The disc, more appropriately known as the intervertebral disc, is the cushion that sits between each vertebra in your spine (with the exception of the top 2 vertebrae). Each disc is composed of 3 segments: the vertebral endplates (which border the top and bottom of each disc), the nucleus pulposus (the center that acts as a fulcrum for movement between the vertebral segments and absorbs fluid and nutrients to keep the disc healthy), and the annulus fibrosus (the fibers surrounding the nucleus that make up the majority of the disc).
Disc herniation (or disc bulge) is when fibers of the annulus protrude from their normal anatomical limits. If protruding back, it can cause irritation to the nerve roots or, in more severe cases, compression of the nerve itself (pinched nerve). It is important to note that a disc herniation does not equate to a pinched nerve. In some cases, the presence of the disc in the epidural space without mechanical compression can cause nerve root inflammation and even irritation to the dorsal root ganglion, which processes sensory information entering the spinal cord. In all cases, sharp pain may radiate down an extremity (think sciatica) along with numbness and tingling, loss of sensation, and/or positional relief.
Several factors may lead to disc injury. Trauma is the most noticeable process of injury. However, in many cases, microtrauma can weaken the disc fibers, leading to an insignificant event that causes a sudden onset of symptoms (i.e. I bent over to pick up my kid and heard a pop, then ouch!) Microtrauma occurs from improper movements that put additional stress on the disc. Symptoms are usually absent or minimal until the disc is so weak that a sudden herniation occurs, resulting in intense pain.
Diagnosing a disc herniation is dependent on symptoms and orthopedic testing. Pain down your arm or leg does not necessarily mean you have a disc injury. Orthopedic testing is the most effective way to determine disc injury. It is important to note that the only imaging method to diagnose a disc herniation is by MRI. Discs do not appear on an x-ray film; therefore you cannot diagnose a disc herniation by looking at an x-ray! It frustrates me to hear how many people say their doctor diagnosed their x-ray with a disc injury... in some cases you can suspect herniation but ortho testing or MRI is the ONLY way to properly diagnose this condition.
There are many different treatment methods that chiropractors utilize for herniated discs. The chiropractic adjustment is the staple of chiropractic care. In disc injury, the adjustment restores motion to the vertebral segment that is affected by the disc injury. By restoring motion, the adjustment allows for a process called imbibition to take place. Imbibition is a physiological process in which fluid and nutrients are absorbed back into the disc. When a load is applied to the vertebral segment (such as in movement), water is lost in the disc, but electrolytes such as sodium and potassium remain. When the load is removed, rapid rehydration of the disc occurs due to the electrolyte concentration. In disc herniation, this fluid motion of the vertebral segment is interrupted and the load remains on the disc, preventing the rehydration mechanism. Mechanical decompression is also a treatment used in many chiropractic offices that simulates the process of imbibition. Mechanical decompression removes loads on the disc for an extended period of time, allowing for more rehydration to take place. This process is repeated over a period of time to speed up healing.
Your chiropractor or orthopedist may also give you specific exercises to perform as you recover from disc herniation. The purpose of the exercises is to strengthen the muscles supporting the spine, in order to prevent future injury. Talk to your chiropractic or orthopedic physician to learn more about disc injury and how to prevent it with proper ergonomics and stability exercises.
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