Herniated Disc – Symptoms, Causes & Treatment

What is the Difference between the Herniated Disc and Healthy Disc?

A healthy disc is composed of two parts namely the nucleus pulposus and annulus. Nucleus pulposus is a soft, jelly-like tissue that is surrounded by the hardcore-like covering called an annulus. The nucleus pulposus is comprised of a water and collagen network that is responsible to bear the compression and torsion in between the vertebrae. Whereas the outer covering of the annulus is responsible to protect and nucleus pulposus and providing connection between the vertebrae [1].

In a herniated disc, the annulus is cracked and tore due to which the soft nucleus pulposus finds a way to bulge out of the annulus, compressing the nerves. Herniated disc is the neurodegenerative disorder in which the annulus is degenerated, ruptured, or cracked, allowing a fragment of nucleus pulposus to be pushed out and suppressing the nerves coming out of the spinal cord [1, 2].

Causes and Risk of Herniated Disc

Although there may be a lot of reasons for a herniated disc as it is a progressively slow disease that is not caused by a major incident except for the lower back injuries. 

  • Lower back injuries can cause rupturing of the annulus leading to the herniated disc.
  • Being overweight can be a cause of herniated disc because of the continuous high pressure at the vertebral column and greater degree of wear and tear of the disc.
  • Most of the people who do not sit at an upright position, or with curved vertebral columns are more prone to be affected by the herniated disc. This is because, an improper posture can be a cause of the rapid wear and tear of the annulus, which ultimately changes into the herniated disc [2].
  • People associated with jobs related to heavy lifting of objects are more prone to be diagnosed with herniated disc because lifting heavy objects regularly exerts pressure and compression on the vertebral disc, hence causing the rupture of the annulus and herniated disc. Similarly, poor posture of lifting the objects can also cause herniated disc incidence.
  • Diseases like diabetes and osteoarthritis can also be risk factors for a herniated disc. According to Ozturk et al., diabetes is a leading root cause of several life-threatening diseases, and in the herniated disc of a diabetic patient, the physician must undergo a thorough and rapid examination of the blood glucose level before prescribing the treatment intervention to the patients. On the other hand, the bones and joints of the osteoarthritic patients become brittle and fragile due to which the annulus gets cracked leading towards the herniated disc [3].
  • Smokers and sedentary lifestyles are one of the rising cases of the herniated disc because of the lack of oxygen and blood in smokers, the inadequate blood supply to the annulus leaving it to be cracked [2].

Healing Mechanism of Herniated Disc

The healing mechanism of a herniated disc is followed by the three stages including inflammation, proliferation, and maturation. The inflammation stage is triggered as soon as the annulus is cracked and the nucleus pulposus is pushed out. This includes redness, swelling, pain, and increased temperature at the affected area.

The proliferation stage of healing is started right after the identification of the inflamed area and the formation of scar tissue and the release of trigger points is started. After the release of scar tissue and trigger points, the superficial and deep layers of the fascia are released so that the affected area of the damaged nerve and the herniated nucleus pulposus can be covered [3].

This cascade of events leads towards the maturation stage in which the slight rupture of the annulus and slightly herniated nucleus pulposus are healed naturally. Whereas in chronic conditions, the inflammation and proliferation stages go back and forth and do not reach the maturation stage due to the inadequate scar tissue, trigger points, or fascia release required for the healing of the annulus, and for that, effective treatment interventions are required that can be done at home. However, most of the home-based treatment options are ineffective yet some are effective that are described below [4].

Ineffective treatment Options for Herniated Disc

The most common remedy for back pain is heating or icing at the back which is not much effective for the herniated disc. Although it can provide temporary relief in pain it is not a potential solution for a herniated disc.

Muscle stimulation techniques are also ineffective for a herniated disc that usually include Electronic stimulation (EStim), massaging, and foam roller [4, 5].  

Exercising like stretching of the vertebral column, stretching exercises and other workouts can make the herniated disc more severe as it can increase the pressure exerted on the nerves by pushed out the nucleus pulposus.

Effective Treatments for Herniated Disc

Inflammation Stage

Taking complete bed rest at a flat surface is the best remedy for healing herniated discs. Rest is recommended for chronic herniated disc along with the medicines and external therapeutic treatment [4, 5].

Magna Heal is the most common treatment instrument used for back pain in which the magnet enclosed in a wearable belt utilizes the magnetic field to align the bony structures. According to Desmoulin et al., this technique is effective for a herniated disc as this problem is related to the disc disorder [5].

Diet can also be one of the effective treatment options for the herniated disc which may include an anti-inflammatory diet and nutritionally rich diet with vitamins, calcium, and minerals. Although supplemental products can also be used to restore deficiencies [4, 5].

Proliferation Stage

At the proliferation stage, an effective treatment is recommended by Desmoulin et al in which the soft tissues are triggered by exerting pressure by ergonomically designed instruments (A1, A3, and A5) so that the proliferation events are stimulated externally so that the healing cycle may reach the maturation stage [5].

To facilitate the scar tissue release and trigger points release superficially, pressure-based alignment through A3 can be used, whereas, for deep pressures, A5 is effective. For the fascia release at the superficial layer, A1 is used and for the deep fascia layers, A5 is used to align the soft tissues at the proliferation stage [4, 5].

References 

  1. Elsharkawy AE, Hagemann A, Klassen PD. Posterior epidural migration of herniated lumbar disc fragment: a literature review. Neurosurgical review. 2019 Dec 1:1-3.
  2. Jordan JL, Konstantinou K, O’Dowd J. Herniated lumbar disc. BMJ clinical evidence. 2011;2011.
  3. Ozturk B, Gunduz OH, Ozoran K, Bostanoglu S. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation. Rheumatology international. 2006 May;26(7):622-6.
  4. Mutubuki EN, van Helvoirt H, van Dongen JM, Vleggeert‐Lankamp CL, Huygen FJ, van Tulder MW, Klopper‐Kes HA, Ostelo RW. Cost‐effectiveness of combination therapy (Mechanical Diagnosis and Treatment and Transforaminal Epidural Steroid Injections) among patients with an indication for a Lumbar Herniated Disc surgery: Protocol of a randomized controlled trial. Physiotherapy Research International. 2020 Jan;25(1):e1796.
  5. Desmoulin GT, Pradhan V, Milner TE. Mechanical aspects of intervertebral disc injury and implications on biomechanics. Spine. 2020 Apr 15;45(8):E457-64.