the brain to the body's nerves.  The nerves exiting the spinal cord travel outward, innervating both the left and right sides of our bodies.

Injury to a disc can create a bulge that pinches one of the nerves exiting the spinal cord. This is known as nerve impingement. Signs and symptoms depend on where the disc is located and whether the disc bulge or injury is pressing on a nerve.

If this is the case, depending on where the pinched nerve is in the spine, it can result in pain, weakness, or odd sensations called paresthesia in an arm or leg!

Signs of a disc herniation causing nerve impingement include7:

• Arm or leg pain. If pain is left in the upper or lower extremities, it is usually only on one side. 

  • A disc herniation in the neck may cause pain and discomfort in the shoulder and arm. 

  • If the disc herniation is in the lower back, it may cause pain and discomfort along the beltline, thigh, and even into the foot. 

  • This pain can feel sharp or shooting when you cough, sneeze, or move into certain positions.

• Weakness. A disc herniation may pinch the nerve, resulting in muscles controlled by the nerve becoming weaker.

• Paresthesia. This may feel like tingling, numbness, strange sensations, or even ants crawling on the skin. The areas of the body that experience these symptoms are often supplied by the nerve being impinged.

Certain conditions increase the risk of developing disc herniations and disc injury. These are:

• Weight. Obesity and excess body weight places additional stress on the discs, primarily in the lower back.

• Occupation. People with labor-intensive jobs have a greater risk of developing back problems. This includes repetitive lifting, pulling, pushing, twisting, bending at the waist, and leaning from side to side.

• Genetics. Some people inherit a predisposition to developing a disc herniation.

• Smoking. Smoking decreases the oxygen supply to the disc, causing the cartilaginous fibers to break down more quickly.

Is your pain coming from a spinal disc injury?

What should you do if you suspect you have a disc herniation?  Because the nature of this injury is mechanical, which means it occurs in relation to the muscles, joints, and bones of the body, addressing the musculoskeletal components and making changes to overall bodily movement becomes a crucial part of an effective treatment plan.

Management of a disc herniation will depend on whether the condition is acute (sudden onset) or chronic (repeatedly occurring over time). It will also depend on the severity of symptoms and the size of the injury to the disc.

Thankfully, with the right interventions and tools, intervertebral discs can heal – although it can be slow!

What should you do if you suspect you have a disc herniation? To help prevent a herniated disc, you can:

• Exercise. Strengthen the trunk muscles (think core muscles: abs and back) as these muscles work together to stabilize and support the spine.

• Change your ergonomics. Lift heavy objects properly, making your legs and hips — not your back — do most of the work. Take breaks to change positions and move when sitting for long periods.

• Maintain a healthy weight. Excess weight puts more pressure on the spine and discs, making them more susceptible to herniation.

• Quit smoking. Avoid the use of any tobacco products.

Is a doctor's appointment necessary?

If you're having back pain, you may want to see your Doctor of Chiropractic to determine if you have a disc herniation.  A chiropractor is a trained doctor with the necessary educational background to analyze the physical movements of the body.  A chiropractor can be an asset in directing the course of care best for recovery if you have a disc injury or other musculoskeletal condition.  

Give our office a call if you feel you may have a disc injury or other condition causing your pain! Treating disc herniations and related conditions is right up our alley, and we have many methods to manage your care safely and effectively. In most herniated disc cases, a physical exam and a medical history are all that's needed for a diagnosis.  If you have another condition or extensive injury is suspected, you may be referred out for imaging.

Our office is well-equipped to assess, diagnose, and treat mechanical conditions — like disc herniations and pinched nerves — through gentle, conservative interventions that don't include injections or surgery.  Make your appointment today.  Living in pain is not an option if you have disc-related pain!

Low Back Pain and McKenzie Exercises

The visual that comes to mind when thinking of low back pain is a person half-bent over with a hand on the sore spot of their back.  Many of us have experienced low back pain, and you may recall feeling severely limited or even helpless during the acute phase of your last episode.   Feelings of pain and helplessness are some of the reasons why low back pain is of the most common causes for patients to seek emergency care!1

In fact, over 80% of people have experienced at least one episode of low back pain in their lives, and up to a quarter of adults have experienced low back pain in the last three months2,3!  That’s pretty... painful to think about, actually.

On top of this, chronic low back pain is considered the second most common form of disability worldwide,3 and one of the most common causes for adults to see a family physician.4

In the past, patients were told to “take it easy” during a flare-up of low back pain.  They may have been prescribed bed rest by their family physician, thinking that avoidance of movement would help relax muscle spasms and ease pain to more tolerable levels.

However, times have changed.  Treatment guidelines instead recommend specific exercise4, gentle stretches, and other ways of staying active during the recovery process.  Total bed rest is to be avoided.

Why the change?

Part of the reasoning is anatomical.  Two types of muscles exist in our backs: superficial muscles (or surface muscles) and deep muscles5.

Superficial muscles are used to perform motions like bending and twisting.  These muscles are strengthened by exercise that places stress on the muscles.  Think of the person at the gym lifting weights: they’re building and growing these superficial muscles.

Deep muscles, on the other hand, help stabilize the spine and maintain posture.  Physical activity such as yoga, walking, or specific exercises help keep them in shape. 

A common scenario is bending over to pick something off the floor.  You may hear a “pop” in your low back, followed by pain and muscle tightness.  You’re bent over, unable to fully stand upright, and your world suddenly hurts no matter what you do.  You go to bed – and stay there, unable to move because movement equals pain.  You call out of work because you can’t get out of bed.  You remain largely sedentary for a week, under the guise of “waiting it out.”

When a person goes on lengthy bed rest, the deep muscles in the back will weaken and begin to lose mass and strength.  This is a process known as atrophy.6

As the pain subsides and the person feels some improvement, activity is slowly resumed.  In order to do this, the body will recruit the bending, twisting, superficial muscles to help stabilize the back.  Although they can function in this capacity, superficial muscles are NOT well-adapted for this function!  These superficial muscles will tire more easily, resulting in impaired normal movement or motor control.

This can place abnormal stress on the structures in the spine such as joints and muscles, as well as joints and muscles in other areas of the body, increasing the risk for additional musculoskeletal injuries.7,8

There are specific exercises that help strengthen the stabilizing muscles that lie deep in our bodies, close to the spine.  Doctors of chiropractic regularly prescribe exercise to address an acute flare-up of low back pain and may suggest general activities, such as swimming or walking, to improve your overall fitness.8  

Some specific exercises, known as McKenzie exercises, are especially effective for patients who are suffering from an intervertebral disc injury.4 “McKenzie exercises” is a term you may not be familiar with. Yet. But hang with me. They have become a staple in the conservative management of low back pain. They entail simple exercises that have very profound impacts on a patient’s low back pain. They are named after Robin McKenzie, the physical therapist who first began using them.

McKenzie exercises are designed to be used after a thorough evaluation from your medical practitioner. In fact, McKenzie refers to a method of mechanical diagnosis and series of therapeutic exercises prescribed based on the determined diagnosis. The exercises I will be teaching here are simply one protocol of McKenzie exercises. It is the most commonly followed protocol; however, it will not help every low back pain patient. This is also not a substitute for a mechanical examination. Instead it is a tool for patients in acute pain seeking relief until obtaining professional care. 

In their most basic form, McKenzie exercises are most effective for patients suffering from intervertebral disc injuries. Disc injuries can cause a variety of low back symptoms from intense back pain to pain radiating into a lower extremity. These exercises may reduce the intensity of the pain and in some patients, eliminate it completely. 

When you are experiencing a disc bulge or herniation, the disc material will often protrude to the back side of the disc. While there are other kinds of disc injuries, these are the most common. Disc injuries are extremely prevalent in today’s population. Many who seek medical care for these injuries will be told their options are rest or surgery. Although in some severe cases surgery is necessary, the body has the ability resorb the disc naturally. McKenzie exercises are a mechanical tool that patients can use to help the body resorb this disc.

McKenzie extension exercises work because they force the spine to go into an extended, arched back, position. This arch will actually cause the two vertebrae to close down over the disc at the posterior aspect. This “closing” of the disc space can actually cause the protruding disc material to retract back into the spine and relieve many of the symptoms associated with a lumbar spine disc injury.

Before performing these exercises there are a few things you should pay attention to:

1. While performing the exercises it is common to experience pain throughout the exercise. Often after multiple repetitions the pain intensity will begin to decrease. If you perform the exercises and the pain gets worse and stays worse these exercises may not be right for you.

2. If you are experiencing symptoms into your lower extremity, these exercises may also help reduce those symptoms. As you perform repetitions, pay attention to the intensity of the pain in your leg. Has it been improving? Does the pain travel as far as it did when you began? If either of these occur continue with more sets and repetitions. These exercises may be right for you. It should be noted that even if symptoms in the lower extremity begin to trace back up the leg or decrease, it is not uncommon to simultaneously have increased pain in the low back. It sounds counterintuitive, but increased back pain is not always a bad sign when the pain in your leg is improving.  Typically, when there is radiating pain in the lower extremity, to get rid of the pain completely (from the leg AND back) the leg pain must be eliminated first. While performing these exercises, we often see the pain tracing up the leg towards the back becoming more intense, but over a smaller surface area. The smaller the area of pain, regardless of intensity, the closer you are to abolishing it completely.

How do we perform these exercises? 

You can begin these exercises in a standing or prone (on your stomach) position. When standing you will put your hands at the base of your spine and drive your hips forward. The goal is to push your hips over your toes or past them. Take the stretch to the point of pain or until you are unable to go any further and repeat.

If you are on your stomach, keep your hips on the floor and bring your hands up to your chest as if you are doing a push up. Push your chest up, going as far as you can without lifting your hips. If you are in a lot of pain, you may only move a couple inches. Do not force yourself through the pain. Let each repetition gradually improve your range through these exercises. 

A good place to start is with 3 sets of 10 repetitions. If the pain increases after three sets, it may not be the right exercise for your condition. If you experience no change or even mild improvement, perform more repetitions to see if you can create lasting improvement. For many patients these exercises may not only help decrease overall pain but also are useful for mitigating flare ups.

Remember these are just one of many different types of McKenzie exercises. You may require a different direction or progression of exercises. This is a great place to start if you are on your own but remember - it is highly recommended to get a proper evaluation from a McKenzie practitioner to determine exactly which exercises will treat your individual ailment.

References

1. Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.

2. “Back pain fact sheet.” (2014). National Institute of Neurological Disorders and Stroke. Retrieved March 2020 from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

3. Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. 

4. Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.

5.  Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.

6. Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.

7. Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.

8. “Low back pain.” (2020). American Academy of Family Physicians. Retrieved from https://familydoctor.org/condition/low-back-pain.

Your Foundational Core

Your core is made up of the groups of muscles that provide stability in the abdominal and lower back regions. It includes your abs and the deep muscles that surround and support your spine. These muscles also coordinate the movement of your arms, legs, and spine. Ideally, your core and low back work together in a balance of strength and flexibility. A lack of flexibility or strength in your core can contribute to low back pain.

Strengthening your core muscles can help your endurance, improve your posture, and take the pressure off your low back. Having strong core muscles makes it less likely that you will suffer back pain and can give you better balance. Everything you do in daily life or during a workout will be easier if you have a strong and flexible core. It's the centerpiece of all body movement.

• A strong and flexible core can help improve your posture, balance, and reduce your risk of experiencing back pain.

• When your core muscles contract, they stabilize your spine, pelvis, and shoulder girdle to create a solid foundation for movement.

• Weak core muscles can alter your posture and spinal curves which often leads to back pain.

There are a million ways to work your core. So how can you decide what's best? Just ask us! We are happy to provide you with some of our favorite core strengthening exercises to fit your activity level and health goals. Some of the most efficient core exercises don't require any additional equipment, just the desire to improve your health with better strength and flexibility.

Fixing Low Back Pain

Restrictions and limited mobility of your lower back may be causing your pain. If your low back doesn't have a full range of motion, then you are setting it up for future injuries. Bending forward and back (flexion/extension), side bending (lateral bend), and turning side to side (rotation) are the three movements that make up a full range of motion. You have to use it, or you'll lose it. Neglecting your lower back and not actively improving and maintaining a full range of motion can cause restrictions, deconditioning and increase your chance of injury.

The care given in our practice is specifically designed to address both aspects of improving your range of motion, segmental, and global. That means our chiropractic adjustments work the specific joints of your spine that are "stuck" or restricted. This begins the process of improving your range of motion and often provides quick relief from pain. The next steps are to improve the overall, or global, range of motion. This is where we may recommend at-home stretches, specific exercise, or even periodic adjustments to help continue your progress and hopefully keep you pain-free in the future.

• Limited range of motion in your low back can lead to a combination of shortened and weakened muscles that increase your risk of injury.

• Chiropractic care provides relief by improving the motion of your facet joints and limiting the pain signals traveling through your central nervous system.

• At-home stretching, daily exercise, and even periodic chiropractic adjustments are all ways you can take a proactive approach to stay pain-free.

If your low back is de-conditioned and limited in its mobility, you likely have a combination of shortened and weakened core muscles that are over-stressed and causing pain. Our practice is focused on helping you decrease pain, improve your mobility, and live a healthier life. The first step is to give us a call and let us help you get back in motion.

What is Sciatica?

Nearly everyone will have back pain at some point in their life, but with sciatica, you'll know something is different right away. Pain that begins in your back travels down to your buttocks, and shoots down your leg is a classic sign of sciatica. The shooting pain down your leg is caused by compression on one of the nerves exiting your spine. Even a small amount of pressure can cause a tremendous amount of pain, so getting rid of the inflammation and opening up space, the nerve is essential to find relief.

Pinching, or compression on a spinal nerve can occur because of an injury to one of your spinal discs (such as disc herniation) or the development of a bone spur. Either way, it's likely to cause pain and discomfort until you can decrease the inflammation, open up space for the nerve, or improve the movement of your spinal joints.

• Sciatica occurs when a spinal nerve gets pinched by a disc, bone spur, or ligament and can cause pain that travels down the buttocks and leg.

• Research has discovered that 60% of people with sciatica benefited from chiropractic adjustments to the same degree as if they underwent surgical intervention (without any of the risks!).

• Exercise and rehab can help strengthen the muscles supporting your spine and reduce the likelihood of a relapse.

Pain, numbness, or weakness in the legs can be scary. If you experience any of these symptoms, it's best to consult with our office right away. Top research publications have shown that people struggling with sciatica can get fantastic results with chiropractic care. Reach out today to discover if the techniques we offer in our practice can help you get on the road to relief.

How Heavy is that Backpack?

Even though an iPad can store an entire library worth of books, most kids still trudge to and from school each day carrying an oversized and overweight backpack filled with heavy textbooks and loads of school supplies. While it may not seem like a big deal, recent studies have shown that carrying the weight of a typical backpack is one of the top reasons for kids to have back pain.

A vast majority of kids wear backpacks every day that weigh 15 lbs. or more. That’s a heavy backpack! Over time, the stress of the load can result in back pain, a rounding of the shoulders, and postural changes. The spinal compression caused by heavy backpacks often has kids leaning forward to compensate, which begins a vicious cycle of postural issues, compensation, and pain.

• Up to 30% of kids may suffer from back pain due to carrying a heavy backpack.

• Limiting the total weight of the backpack to less than 10% of your child’s body weight is recommended.

• Instruct your child to wear their backpack with both shoulder straps fit snugly, so the backpack isn’t carried below the waistline.

Kids typically choose their backpack based on what makes them look cool. We recommend taking a second look and making sure the straps are wide and padded, the size is appropriate (and not too big) and that it has compartments to help distribute the load. If your child has pain, numbness, or tingling, give us a call. We would be happy to help get them back on track!

Your Body is Designed to Move

Your body is built to move. Every spinal disc and joint is designed to help you sit, stand, run and well...move! Your discs are soft enough to flex as you bend forward and back. The spinal facet joints slide as your turn and twist. The ligament-connected spinal bones keep you supported as your muscles push and pull. It’s an incredibly strong and resilient system when you stop and think about it.

New research has started to give us a glimpse at just how important movement is in our life. For example, movement of the spine has been shown to stimulate and accelerate the healing process. In fact, movement is so crucial in the healing process that even people who have spine surgery are encouraged to get up and to move as quickly as possible after surgery.

-All the bones, muscles, ligaments and joints of your spine are specially designed to support movement.

-Movement of the individual segments of your spine can affect how you heal.

-Blood flow, strength, and flexibility are all enhanced through movement.

I believe that encouraging healthy movement and activity is part of my job as your Chiropractor. If you have any questions about stretches, exercises or other ways you can pro-actively stay healthy, ask! Have you ever heard that old saying “you don’t get old then stiff, you get stiff then old?” We want to help you stay young by helping you keep your spine and body moving better!

Facet Joints: Gliding Your Way to Better Health

If you’ve had neck or back pain that you could pinpoint with your finger, or experienced sharp pains when you move, it may be related to the facet joints of your spine. It’s easy to think of your facet joints like the “knuckles”of your spine. They are small joints and have a capsule and cartilage pad that glides and slides, allowing your spine to move.

As you go through life and your spinal discs go through the aging process, your facet joints end up taking on extra load. Unfortunately, this excess stress and pressure can wear down your facet joints. What results is the beginning of the degenerative process,which means you can end up with adhesions, restricted motion, bone spurs and pain.

-The facet joints of your spine slide and glide as you move.

-Restrictions or adhesions in the facets can occur with age and injury.

-Chiropractic adjustments help the facet joints move freely and decrease painful restrictions in motion.

The facet joints of your spine love to move, and, in fact, movement helps them stay healthy and may even slow down the degenerative process. Chiropractic adjustments can help reduce adhesions on these joints ,allowing you to move more freely and with less pain. In our office, we believe that when you’re moving better, you’re feeling better, and we’re proud to be a part of the healthcare team that helps you stay active!

Finding Relief From Disc Herniations

So, you’ve suffered a disc herniation, and it’s causing severe pain. Do you need an injection or surgery? What type of doctor should you see? Can a Chiropractor make it...worse? These are all common thoughts that may race through your mind after you’ve experienced a spinal injury. First, take a deep breath and relax. Leading research journals have shown that you made a smart decision by choosing chiropractic care. Many leading health organizations are now recommending chiropractic as a top choice to find relief from disc herniations.

Studies have shown that over 90% of people with a lumbar disc herniation that were treated with spinal adjustments improved within 3 months, and 88% improved within 1 year. Perhaps even more impressive was another study, which indicated that, for disc herniations in the neck, 86% of people found relief with chiropractic adjustments compared with less the 50% of people who underwent a spinal injection. We continue to learn that, most of the time, the benefits of medications, injections, and surgery just don’t outweigh the risks.

• Top healthcare organizations recommend taking a conservative approach to care, such as chiropractic. In most cases medications, injections, and surgery should only be used when conservative treatments have failed.

• In a recent study, researchers found that over 90% of patients with a lumbar disc herniation improved within the first 3 months of receiving chiropractic adjustments.

• Over 35% more people with cervical disc herniations found relief with chiropractic adjustments than with spinal injections.

Discovering the most up-to-date Research That Matters is part of our practice. We focus on using this research and combining it with our clinical expertise and experience to provide you with the best care possible. So, if you are suffering from a disc injury, please know that you’re in the right place, and we are grateful you have trusted us with your recovery.

Disc Bulge vs Disc Herniation

The bones, discs, ligaments, and muscles of your spine are designed to help you maintain

proper spinal alignment, posture, and movement. Between each set of bones or vertebrae is a

small rubbery disc. These discs act as small shock absorbers for your spinal bones and nerves.

They have a tough, rubber-like outer layer called the annulus fibrosis and a soft jelly-like center

that is called the nucleus pulposus. As you age or encounter injuries, the curve of your spine

may fall out of alignment. This can place uneven stress on your spinal column and

discs,increasing the chance of having a disc break down and herniate.

A disc herniation occurs when the outer portion of the disc ruptures (or tears) and the soft

inner portion squeezes out. This type of injury can cause pain at the site of herniation, or

sometimes the herniated disc can pinch a nearby nerve, causing pain that can radiate down into

your arms or legs. Similarly, a disc bulge occurs when the outer wall of the disc is weakened, but

the inner portion has not yet broken through.

• A disc herniation occurs when the inside of a spinal disc breaks through its outside wall.

• Disc herniations often contribute to nerve compression, which can send pain, weakness, or numbness into your arms or legs.

• By maintaining proper spinal alignment, you can reduce added wear and tear on your discs and potentially decrease the likelihood of a disc herniation.

Now that you know what a disc herniation is, be sure to stay tuned. Next week, we’ll reveal the

best ways you can find natural relief. Can you guess what type of care resulted in over 90% of

people with a disc herniation finding improvement within the first few months? We’ll be back

next week with the answer!