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Herniated Disc: Pain and Treatment


Whether from a car accident, a sports injury, gardening, or a simple slip and fall, herniated discs are caused by some form of trauma.  Unlike a disc bulge, which tends to happen over time due to degenerative changes, a disc herniation is due to a frank tear through the outer fibers of the disc.  This allows the softer material from the inside of the disc, called the nucleus pulposis, to leak out.  The herniated disc material causes an inflammatory response, creating a painful noxious "chemical soup" in the area.  If the herniation presses against a nerve root or the spinal cord, the pain can be excruciating.  Adding fuel to the fire, the disc itself is innervated by pain fibers which fire off additional pain messages.herniated disc-illustration

The picture to the left nicely illustrates a herniated disc in the neck.  Notice how the tear through the outer, annular fibers (in grey) allows the inner nuclear material (blue) to ooze out and press on the nerve root (red).  This will almost always cause severe neck pain, and will usually cause pain into the shoulder and or arm as well.herniated disc-mri

This  next picture is a cross sectional MRI image of the lumbar spine (lower back).  The arrow is showing a large disc herniation which has broken away from the body of the disc and is now a "free fragment."  This disc injury will most likely cause pain due to pressure on nerve roots, inflammation and discogenic pain (pain generated from the disc itself). 

Interestingly, it is not always the size of the disc herniation that dictates the amount of pain one feels.  I can't tell you how often I have seen a relatively small disc herniation cause intense pain while a large herniation may cause only mild pain.  This often has to do with the size of the spinal canal (the spinal cord is inside the spinal canal).  Some of us are blessed with nice big spinal canals, while unfortunately, others are born with smaller canals which don't offer enough room to absorb the extra space the disc herniation occupies. 

Additionally, one must consider the amount of degenerative arthritis that has accumulated.  If there is a significant amount of degeneration in the spine, bony spurs, disc bulging and ligamentous buckling can all encroach on the size of the existing spinal canal squeezing the spinal cord or cauda equina (the spinal cord ends at the level of the first lumbar vertebrae and becomes the cauda equina, a group of nerves which exit the spine below that level).  These degenerative changes also close down the inter vertebral foramen (IVF), which are the openings between the vertebrae where the spinal nerves exit the spine.

Flex-dist girl tableMost people respond to the common "adjustments" performed by most chiropractors.  Adjustments entail manipulating the spine to reduce misalignments and "stuck" joints, or using parts of the table that drop away while the chiropractor imparts a gentle thrust.  In the case of herniated discs, however; I have found that Flexion/Distraction technique tends to work better.  During a flexion/distraction adjustment, the spine is gently stretched, opening the IVF's (spaces where the nerves exit the spine) and taking pressure of the spinal nerves.  Flexion/distraction therapy mobilizes the spinal segments reducing joint restrictions and improving range of motion. The most important benefit to flexion/distraction therapy may be the creation of negative pressure inside the discs.  This negative pressure or "sucking action" causes an increased flow of nutritients to the injured discs, and can reduce the size of the disc herniation.  This has been shown in the scientific literature many times on pre and post MRI's.fruits and veggies

In my clinic, I tend to combine a variety of therapies and assign specific home exercises  (click to view).   In addition I like to discuss proper nutrition as healthy foods promote a faster healing response.  Targeted supplementation with appropriate nutrients also tends to be helpful, promoting a healthier inflammatory response and giving damaged tissues the high octane fuel they need to heal at an optimal pace.

During my 15 year tenure, I've helped hundreds of people with mild to severe disc pain get well; some with incredible rapidity, while others take longer.  I expect to see a patient improve by at least 30% within the first 3 weeks, and at least 50% within 5 weeks.  If a patient fails to progress, I then refer them for a neurosurgical consult.  Fortunately, this is rarely neccessary.  Feel free to e-mail any questions you may have (drneil@drneillevin.com) or call the office for more information.

To Your Good Health,
Dr Neil Levin- Chiropractor, Nutritionist, Certified Fitness Trainer

Dr Levin practices in East Northport, NY
www.drneillevin.com
(631) 651-2929