Herniated Disc

What is a herniated disc?

A herniated disc (in full: hernia nucleus pulposus) is a bulge of an intervertebral disc. Between two vertebrae lies the shock-absorbing intervertebral disc, which provides elasticity and increases freedom of movement. The anatomy of an intervertebral disc can be compared to an onion. There are layers on the outside and in the centre is a gel-like material. The bulge of the intervertebral disc occurs because the soft inner part exerts pressure on the outer layers.

The bulge presses on nerves, causing pain or other complaints. A herniated disc occurs when the intervertebral disc loses its flexibility. This disc, which acts as a kind of 'shock absorber' in the spine, can no longer absorb certain movements properly. The result is that small cracks form in the outer wall of the disc, leaving the soft inner part inadequately protected. When part of the soft material bulges outward, we call this a hernia nucleus pulposus. The pressure on the nerve can lead to reduced nerve function.

Intervertebral discs have no sensory nerves, so the herniation itself is not painful. Pain is caused by the bulge pressing against nerve tissue. Symptoms vary depending on which nerve is irritated. Disc herniations in the lower back mainly cause radiation into the legs, such as tingling and numbness, and can even cause paralysis symptoms such as foot drop.

What complaints does a herniated disc cause?

A herniated disc causes back pain and can radiate into one or both legs. Tingling in the leg or foot can also indicate a herniated disc. As complaints worsen, the leg muscles may lose strength or become numb. A large central herniation can cause cauda equina syndrome — a medical emergency, as it can result in loss of function in the legs and loss of bladder and bowel control. In that case, immediate referral to a neurologist is required.

How does a herniated disc develop?

A herniated disc is a common condition of the lower back, which is accompanied by symptoms in only about 50% of cases. As people age, the intervertebral disc becomes less elastic and many people gradually develop weak spots in their discs. The average age for developing a herniated disc is between 20 and 45 years, and it occurs slightly more often in men than in women.

The tears usually develop gradually as a result of incorrect posture and movement. Limited variation in posture (such as with many types of seated or standing work) increases the risk of developing a herniated disc. The same applies to work involving repetitive movements, such as lifting, frequent bending and twisting. Sometimes a herniated disc occurs suddenly due to an accident.

Treatment

The chiropractor will ask about your back pain and your general health. The pain may be related to other health complaints. A thorough physical examination follows. If a herniated disc is suspected, the chiropractor will perform neurological tests. Nerves supply our muscles and skin, and each nerve has its own destination. With a herniated disc, it is possible to determine specifically whether there are abnormalities in muscle function or other disorders. From the described pain radiation and the chiropractic-neurological examination, the chiropractor can often determine which nerve is involved.

The chiropractor may advise further diagnostic investigation, in consultation with your GP or neurologist. A herniated disc is not visible on a standard X-ray. A thinner intervertebral disc may be visible, but this does not necessarily mean there is a herniation. Herniated discs are clearly visible on a scan such as a CT or MRI scan, which can also show whether there is direct pressure of the herniation on the nerve root. If an X-ray, CT or MRI scan is available, it can be useful for the chiropractor to determine the prognosis and tailor treatment accordingly.

Herniated disc is a loaded term and a major fear for people who occasionally suffer from back pain. Most herniated disc complaints can be treated effectively by a chiropractor without surgery. The chiropractor has various techniques depending on the condition of the intervertebral disc, including traction techniques, spinal movement techniques and muscle relaxation techniques. The treatment itself is usually not painful.

For a severe herniated disc, the chiropractor will refer you to a GP or neurologist, for whom surgery may be the solution. However, after surgery the pain at the herniation site is normally gone, but other areas of the back or pelvis may still be painful. Neurological chiropractic treatment can provide relief there.

In addition to hands-on treatment, the chiropractor can advise you on posture, ergonomics, exercise, and nutrition. Even if treatment is successful, your back remains a vulnerable area that deserves extra attention. Developing strong abdominal, gluteal and back muscles is very important — it spares your spine and allows you to lead an active life.