The term slipped disc is often used to describe a herniated disc, but it’s not quite accurate. When a disc is damaged, the annulus fibrosus is weakened and develops micro-tears. As a result, the nucleus pulposus bulges out of its confined space. If the weakened area is near the rear of the disk, which it often is, because this area is stressed by bending forward so frequently, pressure may be put on the nerve root, the part of the nerve that branches off the spinal cord. When performing activities that push the nucleus pulposus toward the area of injured cartilage rings, expect pain from inflammation, or worse, pain that radiates to other parts of the body that follow the pathway of that nerve. The more aggravated the nerve root is, the farther along the pathway of the nerve pain will travel and be felt.
Discs are not usually injured from one traumatic episode, but rather from a series of small episodes. Every time a person bends forward with their back unsupported and every time they sit slumped in a chair the front of the disc is squeezing and pushing the nucleus pulposus toward the back of the disc. Over time, the rings of cartilage weaken, even if pain is not felt. Until finally, some random, ordinary movement like bending over to tie a shoe and suddenly that simple, everyday motion will be the straw that broke the camel’s back and the disc bulges. If the annulus fibrosus is not broken, only stretched, the bulge is called a protruded disc. If the sheath is broken, but the disc material hasn’t penetrated a secondary boundary formed by the posterior longitudinal ligament running along the spinal canal, the condition is diagnosed as an extruded disc. However, if the disc has broken beyond that layer as well, then a fragment may actually float freely within the spinal canal, a condition known as a sequestrated disc.
The overwhelming majority of bulging discs occur in the lumbar region, an area that is under tremendous stress when bending forward and sitting. When sitting, unless the natural inward curve of the low back is maintained, the discs experience stress similar to bending forward. The nerves in the lumbar region, the femoral nerve and the sciatic nerve, that run to the buttocks, thigh, and lower leg, will feel pain, tingling, or limb weakness that shoots down the leg, hence the term sciatica. When standing, walking or lying down, particularly with feet flat and knees bent, the compression is lessened and pain is relieved.
In 90% of all cases, conservative measures; rest, heat or ice, topical analgesics and an anti-inflammatory drug such as ibuprofen, will allow the disc and nerve inflammation to heal on its own. Since inflammation is present, things that increase circulation, like activity, speed up the process. Avoid activities that stress the back like bending forward and sitting, two of the most stressful to the discs of the back.
It’s important during the healing time, a period that can take between 2 and 6 weeks, to refrain from lifting heavy objects and performing activities that can re-injure the area. Once healing is more than 75% complete, gradually introduce an exercise program geared at strengthening the muscles of the back, abdomen and lower extremities, thus reducing the possibility of a recurrence. All exercise should be performed with the spine maintained in a neutral position, and with the 3 normal curves of the spine intact. When lifting weights or heavy object, take care to do so with good mechanics, use the strong muscles of the legs and don’t lift from the low back. In extreme cases, surgery may be required to reduce a bulged disc or even fuse vertebra to an adjacent one, thus relieve pressure on the nerve root.
Cervical disc injuries is inflammation of the intervertebral discs and possibly the adjacent nerve roots in the cervical spine. They are caused by degeneration or injury of the discs. This condition causes pain along the pathway of the nerves that run into the upper extremities. Some cases of chronic low back pain may be caused by degeneration of the articular cartilage of the facet joints, the joints that connect the vertebrae, this is also referred to as facet joint syndrome. As a result, they can grind against each other, causing the formation of bony spikes that press against the nerves from the spinal cord. In the case of a herniated disc, the pain can be felt in the area of the injury, or anywhere along the pathway of the irritated nerve. In this case, extending the spine backward may be irritating, as that is the position that compresses the facet joints.
As distinguished from spinal pain, a muscle strain or muscle pain is more likely to feel localized and is more sensitive to touch. The pain doesn’t radiate as it would with a disc herniation. Acute muscle pain of the back, like muscle pain elsewhere in the body, responds well to cold therpay during the first 48 hours.
Spondylosis is a condition in which a vertebra is misshapen, either congenitally or as a result of a stress fracture. The vertebra can then slip forward on the vertebra just below it, a condition known as spondylolisthesis. Some cases are extremely unstable and require surgery to stabilize them.