Prolapsed Disc

Herniated discs are one of the most common of all spinal abnormalities blamed for causing potentially severe and chronic back pain in multitudes of suffering patients each year.  While herniations can be problematic in the short term for a minority of patients, they are rarely responsible for causing the long term or excruciating pain that is inherent to their fearsome reputation. 

Herniated discs are the most common of all spinal irregularities.  They are diagnosed in untold numbers of people, both with and without back pain.  Herniations have become the bread and butter of the back pain industry and even enjoy a plethora of colorful nomenclature attached to their diagnosis.  The most common terms associated with disc pathologies include: disc herniation, bulging disc, ruptured disc, prolapsed disc, disc protrusion, slipped disc, collapsed disc and degenerated disc.  While these terminologies might have some circumstantial differences to some care providers, they are often used interchangeably, much to the confusion of the affected patient.

Herniated discs are theorized to create back pain through several distinct processes.  The most common of these causations is called foraminal stenosis.  This condition is often termed a pinched nerve.  Foraminal stenosis occurs when a herniation bulges into the neuroforaminal opening, impinging on the nerve root exiting the spine at that vertebral level.  While this process can indeed exist, it is diagnosed far more often than it truly occurs.  In order for the herniated disc to significantly affect the neurological functionality of the nerve root, the neuroforamen would have to be almost completely sealed off, which is a very rare event.  This diagnosis is commonly made even when there is no evidence that the herniation even touches the nerve root in question; forget about actually compressing it…

Spinal stenosis is the second most common disorder blamed on herniated discs.  Spinal stenosis describes a condition in which the herniation pushes against the actual spinal cord or cauda equina, limiting full neurological functionality from the entire spinal structure.  Spinal stenosis can be a very serious problem and might lead to such devastating symptoms as cauda equina syndrome.  Once again however, the diagnosis of spinal stenosis from a bulging disc is made very often, while the actual condition rarely ever exists, except in cases of extreme spinal trauma.  Typically, the herniated disc might come in contact with the membrane surrounding the spinal cord and spinal fluid.  A disc bulge touching this membrane does not mean that any effect will be passed along to the neurological function of the spinal cord.  In fact, many herniations impinge on the thecal sac completely unknown to an affected person, since the disc condition creates no symptoms whatsoever.

Chemical radiculitis is a less typical diagnosis commonly associated with severe annular tears in the outer disc wall or complete disc ruptures.  The interior of the intervertebral disc (called the nucleus pulposus) contains proteins which might cause nerve irritation in some individuals.  When the nucleus spills out of the disc structure, this protein can affect local nerve tissue, enacting radicular pain in the immediate area and the regions of the body served by the irritated nerve structure.  This is a somewhat controversial diagnosis, since many people experience full disc ruptures, yet have no pain at all.  It seems that only some people might be sensitive enough to suffer from considerable lasting pain after a chemical radiculitis event occurs.

Finally, discogenic pain is the last and least common of all diagnoses.  Discogenic means that the pain comes from the disc structure itself.  While the disc has no nerve endings or blood supply of its own, it is attached to the neighbor vertebrae by cartilaginous endplates which do contain tiny nerves.  It is these small nerves which are implicated in discogenic pain conditions, although most doctors who make the diagnosis are not always sure why the nerves hurt to begin with.  This diagnosis is certainly on very shaky ground in most instances…

Ironically, although herniated discs are blamed for a tremendous amount of pain, they are rarely the actual symptomatic source.  Most disc herniations are merely coincidental to any pain experienced and actually exist in a vast number of people who have no pain at all.  Generally, herniations due to trauma will most likely cause pain for a short time, although this discomfort might be severe.  Luckily, this condition usually resolves in 6 to 8 weeks, even without any medical treatment.  Herniations which exist due to the normal degenerative processes in the spine, such as the laughably named degenerative disc disease, are rarely painful, even in the short term.  Most of these degenerative induced bulges are not even discovered till many years later, since they raise no warning signs, cause no pain and exist innocently in the spine.  The possibility that any herniated disc might cause pain for months, years or even decades is highly unlikely.  Unfortunately, the mythology surrounding disc conditions, as well as the considerable nocebo effect of the diagnostic process, have both contributed to the current epidemic of disc related back pain. 

As a final thought, remember that herniated discs are a huge industry in the medical sector.  Doctors, chiropractors, complementary therapists, drug manufacturers, pharmaceutical suppliers, orthotic makers and a variety of other entities all profit hugely from disc pain.  If the reality of the average herniated disc ever became common knowledge, the viability of this extremely profitable business niche would be decimated.  Therefore, do not count on the diagnosis of disc herniations as a major source of pain decreasing any time soon…

Sensei Adam Rostocki

Peter, 43, is an active man who prides himself on his fitness. He does a lot of jogging, cycling, yoga and of course plays active games with his 3 kids, aged 8, 11 and 13.

He was getting aware of a worsening pain in the lower back, which at times   seemed to spread into his buttocks and down his right leg. As a consequence that leg at times felt  weaker than usual, sometimes even numb.

These symptoms are typi­cal of a pinched nerve in the back. The nerves to the legs exit the spine in the lower back, so if they are pinched, pain, weakness or numbness in a leg may result. But how exactly does a nerve become pinched?

Our backs are made of many small bones called vertebrae, arranged in a vertical but S-shaped column. This shape helps in shock absorption and provides flexibility to our body, respectively back. Between one vertebrae and the next we have a soft cushion called a spinal disc. These disks also give our backs their flexibility and are an im­portant part in shock absorption.

But, as we get older, these discs may become damaged and bulge out or even rup­ture. At this point it is called a herniated or prolapsed disc. But if the damaged disc then begins to press on the spinal cord or nerves in the spine we can experience nerve pinching and pain which in severe cases can even lead to immobility.

In general symptoms like weak­ness, numbness or tingling are the result of nerve pinching. As this occurs most commonly in the lower back, to be precise in the area of the lumbar vertebra 4, 5 and sacral vertebra 1, the nerves to the lower limbs are affected, and hence that is where the symptoms are felt. The pain is often a rather sharp pain, sometimes it can also be felt as a dull pain and is called sciatica. This comes from the sciatic nerve which is mostly being pinched in this lower back when the described symptoms occur.

On examination we might find that a patient’s leg is weaker on the pain affected side and that the reflexes on this side are not as brisk. We would also expect that an area over the lower back where the nerve is pinched would be tender on touch.

Immediate therapy for sciatica includes rest, pain relief and avoiding ac­tivities that aggravate the condition. In order to relax the pain you can also take an anti inflammatory or a pain killer but you should as quick as possible see a therapist of your choice.

But what choices do you have?

Well there is of course your GP who will give you various options of pain treatment. Then there is physio therapy which might help given you are doing all the exercises on a regular basis for quite some time, even when you don’t feel the pain anymore. And chiropractic or osteopathic treatments which can be long and painful for your wallet and in some cases very traumatic for your body, depending how you respond to high velocity movement treatments and manipulation.

But now there is also a new treatment available called Dorn Spinal Therapy. This gentle but very effective treatment form comes from Germany and over there is now one of the most sought after treatment for any kind of back pain and for many people has proven to be the one and only treatment that has helped them overcome years of pain and unsuccessful treatments. Dorn Spinal Therapy is a holistic treatment which involves leg length balancing, balancing of the sacro-iliac area and alignment of the vertebrae. All in a non violent procedure and with very few treatment repetitions. For more information please go to www.backcaresolutions.net  Dorn Spinal Therapy is ideal when combined with massage therapy or any other treatments adressing muscular skelettal issues and the results speak for themselves. So why go to use drugs or other invasive treatments when there is a real alternative to fix a crook back.

A dull

Barbara E Simon