One of the most common questions I am asked as a Doctor of Chiropractic (DC) is whether or not chiropractic treatment is effective for herniated discs. More often than not, the answer is yes. However, it is important for an individual with disc symptoms to be thoroughly evaluated by a DC prior to the initiation of treatment to determine the degree of severity and if chiropractic care is appropriate for their specific condition.
It is also important to understand what a herniated disc is and the appropriate treatments are for the various levels of disc involvement. The intervertebral discs are the cushions that act as shock absorbers between the individual vertebrae. They also act as ligaments to hold the vertebrae together and form part of the wall of the intervertebral foraminal where the spinal nerves exit the spinal cord. Spinal discs are made up of the annulus fibrosus (the tough outer layer) and the nucleus pulposus (which contains a soft, gelatin-like center). When cracks occur in the outer layer of the disc, the material inside of the disc can begin to push out. Intervertebral discs don't really "slip"—although the phrase "slipped disc" has come into popular usage to refer to bulging, ruptured, or herniated discs.
At your initial appointment, your chiropractor will go through your medical history, do a physical exam, and perform orthopedic and neurological tests including deep tendon reflexes, loss of muscle strength or muscle wasting, loss of sensation along a path of a nerve. She may order radiographs, an MRI, or nerve conduction studies if necessary, to help with the diagnostic process.
After reviewing this information, your chiropractor can determine if you have an intervertebral disc injury. The type of disc injury you have will determine what treatments your chiropractor will use to address your symptoms.
The following findings would contraindicate chiropractic treatment and require a referral to a spinal surgeon:
· Cauda equina syndrome (loss of bowel/bladder function
· Severe muscle loss with decreased reflex
· Loss of sensation in the lower extremities or along a nerve root.
Chiropractic care may exist of the following treatments
· Specific, gentle spinal manipulation
· Flexion/extension distraction technique
· McKenzie exercise protocol
· Stretching and Core Stability exercises
· Cold laser
Spinal manipulation refers to the use of a high velocity, low amplitude thrust that restores normal mobility and alignment to s spinal segment. Flexion/extension-distraction involves the use of a specialized table that gently "distracts" or stretches the spine. This allows the chiropractor to isolate the affected area while slightly "flexing or extending” the spine using a pumping rhythm.
which allows the center of the intervertebral disc (called the nucleus pulposus) to assume its central position in the disc. Flexion-distraction may also improve disc height. This technique can help move the disc away from the nerve, reducing inflammation of the nerve root, and eventually any associated pain and inflammation into the leg (if there is any related to your herniated disc).
McKenzie protocol utilizes a variety of maneuvers, most commonly lumbar extension, that are also designed to assist the nucleus to assume it’s normal position in the disc. Cold Laser is the use of photon light therapy which reduces inflammation created by the disc herniation and promotes healing of damaged, soft tissue. Core Stability exercises and stretching are introduced when the initial pain is minimized to strengthen the muscles of the abdomen and lower back to support the spine and prevent reoccurrence.
In my 31 years of clinical experience, I have found most herniated discs heal quite well with conservative treatment. On occasion, particularly in cases of severe extrusion and sequestration, a referral may be needed for an epidural steroid injection or evaluation by a neurosurgeon. You can be assured that a Doctor of Chiropractic will provide the best possible conservative treatment yet also make an appropriate referrals should they become necessary.