Brendan M. Murray Dawn Yoshioka

Brendan M. Murray
D.C., D.A.C.B.S.P., Q.M.E.
Dawn Yoshioka
D.C., C.S.C.S., Certified A.R.T.
2825 Santa Monica Blvd., Suite 101
Santa Monica, CA 90404
(310) 998-5800 phone
(310) 998-5811 fax
Disc Injuries:
Intervertebral disc disease is among the most common causes of neck and back pain.
Cervical disc herniations (in the neck region) are less common than lumbar (lower back)
herniations. Lumbar disc herniations affect an estimated four out of five patients
complaining of back pain. Several factors may contribute to a herniated disc, such as poor
posture, work-related strain, traumatic injuries due to falls or blows to the back, improper
weight lifting, and sport-related muscular strain. Disc herniations may also occur because
of age-related degenerative processes that cause progressive loss of disc elasticity. Risk
factors associated with disc hernias are lack of regular physical exercises, inadequate
nutrition, smoking, and genetic factors.
In the United States Herniated disc is a common problem, with approximately 1 in 32 or
8.4 million people affected each year.
So what is a disc?
Intervertebral discs are circular ring-like flat structures that function as cushions between
two spinal vertebrae, allowing spinal flexibility and acting as shock absorbers. They are
also responsible for the attachment of the vertebral bodies to each other. Each
intervertebral disc contains a nucleus (a gel like substance in the center) surrounded by
fibrocartilage, called the anulus fibrosus, (fibrous, connective tissue), rich in collagen
(fibrous protein). With aging, the disc undergoes significant changes in volume and shape
as well as in biochemical composition and biomechanical properties. Lumbar disc
herniations are believed to result from annular degeneration that leads to a weakening of
the anulus fibrosus, leaving the disc susceptible to annular fissuring and tearing.
FIGURE 1. Four
concentric layers of the
intervertebral disc: (1) an
outer annulus fibrosus, (2)
a fibrocartilaginous inner
anulus fibrosus, (3) a
transition zone and (4) the
central nucleus pulposus.
So How Do Discs Tear or Herniate?
Laboratory studies have shown that repetitive flexion (bending) between two vertebra
will cause the nucleus, the center, to push backwards into the rings of fibrocartilage. As
this is done over and over tears in the cartilage will occur. Initially no pain is felt because
the inner fibers are believed to have no nerve innervation, but as the tear progresses it
reaches the outer fibers which do have nerves and you feel significant pain. Usually this
is a gradual process and one small movement will cause the final tearing into the painful
zone. A large majority of the patients with this type of injury report they were bending to
pick up something when they experienced intense crippling back pain. This causes acute
pain in the back or in the neck, and movement restriction. This condition is also known as
a slipped disc, an intervertebral disc hernia, a herniated intervertebral disc, and a
herniated nucleus pulposus. If the herniation is large enough or just in the right place it
can push into the area where the nerve exits the spine. The pressure on the nerve will
cause pain that radiates down the arm or leg.
So What Can You Do About a Disc Herniation?
The disc heals from the outside in, so the outer annular fibers will begin to heal first then
the inner fibers will heal second. Treatment for a disc herniation is first; if there is nerve
irritation or pain you must relieve that first. Nerve pain can be caused by the disc pushing
on the nerve and or inflammation. The use of therapies to decrease inflammation is used
for the nerve root as well as the disc. Braces and supports are also helpful to take pressure
off the injured tissues.
We use mobilization of the spine to restore normal movement to the vertebrae which will
take pressure off the injured disc fibers and spinal structures. Manual
therapy/manipulation is recognized in the literature as one of the most effective and safest
forms of treatment. Doing specific types of stretches called McKenzie exercises can also
be helpful to take the pressure of the injured tissue. It is important not to do exercises or
stretches which a doctor has not prescribed. Doing the wrong stretches or doing them too
early in the treatment may make your condition worse.
Once the pain is subsiding and you are feeling
better now what? Are you now going to have a
“bad” back, or be susceptible to reoccurrences?
The answer is yes and no. Research has shown that people with chronic low back pain
have weak or atrophied (smaller) musculature around the spine. There are a group of
muscles that are designed to just stabilize the joints of the spine. They don’t move the
spine but rather prepare the joints to move or protect the spine during movements. These
are the muscles that are not working following an injury. If you do not rehabilitate these
muscles they will weaken and atrophy. It is very important to do specific exercises
designed to target these muscles so that you can avoid a chronic low back problem.
Learning how to protect you back when moving while it is healing is also important,
remember the disc heals from the outside in so the outer fibers of the disc may be healing
but if the inner are not healed and you start to move in a way that puts pressure on those
inner fibers and the injury can return.
There are some disc herniations that are so
large that they can not heal or because of the
anatomy of the back there is too much pressure
on the nerve from the disc bulge that surgery or
other more aggressive measures should be used.
Even in those cases most spine surgeons agree
for a successful surgical proceedure they want
the patient to go through some form of conservative care, chiropractic care or physical
therapy, first. In other words they want to make sure that it won’t get better with
conservative care before they do surgery. If you have questions about your particular
condition options etc please feel free to speak to one of the doctors in our clinic. This is a
complex injury and this article is designed to just give an overview and to help educate
people with disc injuries.