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SLIPPED DISKCHIROPRACTIC HERNIATED DISCA slipped disk - the material that lies between each adjacent pair of bones in the spinal column is a fairly common occurrence. The spinal column is made up of 26 vertebrae that are joined together and permit forward and backward bending, side bending, and rotation of the spine.
Each disc is composed of two parts: a gelatinous material not unlike egg-white called the nucleus pulposus, surrounded by rings of a fibrous tissue called the annulus fibrosus.
From the Coal Face'I don't need to ask what's wrong with you, Mr Jones. But tell me how it happened, and when.'The tall angular man looked like the leaning tower of Pisa. He stood with an acute angled posture, yet declined to sit. Instead he sat with his buttocks against the desk. 'Six months ago, and gave a hard tug on the sheet on my boat, and felt a sharp stab of pain in my back.' 'And then?' 'My doctor said I had sprained my sacro-iliac joint. I had some pills, some physio-therapy, and then after a sneeze it started down my leg.' We eventually won with Mr Jones' back, but I won't pretend it was easy. It wasn't. It all starts with the right diagnosis. His doctor I'm sure would be streets ahead of most chiropractors in diagnosing pain in the abdoman, but in the back he was out of his depth. Pain with coughing, sneezing, or straining on the toilet is a sure sign that you need to be careful. It could be a slipped disk in the making.
In a slipped disk, the inner bubble of gel, the nucleus pulposis herniates or slips through the surrounding annulus fibrosus towards the spinal canal. Initially it causes no frank pressure on the nerve root, but it releases noxious chemicals that inflame the nerve. Sudden wrong movements, sneezes, heavy lifting, or just prolonged sitting may cause further bulging, placing pressure on a spinal nerve and causing more severe pain in the leg and damage to the nerve. Slipped disk most commonly affects the low back and neck. Prolonged exposure to a bent-forward work posture is correlated with an increased incidence of disc herniation. This condition is also commonly called a herniated nucleus pulposus, prolapsed disc, ruptured intervertebral disc, bulging or slipped disc.
THERE ARE FOUR LEVELS OF SLIPPED DISCGrade I: A protrusion may occur where a slipped disc bulges without rupturing the annulus fibrosis. Classically there is only low back pain which could be mild or very severe.Grade II: The disc may prolapse where the nucleus pulposus migrates to the outermost fibres of the annulus fibrosis. Pain or tingling, or a numb feeling will be felt in the leg.. Grade III: There may be a disc extrusion, which is the case if the annulus fibrosis perforates and material of the nucleus moves into the epidural space. The pain in the leg becomes worse, and weakness and numbness in the leg develops. Grade IV: The sequestrated slipped disc may occur as fragments from the annulus fibrosis and nucleus pulposus are found outside the disc proper. The pain in the back lessens, but the leg becomes a consuming fire. Disturbance of bladder control should be reported immediately. For some interesting cases of low back pain (and other) from the Chiropractic Coalface, click here. PREVALENCELow backache is extremely prevalent, and is the second most common reason for the people to seek medical attention. Not all obviously are slipped disks. Low back pain accounts for approximately 15% of the sick leave in First World countries, and is the most common cause of disability in persons less than 45 years of age.Every year 5% of the population will have a slipped disc. Mostly the prognosis for a Grade I protrusion is good, and improvement often occurs with little or no intervention. However, if it lasts longer than 12 weeks...some authorities say 6 months, we call it chronic, and the chances of progression with leg pain is now much greater. While it is not recommended that every sore back needs to go to the doctor or chiropractor, pain which does not improve within a few weeks certainly demands assessment by your chiropractor. THE CAUSES.Mechanical low backache or "musculoskeletal" backache as it is called, is the most common form of back pain. This may result from strain of the muscles or the ligaments in the back or sacro-iliac joints.Only 1-3% of the patients with low back ache will have a slipped disk causing frank compression of the nerve root (Grades III or IV). Sciatica is the pain due to the irritation of the sciatic nerve root (a nerve which supplies the lower limb) due to lumbar disc prolapse. (There are other causes, such as Piriformis syndrome). Sciatic pain is usually present in the low back and buttock and goes down the thigh and ultimately to the foot. Several studies have shown that smokers are more prone to get back pain, sciatica and spinal degenerative changes. Smoking also delays bone and disk healing, increasing the chance of surgical failure. Failed Back Syndrome is a reality. IMPORTANT CONSIDERATIONS* Age of the patient. * Any history of cancer (like prostate or breast carcinoma). * Unexplained weight loss. * Long term use any steroidal drugs or drugs for AIDS. * Duration of back pain. * Any pain or worsening of pain at rest. * Drug abuse * Numbness or weakness of legs * History of injury to the back. * Difficulty in passing urine * Previous failed treatment for backache. * Depression.What tests are recommended?For over 90% of the patients with back pain, no further testing is necessary beyond X-rays in the first month. Otherwise one must proceed with investigations like CT, MRI and bone scan for the back if there is no good response to treatment, or if leg pain is developing. These tests will reveal if there are bony abnormalities, a slipped disk or a spinal tumour.What are the treatments available?.Low back pain should always be managed conservatively in the initial weeks, unless there is loss of bladder control, or weight loss, or fever.Non-surgical treatment of slipped disk includes: * Bed rest: This will reduce the intra discal pressure and pressure on the nerve roots. Bed rest up to 4 days is allowed provided it includes gentle exercises and periods of walking around the house. Prolonged bed rest does more harm to the patient, producing weakness, stiffness and pain. * Activity modification: For some six weeks after a slipped disk, patients are advised not to lift any objects, not to sit much and not to bend or twist the back. * Exercise: Low stress aerobic exercise is advised. Walking, cycling (only a lady’s bike) and swimming (backstroke) are allowed in the first two weeks. Pain should be the judge. * Analgesics: For acute pain, an icepack used for up to 30 minutes is best, but paracetamol, or other drugs like diclofenac can be used. Unlike drugs, ice has no side effects. * Patient education: Patient should be educated how to modify the daily activities, how to lift weight etc. * Physical treatment for slipped disk. Manipulation has shown great benefit when correctly applied. Inversion and McManis lumbar traction have value, but continuous traction is of no use. CHIROPRACTIC TREATMENTDifferent chiropractors favour differing treatments depending on the seriousness of the condition.Mostly, there will be treatment with patients lying on one or both sides, perhaps with a drop mechanism for better effect, and less force. A popping sound may be heard during the adjustment, as the herniated fragment is manipulated back into place. Different forms of mobilising traction may be used to good effect. Stationary traction while lying in bed at home or in hospital has no good effect. Some chiropractors favour a mechanical device called an activator. Deep muscle work, and various modalities have good effect. Intermittent bed rest may be an important aspect of the treatment in severe cases. Standing up, and walking about hourly is important. As in all acute sprains ice acts as a powerful pain killer and anti-swelling agent. In the recovery phase, rehabilitative exercises are important. For a course of simple low back exercises, subscribe to Chiropractic Tips. SURGERYIn the United States each year, 1.5 million people have lumbar MRI scans to look for the cause of the buttock and leg pain called 'sciatica'. More than 1.2 million of those scans fail to find the cause in the spine. Three hundred thousand of the scans are sufficiently positive that the patient has lumbar spine surgery. Of the 300,000 surgeries for slipped disc, as many as 25% fail to relieve the pain - in many cases this is because the diagnosis of a spinal cause for the sciatica was incorrect.There are many other causes of sciatica. For example, Piriformis syndrome, and Sacro-iliac syndrome. Financial burden of Low back painBack pain is providing modern society with a huge financial challenge. Despite huge jumps in technology, the economic burden to both individuals and society is soaring. For more, click here.For more information on the dangers of anaesthetics follow this link. Return from Slipped disk to Chiropractic conditions Monthly free newsletter.
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