Disc Herniation
(Ruptured, Protrusion, Slipped)
What Is Disc Herniation?
Disc herniation terminology can be confusing. Terms such as disc protrusion, ruptured disc or slipped disc are commonly used to describe this condition.
The Disc is made of rings. It looks similar to a tree trunk that is cut in half. These rings make up the annulus. The center of the disc is made up of a gel-like substance, which we call the nucleus. It contains a high degree of water when we are younger. With time, genetic influence as well as wear and tear, the disc can develop cracks and the nucleus can push the annulus out. In simple terms, when the annulus starts pushing out, we call it a bulge or protrusion. If it gets worse and the nucleus begins breaking through the annulus, then we use terms like herniation or ruptured.
Common Signs and Symptoms
- Pain may stay in the back or radiate down the leg. If pain stays in the back, it tends to be diffuse, difficult to pinpoint.
- If there is radiating pain (sciatica), it is usually in the back or side of the thigh and calf or front of the leg. It can go all the way to the foot or toes.
- Tingling, numbness or burning is often present.
- It is often worse with sitting, coughing, sneezing or bowel movements.
- The patient may lean to the right or left or find it painful to stand straight.
What Causes It?
Most back pain is cumulative in nature. There is seldom any one thing that you may have done that will cause a disc herniation. Sitting increases disc pressures and can be a contributing factor. The combination of forward bending and twisting puts a lot of stress and discs and can lead to tearing of the disc fibers. As a matter of fact, your last two vertebrae only rotation 3 degrees before they strain the disc.
The disc weakens over time, and then it may be something as simple as bending over to pick up a sock that brings on the pain. It is like heart disease. One day you suddenly experience a heart attack. The heart disease had been forming for years, you just had not experienced symptoms yet. It is years of activities and genetic influences that finally lead to the herniation.
How is it Diagnosed?
We can generally diagnose symptoms related to disc herniation from the patient history and a good physical examination. Just having a positive straight leg test is reported to be 86% accurate for a disc herniation. Adding imaging only increases the accuracy to 95%.
Pain Patterns
Patterns of pain, tingling or numbness are good indicators of which nerve and disc level are involved.
The L3/4 disc can pinch the L4 nerve, creating symptoms that wrap around the front of the thigh and go all the way to the inside of the calf.
The L4/5 disc can pinch the L5 nerve, causing symptoms down the outside of the thigh and to the top of the foot.
The L5/S1 disc can pinch the S1 nerve, causing symptoms down the outside/posterior thigh and little toe side of the foot.
MRI
The majority of the time, MRI is unnecessary. It does not change the initial treatment plan. MRI does not predict who will and won’t need surgery. Even massive disc herniations often respond to conservative care. Over half of the population has disc herniations but are without symptoms. See the MRI Dilemma for more information.
Our Treatment
Cox flexion distraction manipulation is used to decompress the disc. This helps to pull fluid back into the disc, relieve pressure from the nerves and restore more normal motion. If pain is severe or extends below the knee, we recommend daily treatment. When the leg pain reduces 50%, then we cut the treatment frequency in half.
Therapy modalities may also be used to sedate the nerves, reduce inflammation, and increase circulation.
Nutritional supplements such as glucosamine sulfate and chondroitin sulfate are recommended to help in the healing and maintenance of the disc.
Referral Indications
Our goal is attaining at least 50% improvement in leg pain or other symptoms within 3-4 weeks of care. If that has not been reached or if a patient is continuing to get worse, imaging such as MRI may be recommended, or you may be referred to another healthcare provider. Other treatment options may include epidural injections at a pain center or referral for a surgical consult.
INTRODUCING
THE MOST ADVANCED COX TABLE EVER DESIGNED
We are pleased to announce the addition of the most advanced Cox decompression table ever designed, to our office! The Cox 8 Force Table is a state of the art instrument. Built in sensors send data to a computer, giving the doctor real-time information about the amount of decompressive force being applied.
Discuss your case with the doctor to see if you are a candidate for treatment.
Happy patients
“I have had physical therapy, I have had epidurals, nothing worked.”
“It was a miracle. I feel good. I’ve got my life back.”
“I was looking for something where I didn’t have to take pills. I wanted to avoid surgery.”
“Before I came in, I could not even roll over in bed.”
“I had a severe low back injury that left me in the hospital for 3 months. We did physical therapy, pain management and nothing seemed to help.”
“I call it the miracle table… Now I can tie my shoes… I don’t take pain medicine”
Phone
+913-345-9247
Location
11791 W 112th Street #101
Overland Park, KS 66210
drbob@overlandchiro.com
Office Hours
M-W: 8am - 6pm
Th: 1pm - 6pm
F: 8am - 12pm
S-S: Closed