Disc Injuries

Discs separate the vertebrae from one another and act as shock absorbers and are one of the of four primary pain generators in the spine (the others are joints, soft tissues- muscle and ligaments- and the nerve itself). Fortunately, surgical treatment is rarely necessary.

Lumbar Disc Disease

Degenerative disc disease refers to a syndrome in which a painful disc causes chronic low back pain. The condition generally starts with a torsional (twisting) injury to the disc space. The injury weakens the disc and creates excessive micro-motion at the corresponding vertebral level because the disc cannot hold the vertebral segment together as well as it used to. The excessive micro-motion, combined with the inflammatory proteins inside the disc that become exposed and irritate the local area, produces low back pain.

Unlike the muscles and joints in the back, the disc does not have a blood supply and therefore cannot heal itself and the painful symptoms of degenerative disc disease can become chronic. While it is rare that low back pain from degenerative disc disease will progress or increase, the pain will tend to fluctuate and at times may become significantly worse.

It is important to note that disc degeneration is part of the natural process of aging and does not necessarily lead to low back pain. MRI scans have documented that approximately 30% of 30 year olds have signs of disc degeneration on MRI scans even though they have no back pain symptoms. It must therefore be stressed that not all degenerated discs that are seen on MRI scans are pain generators.

Lumbar Disc Herniation

As a disc degenerates, it can herniate (the inner core extrudes) back into the spinal canal. The weak spot in a disc is directly under the nerve root, and a herniation in this area puts direct pressure on the nerve, which in turn can cause pain to radiate all the way down the patient's leg to the foot (sciatica).

Approximately 90% of disc herniations will occur at L4- L5 (lumbar segments 4 and 5) or L5- S1 (lumbar segment 5 and sacral segment 1), which causes pain in the L5 nerve or S1 nerve, respectively.

L5 nerve impingement can cause weakness in extension of the big toe and potentially in the ankle (foot drop). Numbness and pain can be felt on top of the foot, and the pain may also radiate into the buttocks.

S1 nerve impingement may cause loss of the ankle reflex and/or weakness in ankle push off (e.g. patients cannot do toe rises). Numbness and pain can radiate down to the sole or outside of the foot.

Cervical Disc Disease

Injury, poor posture, muscle imbalance or abnormality of joint motion can cause or contribute to "wear and tear" to the tissues of the cervical spine. The cervical discs may become worn out and abnormal growths (bone spurs) may form as a result of repetitive movement of the disc. Bone spurs may narrow the spinal canal through which the spinal cord runs or the small openings (foramina) through which spinal nerves exit, a condition called "stenosis".

What problems might you experience?

Initially, the symptoms of cervical disc disease may be limited to neck pain. Arm pain, weakness or numbness may also occur and require special investigation through x-ray, CT or MRI studies. Pressure on a nerve by a herniated or budging disc or a bone spur may irritate the nerve resulting in pain in the neck and arm, incoordination, or numbness or weakness in the arm, forearm or fingers. Pressure on the spinal cord in the neck (cervical) region can be a very serious problem because virtually all of the nerves to the rest of the body have to pass through the neck to reach their final destination (arms, chest, abdomen, legs); therefore, the function of many important organs is potentially at risk.

Cervical Disc Herniation

Cervical disc herniations are far less common than lumbar disc herniations for two reasons:

  1.  There is far less disc material in the cervical spine
  2.  There is substantially less force across the cervical spine

When they do occur, most cervical disc herniations will extrude out to the side of the spinal canal and impinge on the exiting nerve root at the lower level (e.g. C6 at C5-C6).

Treatment for Disc Disease and Degeneration

Most research shows that, in the majority of cases, non-surgical treatment is very successful in reducing dealing with the symptoms related to the disc. Dr. Douglas is able to use an integrated approach to move from the acute painful stage through to rehabilitation and restored function and prevention. Chiropractic manipulation, cervical and lumbar traction, massage and exercise therapy are all available on site. In cases where there are progressive neurological sign or symptoms, we can arrange for further investigation and consultations.

Dr. Bryan Douglas is a chiropractor treating conditions such as low back pain, neck pain, headaches, and disc injuries in Emporia.
Dr. Bryan Douglas is licensed as a chiropractor in the State of Kansas.

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