If you suffer with back pain, have you ever wondered whether or not you have a disc herniation?

Words Like: “Pinched nerve”, “Torn Muscle” “Bulging Disc”, “Slipped Disc”  or “Sciatica”, can be used to describe different forms of back pain by different people who suffer with back pain

However, although very similar in terms of where the pain originates, all can be very different as to what is actually producing the pain.

That said, IF you have ever suffered with a “true” disc herniation (or disc injury per se), then whether or not you have had an MRI to confirm the injury, you WILL KNOW exactly HOW a disc injury feels.

Disc Herniation Pain:

The term “herniation” refers to an out pouching of material, or “protruding” of material through an abnormal bodily opening.

In the case of a “disc herniation“, disc material, namely the “nucleus pulposus” (which is the center gelatinous material inside the intervertebral disc), protrudes or out pouches through an abnormal bodily opening.

Again, with the case of a “disc herniation”, the abnormal bodily opening that the nucleus pulposus (the inner jelly material, or in the picture, the yellow center filling) goes through, is in fact…itself.

You see, the intervertebral disc, is designed to be tough yet flexible. On the one hand, the discs act to connect our spinal column together so the spine can be a secure, structurally stable unit.

On the other hand, the intervertebral discs act as a weight/shock absorber for the force and stressors that are placed on the spine, so that it can move, bend, twist, and rotate on itself.

When the weight born on the spine is too much, like the case of trauma (motor vehicle accident), lifting injury (picking up something heavy from the floor), or even a repetitive injury (like driving or sitting for hours upon hours on your buttocks), all can cause the discs to herniate.

And when it herniates,  watch out. The pain can be down right immense

Disc Herniation pain is probably like no other pain  you have felt in your life before:

• Sharp Stabbing Pain
• Electrical Shocking Type Pain
• Pinpointed Excruciating Pain
• Throbbing Pain
• “Locked” or “Locked-Up Pain”
• Radiating Pain
• Numb/Tingling/Crawling Pain
• Pins and Needle Pain
• Traveling Pain into The Shoulder, Elbow, Hand, or Fingers
• Traveling Pain into the Buttocks, Thigh, Hamstring, Knee, Calf, Shin, Ankle, Foot, Heel, and/or Toes
• Pain associated with deep breathing

DISC HERNIATION VS. DISC BULGING

I’m often asked “whats the difference between a disc herniation and a disc bulge?”

The best analogy I use is to relate the image of stepping on a balloon with your foot.

Remember with a disc “herniation”, the definition explains a protrusion of disc material through an abnormal opening.

With a disc bulge, the inner nucleus portion of the intervertebral disc never protrudes through an abnormal opening.

So, the result is the entire disc bulges out from underneath the bone above it and bone below it. Sort of like stepping on a balloon.

The interesting thing about a disc bulge vs a disc herniation is the fact that it is not necessarily less painful.

Notice in the picture, the different stages of the disc herniation. Herniations are sometimes referred to as “protrusions” or “extrusion”.

If the protruded or extruded disc material actually breaches the outer lining of the disc, it is considered a disc sequestration or a sequestered disc.

Typically, the more protruded, extruded, herniated, or sequestered the disc material is, one would expect more pain, and more dysfunction.

However, this is not always the case. That’s because it really depends where the “compressed” portion of the disc material is (whether it’s bulging, herniated, protruding, extruding, or sequestered or not).

If the material that is compressed is touching a nerve spinal nerve root, then associated pain to wherever that nerve root goes to, develops as well.

That is when patients will complain of numbness, tingling, electrical, pins and needles, or sharp shooting pain into the shoulder, arm, hand, fingers, thigh, back of the leg, knee, calf, foot, and/or toes.

Interestingly, the disc need not be a “herniated disc” per se to cause the spinal nerve root to be “irritated”.

If a shock absorbing intervertebral disc absorb too much weight, such that it gets compressed, that compression can overwhelm the strength of the disc itself, and cause it to bulge or herniated.

Whether or not it actually bulges or herniated, the excess weight (if strong enough) can cause excess compression to the disc. When this happen, annular fibers may tear, which are the pain sensitive fibers that surround the nucleus.

When this happens, again whether or not the disc bulges or herniates, can cause “irritation” to the spinal nerve root,  thereby causing the sensation of electrical radiating pain into the extremity where that nerve root travels to.

If in the neck, the nerve root will travel into the arm, and if in the lower back, that nerve root will travel into the leg.

DISC HERNIATION AND NERVE ROOT PAIN:

As just mentioned above, a disc need not be herniated to cause nerve root compression.

The injury sustained to the disc because of excess force placed on it (sitting for hours on end, lifting something off the ground from a forward flexed position, or trauma) can cause instead, “tearing” of the fibers.

When this happens, inflammation around the compressed torn material will irritate the nerve root, thereby causing the radiation, electrical, sharp shooting, and/or pins and needle sensations into the extremities.

The example I use here, is when the corporate greedy company of BP had one of its main oil pipe burst in the gulf of Mexico.

I remember seeing the images of the oil spewing out of the pipe into the gulf.

The analogy is similar to the newly injured, torn, and inflamed disc material spewing out what is called inflammatory “exudate” that irritates the spinal nerve.

Confused?

Ok, to summarize:

1. Intervertebral disc injuries occur from trauma (car accidents, falls, direct blows to the disc), from repetitive wear and tear (office workers or drivers sitting for long hours, weight training inappropriately) or from congenital inheritance (a weakened degenerative spine)
2. When the disc is injured, it can be torn fibers, a disc bulge, disc protrusion, disc extrusion, disc herniation, disc sequestration, or any combination or the above
3. A lot of pain will result, and will not be dependent on the amount of disc injury per se, but more dependent on where the injured disc material is and what other structures are involved.

The bottom line: If you suspect that you have injured your disc, have excess wear and tear on it, and you are unsure of exactly what is wrong, the gold standard for determining disc pathology, then you must get an MRI.

Disc injuries are considered “space occupying lesions” that must be differentiated from other space occupying lesions such as tumors or abnormal growths that have much worse prognosis and implications then the disc herniation complex.

 

 

 

 

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1. A Day In The Life Of A Chiropractor Who Suffers With Back Pain