TELL ME MORE ABOUT DISC HERNIATIONS

1/6/2012

Mountain View, Missouri (West Plains / Willow Springs / Winona / Cabool / Summersville) ---- Spinal Decompression Doctor, Russell Schierling, presents another blog article on Spinal Decompression Therapy.

HERNIATED DISCS
A Picture (and several videos) Is Worth a Thousand Words

Image by user:debivort

In the spine, there are 24 vertebrates. In between these vertebrates are cushions called Intervertebral Discs. If you'll notice the two pictures above, the picture of the one on the right is different from the one on the left. On the right picture, the round aqua blue portion (the disc) is bulging back and pressing on the spinal nerve (blue). This is a Herniated Disc. But before we delve into the in's, out's, how's, and why's of Herniated Discs and what it takes to fix them, let's first touch on what a normal disc is, what it looks like, and how it behaves.

Spinal Discs have several functions, but two stand out above the others.

They create space inside the Intervertebral Foramen:
They act as a "cushion" or "bushing" between the vertebrates:

The spinal bones (vertebrate) are held in place with ligaments, muscles, and tendons. As you will see in the following diagrams, the Spinal Disc gives height to the Neural Foramen (often called the Intervertebral Foramen or IVF). This is important to understand because the Spinal Nerves come off of the Spinal Cord, exit the spinal canal through the Neural Foramen (it's kind of like a "window" between any two adjacent vertebrate), and continue on to the various glands, muscles, organs, and tissues that they regulate and control. As you will start to notice, the the Spinal Disc is made up of two distinct parts (look at the two different shades of aqua in the pictures above). These are.......

The Outer Annulus: The outer layer (or more appropriately, "layers") of the disc is called the Annulus Fibrosus and is made up of lots and lots of ligaments. If you were to look at a Spinal Disc under a microscope, you would notice that the Annular Ligaments wrap around and around and around the center of the disc. This is because The Annulus job is to hold The Nucleus (the jelly center) in place. How does it do this? Think of a baseball here. If you have ever cut open a baseball (or even an old golf ball), you will find lots and lots of rubber bands coiled around a center core. Only instead of a core made of rubber or cork, the disc's core is made up of jelly.
The Inner Nucleus: The Nucleus, technically called the Nucleus Pulposus, is the jelly-like center of the disc. Because it is a thick jelly-like fluid, it has the ability to push outwards in all directions. Bend to one side, and the disc tends to push toward the other. Bend forward, and the nuclear jelly pushes toward the back of the disc.

Anything that encroaches on the Intervertebral Foramen (IVF) will compete with the nerve for space. As you can imagine, it is not a good thing for the nerve to be pressed or encroached upon. It's pretty easy to understand that the nerve needs a certain amount of room as it comes through the bony window we call the IVF. When the nerve does not have the room it needs to stretch and move, it can become "pinched" or severely irritated. As you can also imagine, this is not a good thing either. How does this happen? Follow along as I walk you through the process.

As the Spinal Discs bear loads, the pressure pushes the nucleus outward in all directions.   If there is a weak spot in the disc's outer Annulus, its most inner layers (near the Nucleus) begin to tear. As they tear, the jelly center (The Nucleus) begins to push its way toward the outside. Bear in mind that Disc Herniations rarely happen in the front part of the disc. Because people tend to lean forward (not backward) and bend side to side, the pressure tends to push the nucleus toward the back of the disc. This is where discs tend to rupture --- to the back and just lateral of the midline ---- where the spinal cord and spinal nerves are.

Full-blown Disc Herniations rarely happen all at once. Much more common is a Progressive Disc Injury (diagram below). As the disc is continually stressed, the annulus continues to tear just a little bit more; allowing the nucleus "slip" a little bit more ---- always creating a little bit bigger bulge and putting a just little bit more pressure on the nerve. But then it heals some, and might even feel better for awhile. In other words, it's not an "all-or-none" proposition. It is usually a process where a disc goes from normal to ruptured over time ---- even though the terrible pain might have come on all at once.

And while you will hear terms bantered around such as "Slipped Disc," "Herniated Disc," Ruptured Disc," "Prolapsed Disc", etc, the question to ask is whether the disc is Contained or Non-Contained. As long as the Nucleus is at least mostly contained within the Annulus, there is a strong possibility that conservative measures such as Spinal Decompression Therapy can help you avoid surgery. But if the Nucleus slips completely outside of the Annulus ---- a "Non-Contained" lesion...... Unfortunately, you might have a surgical problem on your hands.   Unless your neurosurgeon says otherwise (AND MAYBE EVEN AGAINST THEIR WISHES), as long as you do not have severe leg weakness and / or loss of bladder or bowel function, you might want to consider Spinal Decompression Therapy!

Herniated Discs Respond to Spinal Decompression Therapy

user:debivort

CARDINAL SIGNS OF A HERNIATED DISC
Of course you can and probably should go for an MRI. However, we know that 50% of the general population has disc herniations that show up on MRI's, but cause no pain or overt symptoms (HERE). I am interested in physical findings that indicate a disc injury. There are three Cardinal Signs that I look for in determining if someone might have at least some degree of Disc Herniation. They are.....

ANTALGIA: An antalgic posture is leaning to one side or the other (or to the front). If the Nucleus Pulposus "slips" or herniates to the right, most of the time people will lean to the left, and vise versa. This is an automatic reaction of the body as it tries to pull you off of, or away from the bulging nucleus. Often times you will notice that the belly button is pulled away from the body's center line.
POSITIVE VALSALVA or DeJARINE SIGN: This is pain that occurs specifically when you cough, sneeze, or strain on the stool. When you cough, sneeze, or strain, you develop a great deal of momentary internal pressure. Because force always takes the path of least resistance, the pressure released by a cough or sneeze pushes on the injured (bulging) portion of the disc. I frequently hear people tell me that if they know they are going to cough or sneeze, they hold themselves up on a counter or table so their legs do not collapse out from under them in sheer pain. Speaking of legs......
SCIATICA: The nerves from either side of your low back area grow together into one nerve ---- the Sciatic Nerve. The Sciatic Nerve is not only the longest nerve in the body, it is the biggest as well (as big as your finger). If you cause pressure on one of the nerves that makes up the Sciatic Nerve, you can end up in a world of hurt. This can be in the form of pain. But it can also be in the form of numbness, tingling, weakness, odd sensations (paresthesia), etc. Sometimes the pain will do odd things like start at the knee and go down, or skip certain areas. SCIATICA can manifest itself in an almost endless variety of ways. It can mimic knee or hip problems as well.

ANTALGIA POSITIVE VALSALVA or DeJARINE SIGN SCIATICA
(leaning away from pain) (severe pain when coughing or sneezing) (leg symptoms)

PIRIFORMIS SYNDROME:
One quick word about Piriformis Syndrome. Piriformis Syndrome is literally a "pain in the butt" that can sometimes mimic a disc problem ---- even though it is caused by a problem with a muscle. If you have little or no low back pain but lots and lots of buttock pain (or chronic Sacroilliac pain), this might very well be your problem ---- especially if you are female (notice the relationship of the Piriformis Muscle and the Sciatic Nerve in the picture below). To understand the difference between a Herniated Disc and Piriformis Syndrome, please take three minutes and visit www.DestroyPiriformisSyndrome.com.

MRI'S
OF
HERNIATED DISCS

This MRI is a lateral view of a person facing to your left. The ling white line is the spinal cord. The white areas on the left of the MRI are discs. The fact that they are white indicates that they have water in them ---- a good thing. Notice the circled area of one of the discs rupturing into the spinal cord. The one below it is rupturing as well. The disc is not white. It is gray, fading to black. This is indicative of a disc that is dehydrated.

Image by User:Tonbi_ko

Image by Edave

You can see the same thing in this MRI of the L4 Disc. Notice how it is not only bulged, but is thinning as well. This is called SPINAL DEGENERATION. Note that the healthy discs are white on MRI, but the herniated discs are much darker, depending on their degree of degeneration. This is a really good MRI to study. It shows the progression of disc problems. It starts with a normal disc at the L1-L2 disc, and ends with a Stage III Disc Herniation at L5-S1.

DO NOT HAVE SURGERY WITHOUT TRYING CONSERVATIVE METHODS FIRST!

Have you been diagnosed with a Herniated Disc? Maybe you have the Three Cardinal Signs of a Herniated Disc. Whatever the case, DO NOT under any circumstances consent to spinal surgery without a second opinion. Check out the internet message boards on the subject. Visit the online support groups for people suffering from Failed Spinal Surgery Syndrome (FSSS). Or better yet, talk to people you know who have had spinal surgery. Ask them how they have done. I promise you that over half of those you interview would not do it again ---- even if you paid them!

Call us today (417) 934-6337 to set up a free consultation with Dr. Schierling to see if Spinal Decompression Therapy MIGHT BE RIGHT FOR YOU and your specific problem.

7 Comments

Charles Weber link

12/15/2013 09:19:36 pm

Aneurysms, herniated discs, hemorrhoids, high cholesterol, and emphysema are among the most destructive, painful, and numerous diseases in our society. Slipped or herniated discs are estimated to cost 200 billion dollars directly and indirectly each year in the USA alone [http://www.futuremedicine.com/doi/pdf/10.2217/14750708.4.1.51 ]. Four to six of 100 Americans autopsied died of a ruptured aneurysm. 3.6 to 6 percent of those examined had non ruptured brain aneurysms [Renkel]. Each year, 16,000 Americans die due to a ruptured aortic aneurysm. Of the 200,000 strokes that occur each year in the USA, 20% are aneurysms in the brain. I suspect that copper deficiency status is the most important parameter affecting them. For instance, aneurysms are produced in turkeys by depleting copper [Guenther]. Copper deficiency causes blood vessels to become weak and is probably the chief cause of hemorrhoids and varicose veins. Restoring copper during those diseases is imperative.
Therefore increasing copper intake should have a dramatic effect on our collective health. Copper should always be made adequate even when an operation is in order.
That copper is below optimum in a large number of people is virtually certain from current evidence. Polish people are said to average 30% below the RDR (recommended daily requirement) from food [Pietruska] and 70% of Japanese are below the MDR (minimum daily requirement) [Otsuki]. Keep in mind that the MDR is designated too low to start with, as is the RDR. Young adult American women average 1.16 mg per day [Murphy] and men about 1.5. The difference between the sexes is no doubt primarily due to women eating less food than men. People in Belgium average 1.5 +/- 0.4 mg per day [http://www.springerlink.com/content/m552011168630u37/ ]. Adolescent males, both incarcerated and free, are below the RDA [Gans] which has been set at 2.0 but should be at least 3.0. Porto Rican school lunches are below the federal RDR [Preston]. Hemodialysis patients have low copper and zinc serum levels [Komindr]. Even so, a full blown copper deficiency takes several months to develop in people with an injured digestive system, much longer than for zinc [http://www.nphp.gov.au/enhealth/council/pubs/pdf/copper.pdf (p68)]. This is because the liver stores large amounts of copper. People vary considerably in their genetic makeup, and there are several dozen enzymes and hormones containing or affecting copper, so it should not be surprising that the symptoms of the diseases above should vary greatly or that "spontaneous" remissions are possible. When you further consider that other nutrients and circumstances also vary enormously, at least for those eating processed food, it is not safe to assume that copper is not deficient because all the symptoms are not present. Any symptom should trigger consideration of increased intake from some source. Emphysema [Soskel], premature gray hair [Wu], blood clotting [Milne 1896], slow healing bone breaks [Dolwet], diabetes enhancement [Cohen 1982] and anemia are such symptoms. The median layer of the blood vessel (where the elastin is) is thinner from a deficiency but its elastin copper content is the same as normal men. The overall thickness is not different [Senapati, et al]. Elastin is about as flexible as a rubber band and can stretch to two times its length [Carnes 1977]. The 39 or more different kinds of collagen are about 1000 times stiffer. A healthy artery requires about 1000 mm of mercury or 10 times the normal mean blood pressure in order to rupture [Shadwick]. Therefore keeping strength of arteries up would seem to be even more important than keeping blood pressure down so far as arteries are concerned, although not necessarily so far as kidney glomeruli are concerned. However a copper deficiency coupled with high sodium (or high chloride?) causes disruption of the glomeruli basement membrane resulting in acute kidney failure [Moore].
Copper nutrition is very important in herniated discs, hemorrhoids and aneurisms because copper is essential for lysyl oxidase, which enzyme cross links the elastin tissue. Cross linking is especially crucial for elastin tissue because elastin gets all of its strength from cross linking. The strength of collagen is not as badly affected because of the long length of collagen molecules. However inadequately cross linked collagen is subject to creep.
The articles starting at; http://charles_w.tripod.com/copper.html would be useful to you, especially copper from food in http://charles_w.tripod.com/copper3.html . You may see the references in these articles in http://charles_w.tripod.com/copper4.html . There is also a copper and zinc table at; http://members.tripod.com/~charles_W/copperzinc.html expressed as weight per calorie, the most useful designation.
There are many less lost time accidents in copper producing industries. I am convinced that this is because of copper's role as pa

Mark

4/27/2014 11:06:54 pm

The comments concerning copper deficiency, elastin, and collagen cross linking are very interesting.
I would ask if there is any relationship between an individual body's capacity for scar tissue development, (such as post op) as an indication of adequate (or over-active) collagen tissue production. Does such provide firm witness to the presence of normal (or even above adequate) copper and elastin health?
I had hand surgery where a tendon transfer for a small finger was successful but scar tissue growth repeatedly thwarted normal glide, despite 2 follow-on attempts to clear the path, (with immediate therapy post-op). So does the seeming over-production of scar tissue indicate a healthy presence of copper and elastin activity or are these factors unrelated?

Mark

4/27/2014 11:07:05 pm

Mark

4/27/2014 11:07:34 pm

Mark

4/27/2014 10:42:26 pm

This is a fairly informative piece. I would have liked to see more of the mechanics explained, such as what common chores or tasks degrade degrade the discs, (i.e. shoveling earth, etc.) and how newer "home therapies" (such as the inversion table) may/may not help.
So far as the decision for surgery - it is good to caution people, but honestly, that level of pain will drive anyone to try the most invasive remedy possible. A little "push" and promises from a hungry surgeon can easily sway one to forego slower attempts to resolve the problem when visions of pain-free days seem to be waiting right around the corner in the recovery room.

Cheryl kurcz

9/23/2016 12:28:00 pm

I have severe stenosis, degenerative disc disease siatica,

tricottan link

11/30/2017 02:01:15 am

Probably the most important way in which spinal stenosis and herniated discs are alike is that the risk of developing either can be greatly reduced. As we age, our spine naturally loses its structural integrity. However, you can take steps to decrease the likelihood you will develop spinal stenosis, herniated discs and other spine conditions. Here are some guidelines to follow in the pursuit of a healthy spine:

Exercise regularly and strategically

Physical activity plays a major role in the maintenance of a durable spine. Strengthening the abdominal and back muscles offers spinal vertebrae and discs extra support in the management of the upper body. Consistent exercise may also allow you to reach and sustain an optimal weight, another significant factor contributing to spine wellbeing. If you’re carrying extra pounds, more tension is placed upon your spine, hastening the natural aging process.

Avoid high impact sports such as gymnastics, football or hockey, as falls and blows may lead to spinal injuries. Opt instead for vigorous activities that do not repetitively jog the spine, such as aerobic swimming, yoga and walking. If pain occurs during exercise, stop and inform your doctor.

Practice posture

Over time, bad posture can hasten spinal degeneration. Pay attention to alignment throughout the day. When standing, try to rest with your feet shoulder width apart and with your shoulders back. Proper sitting posture involves retaining a 90-105° angle between your torso and legs. For extra back support, use a lumbar pillow or roll up a towel and place it behind your lumbar spine. Sleeping posture is often overlooked, but is equally significant for long-term health. Recline on your side, with a pillow separating your knees. If you’re waking up sore, your muscles may be overcompensating throughout the night to preserve alignment — Invest in a firmer mattress.

Handling objects correctly also contributes to overall spine health. Avoid twisting the back suddenly. If you must pick up something heavy, squat down and lift using your legs. Never bend forward or attempt to raise an object using only your arms. When carrying multiple objects, distribute the load equally on both sides of the body. Always ask for help when you need it. It’s better to be safe than sorry!

Men and women with jobs that require repetitive motions, such as sitting at a desk, need to be especially aware of their posture. Take a movement break at least once an hour. During long car rides, make sure your seat is properly fitted to your height and frequently pull over to stretch.