Before we begin to talk about herniations; we need to talk about the structure and function of an intervertebral disc.
An intervertebral disc lies between adjacent vertebrae in the vertebral column. There are 23 discs in the human spine: 6 in the neck (cervical) region, 12 in the middle back (thoracic) region, and 5 in the lower back (lumbar) region. Each disc forms a fibrocartilaginous joint ( symphysis), it allows slight movement of the vertebrae, acts as a ligament to hold the vertebrae together, and functions as a shock absorber for the spine.
Intervertebral discs consist of an outer fibrous ring, the annulus fibrosus which surrounds an inner gel-like center, the nucleus pulposus. The annulus fibrosus consists of several layers of tough fibrocartilage that can withstand compressive forces. The nucleus of the disc acts as a shock absorber…think of it as a gliding ball moving in reaction to the movement of the vertebrae. For example as the spine flexes (bends forward) , the nucleus pulposus moves to the back or posterior of the disc absorbing the impact of the body’s activities and keeping the two vertebrae separated.
And as the spine extends , the gliding nucleus moves forward; bend sideways, the gel moves to the opposite side. You get the idea.
However what happens if the spine is “struck in a relatively immobile or restricted position? That means that the nucleus pulposus is constantly in one location pushing up against the annulus fibers; and between the pressure from the nucleus and the increase of compressive forces from the abnormal spinal movement, the annulus fibers start to weaken. This allow part of the nucleus to protrude (and the fibers ) into either the spinal canal or up against a spinal nerve. This is called herniation or a bulging disc.
A spinal disc herniation can happen during a trauma or a result of chronic abnormal spinal mechanics combined w/ poor posture. Both the deformed annulus and the gel-like material of the nucleus pulposus can be forced laterally, or posterior, distorting local muscle function, and putting pressure on the nearby nerve. This can give the symptoms typical of nerve root entrapment. These symptoms can vary between parasthaesia (tingling), numbness, chronic or acute pain, either locally or along the area of the body served by the entrapped nerve (dermatome) and loss of muscle tone.
The two most common areas of herniation are the cervical (neck) vertebrae and the lumbar (low back) vertebrae. Please see below blogs for more information about problems with these regions.
There are varying degrees of herniation; sometimes there is rupture of the annulus fibers and some of the nucleus pulposus escapes into the spinal canal and the area of the spinal cord. This is called a noncontained extrusion, which sometimes requires a surgical correction.
The degree of herniation requires visualization via MRI. However abnormal findings on MRI do not necessary relate to degree of symptoms; in fact, a number of MRI’s done on asymptomatic volunteers showed various herniations.
A proper examination with orthopedic and neurological testing will show at what spinal nerve level does the pain originates from. Muscle testing will show if an imbalance of muscle pull is affecting the spine and the patient’s posture.
I use a table that provides flexion distraction and spinal decompression; biomechanically it can open the disc space by 28%; allowing for a gentle reversal of the herniation. This table and SOT non-force adjustments produce rapid improvement.
As the patient improves, symptoms such as pain or numbness will decrease, orthopedic and neurological tests will go from positive to negative and the muscles will test strong and balanced.
Think you may have a herniation problem? Please give me a call at 212-431-3724 or email me at email@example.com.
And lets talk and see if I can help you.
© 2019-Dr. Vittoria Repetto
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