Disc Herniations

Disc Anatomy

The discs are made up of two main components. The outside consists of a tough cartilaginous material known as the annulus fibrosus. The inside is a jelly-like substance called the nucleus pulposus. Both pieces help act as a shock absorber between the vertebrae of the spine.

Methods of Injury

Degeneration is believed to be the most common cause of disc injury, as opposed to a specific traumatic event. However, traumatic events can certainty cause them as well, such as in contact sports or heavy lifting. As we age, the disc starts to lose its shock-absorbing capacity, and tears in the annulus fibrosus start to occur. It’s believed that the most compromising position for the discs is flexion with rotation, which puts a lot of pressure on them and can result in micro-tears that can ultimately lead to a herniation.
Most disc herniations start off as a disc protrusion, which is when part of the disc starts to bulge out. This may or may not be painful. From the protrusion, if there is additional stress to the area over time, a herniation may occur, where the nucleus pulposus breaks through the annulus fibers. Herniations are most common in the lumbar spine, and may or may not also have pain.
It’s important to remember that radiographic images are NOT a good predictor of pain, as studies have found that disc protrusions are present in 25%¹ and disc herniations present in 19-27%² of asymptomatic patients.

Consequences

Although disc herniations can be found in asymptomatic patients, they can also directly cause compression to the surrounding nerves and cause what’s called radicular pain, which is a shooting pain that affects another part of the body (like down the arm or leg). Most cases of lumbar disc herniations resolve within 6 weeks, but this of course is dependent on the severity of the case.

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Written by Dr. Brandon Buchla, DC, CSCS