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 Key points:
¢ Discs in the low back, mid back and neck do not “slip”, but they can wear and rupture to different extents
¢ That may cause pain in the spine or limbs,
¢ MRIs show disc problems but have also shown people to have significant disc herniations with no symptoms! MRIs must be interpreted in the light of the symptoms and clinical findings
¢ The osteopath’s approach is to reduce pain, to give advice to improve the chances of recovery and to treat musculo-skeletal dysfunctions that are hindering recovery
Discs, also known as intervertebral discs or IVDs for short lie between each of the vertebra of the spine (except the first and second vertebra of the neck and the first vertebra and the skull). They are like a circular pad. The outside is made of rings of cartilage and is called the annulus fibrosus. Inside is the nucleus pulposus, which is made of a gel like substance. The discs’ job is to take and absorb load yet allow one vertebra to move on the other. The disc is kept “pumped up” by the ability of the nucleus to absorb water (you are a little taller in the morning than at the end of the day, when your discs will have lost a little hydration.
As we get older the discs get dry out and get thinner in height, which is a normal part of ageing (technically called “degeneration” – don’t let the term worry you)
Discs can get damaged. Usually by lifting too heavy or unexpected loads, twisting too far or awkwardly, even by vigourous sneezing. What happens is that a tear develops in the annulus that allows some of the nucleus to bulge into it. The bulge is usually at the back and to one side of the disc, although it can also be straight back. This is known as a disc herniation. (“to protrude through an abnormal bodily opening.”) Because of the way each disc is attached to the vertebra above and below it, a disc cannot "slip". There are four stages of disc herniation: bulge, prolapse , extrusion, and sequestration. Disc herniation need not proceed through these stages if the case is managed correctly.Stages 1 and 2 are referred to as incomplete, where 3 and 4 are called complete herniations. A sequestrum is a free fragment of the nucleus pulposus in the spinal canal outside of the anulus fibrosus and no longer attached to the intervertebral disk.
Disc herniations can arise in the lumbar spine, neck, or, less often, the dorsal spine
Pain resulting from herniation may be just around the spine, low back or neck. If the the extruded nuclear material presses against a nerve root the pain may travel. If the herniation is in the low back, the pain will travel into the buttock or leg.If the herniation is in the neck, it will travel down the arm. If in the mid back the pain can travel around the ribs.It is thought that the effect on the nerve asrises not just from the direct pressure but also from the swelling and inflammation that is caused around the nerve.
The peak age for disc herniations is 35 to 55 years of age. Patients with disc herniations are sometimes afraid that they will to problems as they get older . In fact, the attacks of acute low back pain are likely to get less frequent.
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Diagnosis of disc herniations can usually be made clinically, from the the results of examining the patient. Disc herniations do not show up on x-ray.They do show up well on MRIs. However, MRIs have also shown people to have significant disc herniations with no symptoms! MRIs must therefore be interpreted in the light of the symptoims and clinical findings.
Disc herniations can heal given the right circumstances. The osteopath’s approach is to reduce pain, to give advice to improve the chances of recovery and avoid the problem worsening, to treat musculo-skeletal dysfunctions that are hindering recovery. If disc herniations recur, the osteopath will attempt to discover and reduce the predisposing factors”
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