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Friday
May292015

THE TRUTH ABOUT RUPTURED DISCS

Who hasn’t heard the term "ruptured discs"? It is a loosely used expression to describe many conditions causing pain or nerve conduction problems. The disc is a cartilaginous pad; actually a ligament that binds one vertebrae to another. The discs allow the spine to bend. Without the discs, the spine would be like a stick. There is a disease process called ankylosing spondylitis in which the discs get covered over with bone and fuses one vertebra to the other. This disease is also called "bamboo spine" because the spine takes on the look and function of a bamboo stick. People with this condition have an extreme lack of mobility.

There are two primary areas of concern in the disc. The outer portion called the annular fibrosis (think of the rings of a tree after it has been sawed through). It is made of tough fibrous connective tissue. The fibers of each ring run in the opposite direction of the ring next to it. This gives tremendous strength to the disc. There is an inner gelatinous core to the disc called the nucleus pulposus (think of jelly in a jelly donut). Many of the problems with discs occur when the core shifts to one side of the disc. This shift can occur over time due to low grade stress; such as sitting or bending for extended periods of time. A shift of the inner core material can also occur due to an acute loading of the disc to one side; such as picking up a very heavy suitcase with one hand. This shifting of the core probably led to the term "slipped disc". The outer annular rings can break down without any shifting of the core material. This breakdown can occur from twisting type motions especially while holding something heavy. An example of this type injury might occur when picking up a bag of mulch and turning quickly to throw it into a truck bed.

The aging process can lead to a drying out of the disc fibers. The drying causes a breakdown of the annular rings. Eventually, there is a shifting of the core material through the area of weakness. If the core material shifts to one side of the disc, but remains contained by the annular fibers it is called a disc protrusion. If the core material “ruptures" out, it is called a disc prolapse. There are variations of naming these protrusions and prolapses which is more detail than we need to get into.

After treating patients for ruptured discs since 1984, I have come to the conclusion that the majority of ruptured discs come from abnormal dynamics of the spine. The areas of altered vertebral performance, which cause the disc to rupture, are often not in the area of the disc damage. Most doctors focus on the disc as the problem. Injections of steroids or surgery are often performed to no avail since the problem is not the disc itself. The problem is poor dynamic motion in the spine. The altered movement leads to focalized stress on a single disc. The strained disc eventually inflames or ruptures.

The approach I take is to find the area of abnormal spinal performance and restore the motion to as close to normal as possible. The problem area can be either above or below the injured disc. Sometimes, there are problems both above and below that contribute to the disc’s dysfunction. Areas of hypomobility (not enough motion) must have movement restored. Optimizing spinal function distributes stress and lets the agitated disc rest and heal.

About a third of the population has a ruptured disc. I have two in my own neck. Just because a physician finds a ruptured disc in the area of your pain does not mean it is the underlying problem, or that you are a candidate for surgery. I suggest you contact a chiropractor before undergoing any surgical procedures for disc problems. Chiropractic will usually help you recover and is extremely safe. You cannot reverse many of the effects of surgery once it is performed. If chiropractic fails to remedy your condition, you can always have the surgery.



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