Disc herniations are a common cause of low back pain. Many people are familiar with the symptoms of severe dull and sharp pain in the low back. The pain can also radiate down the leg to the foot, which is also known as sciatica. Some people can experience tingling, burning, numbness, or feel like “the leg can give out at any moment.” The pain travels down a distinct pattern to the foot. The sciatic pain is worse with bending, twisting, getting up from a seated position, or coughing. Severe cases can also cause weakness in the foot or big toe. People find themselves tripping or dragging the foot.
CAUSES OF DISC HERNIATIONS
Lumbar disc herniations are usually the cause of years of use or “wear and tear” to the discs. There may be one last incident that started the pain, but usually it is an accumulation of trauma and stress to the discs. The discs are designed to be shock absorbers. Every step or movement you take results in a compression or pounding stress to the low back. Discs help absorb those forces. Discs also help the joints to increase our bending, twisting, and turning movements.
I like to describe lumbar discs of jelly doughnuts. The outside layer is a tough fibrotic layer that absorbs forces and keeps the jelly layer in the middle of the disc. The jelly is a thickened fluid filled substance called the nucleus pulposus. The jelly layer is an excellent shock absorber. However, over time small tears can start to develop in the fibrous layer, and pressure starts to force the jelly through the tears.
Sometimes the jelly layer bulges the outside of the disc layer backwards. People refer to this as a bulging disc. The jelly is still contained within the fibrous disc, but the bulging is creating problems for the nerves that travel behind the disc.
A more severe injury occurs when the jelly breaks through the fibrous layer and the jelly escapes into the spinal column, where it can compress the spinal cord or exiting nerves. The body tries to remove the jelly by breaking it down, but the removal process produces inflammation that brings more fluid to the area. More fluid in a contained space compresses the nerves even more.
SIGNS AND SYMPTOMS
A disc herniations or bulging disc can develop slowly over weeks or with a sudden movement. Slowly developing lumbar discs injuries usually start as a constant stiffness and mild low back pain. The pain gets better with movement but increases toward the end of the day. Over time the stiffness and pain continues to get worse. People feel the pain last longer before loosening up for the day, and the pain returns earlier in the afternoon. The intensity of dull pain increases along with the low back muscle spasms. People feel very tight and restricted in their movements. Soon the pain starts to move from their low back and into the gluteal, or butt area. The pain is usually on one side but can occur down both legs in some cases. The pain radiates down the leg with movements, especially getting up from a seated position, lifting, bending, or twisting.
The sciatic pain begins to get sharper and more severe as it travels to the knee. If the condition gets worse the pain travels to the foot and even toes. It will usually only affect a 1-2 of the toes, not the whole foot. In severe cases people may lose muscle strength, especially in the big toe or foot. People find themselves scuffing their feet when they walk or dragging their foot. They might end up doing an exaggerated walk and “slapping” the foot on the ground. Some patients describe part of their leg feeling different, or experiencing a constant tingling or burning sensation down the leg.
Sudden and severe lumbar disc herniations go through the same steps, only much faster. People report feeling a “small pop,” twinge, or stab. Within hours they progress from stiffness to severe radiating sciatic pain.
TREATMENT FOR LUMBAR DISC HERNIATIONS AND BULGES
The most severe cases may require surgery to remove the disc material from compressing the spinal cord, especially if the person loses sensation on the inside of their legs and bladder control. These are the most severe symptoms and require immediate surgical intervention.
Most cases of lumbar disc herniations or bulges do not require surgery. People can make full recoveries with proper treatment. Muscle relaxers, anti-inflammatory, and pain killers are often prescribed to help get through the first few weeks, which are usually the worst.
Initial treatment goals are to reduce the pain, muscle spasms, and improve your ability to get through your day. Because the disc material is creating inflammation and pain the body tries to protect itself by creating muscle spasms in the low back. The spasms are great for protection in the early phases but they do create more pain during recovery. Chronic spasms prevent joint movement which causes more pain to be sent to the brain. The spasms also slow blood flow to the injured lumbar disc, which slows down the healing process.
Treatment will help reduce the muscle spasms and decrease pain. Light range of motion exercises will help you manage the pain throughout the day. Icing the area will also help control the pain and muscle spasms. With improvement, additional exercises can be given to stabilize the spine and help reduce the chances of future disc injuries.
Several chiropractic treatments will speed your recovery including flexion distraction therapy. Traction is a therapy that developed to help pull the joints apart and reduce the pressure inside the disc, allowing the jelly to be “sucked back toward the middle of the disc.” Traction will separate the joints by a few millimeters which will reduce the pressure inside producing the vacuum effect on the jelly. Traction will also increase the amount of blood flow to an area, which brings more healing nutrients to the area.
Traction will also increase the pain free movement of joints in the low back. People feel a comfortable stretch and the corresponding relief during the treatment. They can immediately feel a difference when standing and walking.
Traction treatments all operate under the same physics, separate the joints to increase blood flow and motion. There are some marketing companies that would like you to believe that certain traction tables are better than others. However, there has not been any outcome studies performed that show any difference between traction performed by a flexion distraction table, Lordex, or Vax D. The name brand tables cost you more for their marketing but do not provide any proven difference in results compared to flexion distraction traction therapy. The name brand tables are also not covered by insurance because they do not provide any better therapeutic results for the cost.
Chiropractic adjustments are a safe treatment and effective treatment to increase joint motion. People can feel significant pain relief within a few visits. Combining chiropractic treatment, strengthening exercises, and flexion distraction traction therapy can greatly reduce your pain and speed your recovery. Properly strengthening the injured area will reduce your chances of experiencing another lumbar disc herniation.