Lumbar Disk Herniation

Just as the name suggests, lumbar disk herniation affects the lumbar spine, the lowest portion of the spine's three sections. The lumbar spine is below the thoracic spine, which makes up the mid back, and the cervical spine, which makes up the neck.

If you reach behind and touch your low back, you may be able to feel bony knobs. These are vertebrae, the bones that compose your spinal column. The vertebrae stack to form a protective casing for your spinal cord, which is a collection of nerves that travel from your brain through the spine and out through the spaces between each vertebra. These nerves then connect to various organs and tissues, and relay messages between them and your brain.

The lumbar spine has five vertebrae. Separating the vertebrae are the intervertebral disks, which are cushion-like and made up of two parts: a thick, tough outside layer called the annulus fibrosis and a gel-filled center called the nucleus pulposis. Because of their construction, disks act as shock absorbers, protecting the vertebrae when the weight of your body forces them together. They also help to reduce wear-and-tear on facet joints, which are the connectors that hold vertebrae together.

Disk herniation develops when trauma or continuous, repetitive activities like bending, lifting and twisting overload or wear out the spine's shock absorbers. All these activities force the vertebrae closer together, squeezing the disk in between them and causing the outer layer of the disk to weaken and develop tiny tears.

Over time, these compressed disks react in much the same way as flattened ice cream sandwiches: their middle bulges out. This bulge or rupture is a herniation. It can occur anywhere in the disk, but most commonly occurs at the side or towards the back and side.

While torn disks themselves may cause some discomfort, patients often feel pain in the thigh and leg as well, which is due to another problem. This pain develops when the nucleus pulposis compresses nerve roots in the spinal column. Nerve roots are the beginning of nerves, as they leave the spinal cord and exit through the space between the vertebrae. Because the nerve roots in the lumbar spine attach to nerves that travel into the thigh, leg and foot, a lumbar disk herniation can cause pain in any one of these areas. This is one of the most common causes of sciatica, which is a collection of symptoms that may include burning, numbness, tingling, and hot or cold sensations that radiate into one or both legs.

A growing number of researchers also believe that nerve root compression is not the only cause of the pain associated with disk herniation. Recent studies suggest that the pain may also stem from inflammation in the area of the nerve root. This may occur when the body's immune system attacks the leaked gel that escapes from ruptured disks, causing an inflammatory reaction. The resulting inflammation irritates the sensitive nerve roots and surrounding nerves, causing the pain associated with disk herniation.

If you're experiencing such pain, your chiropractor can determine the best management techniques for your condition. These may include spinal manipulative therapy, which aims to correct any joint dysfunctions that are contributing to pressure on the disks; a variety of soft tissue therapies, which reduce associated pain and swelling; and nutritional advice, which will be focused on reducing inflammation. As well, be prepared to make some lifestyle changes. While conservative chiropractic care can alleviate pain in most cases, taking proper care of your low back is paramount in ensuring a full recovery.

Chiropractic Care If you're affected by a lumbar disk herniation, easing pain is likely your primary concern. Non-invasive chiropractic care can help, and can also rehabilitate your low back to help prevent recurrences. If your symptoms began within the past two to three days, your chiropractor will probably recommend that you apply ice to your low back for 5 to 10 minutes every two to three hours. Putting ice on the injured area is an effective solution to painful swelling and inflammation, as the cold numbs pain receptors and constricts blood vessels, which diminishes the release of inflammatory fluid. After three days, or when the inflammation is sufficiently reduced, your chiropractor may advise you to switch to a hot application, like a warm water bottle. While heat can exacerbate symptoms in the initial stages of lumbar disk herniation, because it increases blood flow that promotes inflammation, it's helpful for easing muscle spasms that can occur in the chronic stage of the condition. Heat works by increasing blood flow where you apply it, and this fresh circulation washes away any buildup of painful chemical irritants, like lactic acid, that can be present in tight muscles. (Keep in mind that not everyone is suited for heat therapy, as it can be harmful for those with vascular disorders or tumors. Before you use a heat application, speak with your chiropractor.) If you have any joint misalignments or dysfunctions in your lumbar spine, your chiropractor will probably perform spinal manipulative therapy, commonly called an adjustment. To do this, he or she will apply a quick, strategic thrust with his or her hands or a device called an activator, which returns subluxated or stuck joints to their proper place, restores joint motion, decreases pressure on herniated disks and reduces pain and inflammation. If you have muscle spasms, your chiropractor may also use physiotherapeutic tools like interferential current (IFC). IFC is a type of electrical therapy that relieves pain by stimulating muscles to contract and dispersing excess inflammation-related fluid. It also stimulates the nervous system and increases blood flow to injured areas, which helps to speed healing. Once your pain has subsided, your chiropractor will probably also recommend that you stretch and strengthen the muscles in your low back. Herniation is usually the result of increased pressure in the front of the disk, which is why activities that require you to bend forward cause greater pain. Stretching exercises that focus on extending your spine will keep the vertebrae from clamping down, thus relieving pressure on the bulging disk. For that reason, strong and flexible back muscles are vital, as they offer the support you need to keep your spine in a comfortable position and prevent your joints from supporting more weight than they're accustomed to. If conservative chiropractic care like this fails to bring relief, you may need more serious medical attention. In extreme cases, the nerves in the lumbar spine are damaged so severely that patients experience bowel and bladder dysfunction, loss of sensation in the legs and feet, significant muscle weakness and poor reflexes. In these cases, they many need to undergo a medical procedure called a diskectomy, which is a partial or full removal of the disk. This may help remove compression on nerves and decrease inflammatory reactions. Keep in mind that the procedure is only necessary for about 5% of patients with disk herniation, and that in most cases conservative chiropractic care is effective.