Conditions

Disc Injuries

Disc Injury Treatment in Chilliwack

Our spinal discs live between each vertebrae and act as shock absorbers for various spinal movements. Like other tissues they can be injured and cause pain. Most often our neck (cervical) and low back (lumbar) discs are injured, with mid back disc injuries being extremely rare. For most people injury to the disc happens over a period of months to years and is caused by repetitive movements, sometimes with a sudden “last straw” movement that precedes a flare up. Unfortunately, we don’t always feel a disc issue coming on until the issue is bad enough to cause local disc inflammation or tearing of the outer disc material.

Disc injuries are unique in that they usually require a more tailored and thorough approach to successfully manage than other types of low back or neck pain. Often an individual may find out they have a disc issue after repeated treatments that would normally work for muscle or joint issues do not lead to long-lasting relief. Disc issues also have the potential to cause nerve pain down the leg (in the case of a low back disc) or arm (in the case of a neck disc) because of their proximity to our spinal nerve roots.

Studies have various estimates for how common disc injuries are. For example certain low back studies estimate they are responsible for 5-10% of low back pain types, while others estimate as high as 30-40%. Most disc issues are most common in our 30s and 40s, though this varies with what type of disc issue is present.

Below you can read about different types of disc injuries, treatments we use in the clinic to successfully manage them, and some research on different types of disc injury management (conservative care vs surgery, for ex.).

Chilliwack Chiropractor disc injury model

Types of Disc Injuries

Disc bulges occur when the diameter of the disc is wider than it should be. This can effect a certain portion or part of the disc, most often the back end. Visually it looks like a hamburger that is too big for its bun.
Disc bulges are more often a cause of low back and hip pain, and are less likely to cause leg pain or sciatica than other disc injuries.
Like other disc injuries, bulges are the result of repetitive lifting and twisting under “load”. Higher rates of disc injuries happen in those of us who have work or active hobbies that require such movements.
Chiropractic treatment for a disc bulge focuses on improving mobility of the affected spinal segment, improving low back, hip, and lower extremity biomechanics, and using directional preference exercises for relief (mckenzie technique). Some people also benefit from spinal stabilization exercises.
A disc herniation involves the inner material (nucleus pulposus) of the disc leaving the edge of the disc and putting pressure on a nearby nerve root. Since disc herniations more often affect the nerve roots, there are specific exercises that can help to take pressure from a disc off of any affected or irritated nerves. This system of assessment and treatment is called neurodynamics.
Like other disc issues, Chiropractic treatment for a disc bulge focuses on improving mobility of the affected spinal segment, improving neck or back biomechanics, and using directional preference exercises for relief (Mckenzie technique). Some people also benefit from spinal stabilization exercises.
Degenerative disc disease is a common spinal diagnosis where the discs undergo anatomical changes seen on imaging scans. These changes can include reduced disc height, roughening of the disc end plates, and other arhritis-type findings around the discs.
Surprisingly, degenerative discs can be non-painful and are sometimes found incidentally when taking a low back or neck x-ray in individuals who don’t have any pain. Unfortunately for some people, degenerative discs can lead to both local back pain or neck pain and nerve pain. This often depends on the severity of the disc issue and what other factors may be present to cause pain.
Chiropractic treatment involves improving flexibility and mobility of the affected spinal segments where needed and for relief, and is often also focused on improving spinal biomechanics to take pressure off of discs. This could involve stability exercise, posture modifications, and movement modifications such as bending and lifting techniques.
Some types of disc injuries can irritate the nerve roots in the low back and lead to sciatica. Since sciatica is a symptom and not a disease or injury itself, it’s important for a physical exam to help us determine the cause of sciatica.
If a disc is suspected to be causing the sciatica, then we use specific exercises to firstly take pressure off of the nerve roots. This involves a system of assessment and treatment known as neurodynamics. Usually this involves finding a decompression position you can use at home and teaching you how to move and posture in a way that doesn’t reaggravate the nerve. As nerve symptoms reduce, we work further on low back-specific exercises like with other disc injuries.

Disc Injury & Disc Pain Treatments

Spinal mobilization involves putting a controlled force through a spinal joint in order to improve its mobility and movement. The net result is a reduction in pain and an improved range of motion in that vertebral segment. This can help disc issues by contributing to pain relief, improving flexibility, and improving daily function. When a disc issue is suspected, the type of spinal mobilization used is usually less intense and more gentle than with other issues.
Often this technique is used to supplement disc treatment by helping with relief, but for many is not enough to significantly change a disc issue by itself in the long-run. The other techniques below are used for more long-lasting relief.
McKenzie technique (aka MDT, mechanical diagnosis and therapy) is a system of assessment and treatment involving repetitive movements. It is also known as directional preference exercises, and involves testing with a practitioner informed in McKenzie technique to identify a direction of movement that is relieving, aka a “movement preference”. Studies estimate that around 70% of disc issues have a directional “preference” of movement, whereby repetitive movement or loading in the desired direction leads to pain relief and functional improvement. McKenzie technique has therefore mostly been studied for disc-related issues, but has also shown good results for other types of low back pain.
Exercises are prescribed on a case-by-case basis following an exam, and are done at home to provide ongoing and consistent relief. It can be so effective that some disc issues can be managed entirely by McKenzie technique.
Neurodynamics is a both a method of assessment and treatment related to nerve-related pain. A neurodynamic exam can help identify possible sources of nerve pain and the mechanisms that are contributing (compressed versus overstretched nerve for example).
Neurodynamic techniques are an incredibly helpful addition to disc treatment, since discs can often contribute to nerve pain. In most cases, reducing nerve-related pain and potential damage is the priority before working to rehabilitate a disc.
Many of the neurodynamic exercises can be done at home in order to provide continual relief. Some exercises are more helpful as “first aid” for a very sensitized nerve when pain levels are high, and others are more helpful as “rehab” for a nerve at later stages in recovery.
Disc injuries are more common in individuals who have other biomechanical issues in their spine. One of these is a lack of spinal stability. What this essentially means is that you may have reduced or suboptimal muscle control during certain postures or movements. If in these movements or postures spinal control is not as it should be, our discs potentially take more presure and get injured or repetitively reinjured.
As a result, some individuals with disc issues hugely benefit from spinal stability exercises and low back/core strengthening by improving their muscles ability to “offload” other spinal tissues such as the disc. Spinal stability exercises usually involve a combination of “motor control” exercises where you learn to activate specific muscles in certain postures/movements that may help a disc, and then involve strengthening exercises in “disc-friendly” ways to gradually strengthen an injured or weak low back.

Chiropractic Care for Disc Injuries

Often the therapies below will have an additive benefit, and studies recommend combining treatments for maximum benefit whenever possible. Dr. van de Wall’s approach is to choose a combination of therapies based on your exam findings and treatment preferences. Typically some treatments are best used in early stages of recovery where symptoms are quite high and function is very limited, with others being more beneficial for long-term results and prevention.

Using spinal mobilizations and manipulations (hands-on adjustments)

Spinal adjustments are an effective add-on treatment to manage a disc issue, though mobilizations (lighter adjustments) tend to be better for the average person with a disc injury than manipulation (stronger adjustments).
Spinal adjustments are a very safe treatment option with a disc issue.

Using McKenzie technique (Mechanical Diagnosis and Therapy, MDT)

MDT has been shown to be an effective non-surgical approach to disc herniations, slightly better than motor control exercise and other exercise types in people with low back and leg pain, and slightly better than using spinal adjustments alone.

Using Neurodynamic techniques

Neural mobilization techniques have been shown to be effective for all outcomes (pain, function, disability, etc.) in 6 out of 8 randomized controlled trials. The remaining two trials also benefit, but not for all outcomes measured, and no studies showed any negative side effects from the techniques. These techniques are often most helpful in disc injuries that also cause sciatica or other nerve pain (in the arm, for example).

Using Spinal Stabilization Exercises

Spinal stability exercises consisting of motor control exercise, and core and low back strengthening are more effective at reducing pain and disability in disc herniations than general exercise alone. These benefits also last longer than general exercise at measurable levels up to at least a year.