Spinal discs have nerve endings inside them, some of which are capable of producing pain. Pain from the disc is called “discogenic pain”. Discs become painful commonly through traumatic injury or degeneration over time.
Pain from herniated discs can be due to multiple factors:
Disc injury occurs when traumatic force can rip a tear through the annular fibers. Depending on how bad the tear is, the inner nucleus can leak through the tear.
Disc herniations result in a deformed shape of the disc, of which there are three types of disc herniations:
Typically disc herniations are due to traumatic forces creating tears in the disc, such as the annulus, whereas disc bulging is due to gradual degeneration over time.
However, there are exceptions to this; injured discs can also bulge. If the injury is to the surrounding ligaments outside the disc, this ligament damage may be bad enough allowing the disc to bulge.
With degeneration, the circular fibers of the annulus can fray and separate. The disc can start to lose hydration, and then the annular fibers of the disc start to bulge outward as the disc space collapses.
If the disc herniates and the herniation compresses the nerves, it can create radiating pain down the arm or leg. The pain can be inflammatory irritation (radiculitis) or it can be due to actual nerve pinching/compression (radiculopathy).
To diagnose a disc as painful requires a detailed history, physical exam and often requires imaging as an MRI to confirm the location and severity of the disc herniation.
Based on the location and severity of disc herniations, treatment planning may need to be modified and recovery expectations may need to change.
Following a proper diagnosis, then an evidence-based treatment plan can be created to maximize patient recovery. Common treatment includes:
Chiropractic care at our St. Paul, MN clinic is gentle and effective.
Research shows that chiropractic care is very effective at treating disc herniations.
Lumbar disc herniations can be successfully treated with chiropractic management. In a study by Leemann et al (2014) the authors stated, “The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with… spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year.” (p 155). The results of this study showed, “Significant improvement for all outcomes at all time points was reported (P <.0001).”
Cervical disc herniations showed success with treatment. In a paper published by Peterson et al (2016) patients with MRI confirmed disc herniations were treated with either injections or chiropractic spinal adjusting. The authors stated, “Most acute patients with MRI-confirmed symptomatic cervical disk herniation treated with either [injection] or [chiropractic adjusting] reported clinically relevant improvement at 3 months with no significant difference in outcomes between the 2 treatment methods. However, when comparing the 3-month outcomes for the subacute/chronic patients, more than 78% of patients treated with [chiropractic adjusting] reported clinically relevant improvement compared with 37.5% of patients receiving a single [injection]. The treatment costs between the 2 groups were very similar. There were no adverse events for either cohort.”
Therefore from a risk benefit standpoint, chiropractic treatment is a reasonable first line approach for spinal disc herniations in most cases.