Let’s again start with some basic anatomy of a normal disc (Intervertebral disc or IVD). The discs are essentially cushions between every set of vertebrae (bones of the spine). The only areas, which do not have discs, are between the skull and C1 (atlas), and between C1 (atlas) and C2 (axis). The sacrum is really 5 vertebrae that have fused together naturally, hence no true discs. All of the discs make up about ¼ of your height, therefore when your discs begin wearing down and degenerating, you start to shrink in height.
The normal disc has 2 parts to it. Think of it like a jelly donut. The outer part of the disc is called the annulus and has tough fibers laid down in rings. The inner part of the disc is called the nucleus pulposa and is more of a gelatinous material. It works like a ball bearing and a pivot point between the two vertebrae.
There are five types of disc injuries: disc irritations, disc bulges, disc tears, disc ruptures, and disc degeneration. Disc injuries can happen anywhere in the spine. Most people have lumbar (low back) disc injuries, but cervical (neck) and then thoracic (midback) injuries also happen. A disc irritation is where you have dome some heavy lifting, a lot of improper or repetitive bending, or you have strained your back. Sometimes you can hear a “pop” in your back and then feel pain. This is when the disc can become irritated, which is inflamed. Just as when you get an injury to an ankle or other joint, when it is inflamed it gets swollen and is very irritable or sore. The disc itself doesn’t have very many pain nerve fibers, but all of the surrounding tissue do. Every movement is subject to pain, because the entire disc is irritated. The pain may be simple soreness, but it can also be sharp locally. There is typically not any radiating (pain going down legs or arms) at this point in the injury.
Disc bulges are when some of the outer annular fibers have been torn and the integrity of the disc is now compromised. As the name implies, the disc bulges out. The bulge can be either very local (focal) or broad based (across the entire back of the disc). The bulge is usually graded as a minimal, moderate or severe bulge depending on how far out it bulges. The bulge can also be to the side of the disc – which may impact or press on some of the exiting nerve roots, or it may be in the back where it may impact or press on the spinal cord, or a combination of these. Disc bulges don’t typically happen to the front of the disc.
Disc tears are when the annulus fibers have actually torn, but no nucleus pulposa has been extruded out of the disc. This is more severe than a disc bulge, because the future likelihood of a complete rupture is higher. This also is after repeated bulges, and it means that the disc has lost some if not more of the fluid within the disc. Unless it was caused by a “severe” accident, it means that the low back has typically had many injuries and is a chronic condition.
A disc rupture – typically called an extruded disc – is where the annulus fibers have torn, and the nucleus pulposa or part of it has actually pushed out side of the disc and is floating around either the spinal cord or the spinal nerves. The danger with this injury is that the extruded material can press on a variety of nerve components and do a lot of damage and cause a tremendous amount of pain. Much of this pain is severe, sharp, and can easily radiate down arms or legs.
Disc degeneration is when the discs have lost fluid and they have actually worn down over time. This condition is due is a chronic condition. Once you lose the disc, you can’t ever get it back; however, it doesn’t mean that you will constantly be in pain. See a previous post on disc degeneration for more information on that condition.
Treatment for disc injuries can vary; however, the first thing to do is to give the disc some rest. Stop the activity that is irritating it. Use of ice for 10 – 15 minutes at a time will help, you can alternate with heat (a hot shower); however, you must always end with ice. Laying on your side or back for 30 minutes at a time will also take some pressure off the disc. Prolonged bed rest is not all that effective. Gentle walking and swimming(backstroke and freestyle, no butterfly) are good to keep motion in the low back without a tremendous amount of pressure on the disc. Prolonged sitting will typically aggravate your disc.
From a medication standpoint, anti-inflammatories will help reduce the inflammation of the disc. There are over the counter and prescribed medications. One of the things that happens with disc injuries, is that the muscles in the back contract and try to splint the area trying to prevent further damage. Muscle relaxants may be helpful, but a double pull lumbar support will probably do more to give your muscles some relief.
Chiropractors, will assess whether the disc is too inflamed to work on directly in their initial assessments. If there is too much inflammation, they will use some techniques (stretching, disc decompression, ice, topical analgesics, and physcial therapy) to reduce that and then they will adjust (align) the spine allowing the discs to have their normal biomechanics. Additionally most chiropractors will recommend specific back exercises to help strengthen your back so you don’t have future episodes of disc or low back pain.
The main thing to remember is that the earlier you intervene and get chiropractic adjustments, start appropriate exercises, and learn how to lift and work correctly, the sooner you will feel better, and the less prone you will be to future injuries.