What Causes Sciatic Pain, Disc Herniation, and Disc Bulges?

Bad Back? Sciatica? Disc Problems?

Learn more: watch the video or read the transcript below.

Transcript of Video:
What Causes Sciatic Pain, Disc Herniation, and Disc Bulges?

I’m Dr. Shawn Phelan. I am here today from Wake Forest Chiropractic in Wake Forest, North Carolina, to talk with you about disc herniation and bulges and sciatica, which is a condition that can be caused by these conditions.

Many of the patients who come to Wake Forest Chiropractic have these conditions, and we thought it would be beneficial of them and you to understand more about them. This knowledge will help you to understand the treatments that may be suggested to you by us or your local practitioner.

"Spinal Cord"

Figure 1

Let’s start with this diagram (see Figure 1) of the vertebrae, spinal column, spinal cord, and discs. In simple terms, vertebrae are really not much more than a couple of blocks of bone stacked upon each other, which is what creates our spinal column.  The vertebrae are separated by discs (intervertebral discs). The job of the disc is to absorb shock and provide us with stability. Behind the vertebrae and discs is the spinal cord which runs from the brain down to the upper to mid lumbar spine area. Just in front of the spinal cord and right next to the intervertebral disc is the spinal nerve. The spinal nerve leaves the spinal cord and then heads down into the arms and the legs in order to supply the lower and the upper extremities with nerve supply, and the ability to contract and control musculature and activity.

Invertebral Disc

Figure 2

The spinal nerves come in very close proximity to the intervertebral discs. This diagram (see Figure 2) shows what it would look like if we were to look directly down from the top of the spine to see the disc itself. What we would see is bone. This little projection of bone on the top of the drawing is the spinous process. That is the bone that we feel when we push on to the back of our spine.  Just in front of that, or below from the perspective of the drawing, is the spinal cord, it is the red circle which runs from north to south in your body.  The spinal nerves exit to the spinal intervertebral disc, it is represented here by the horizontal red line, and that’s where the trouble can start if we have a disc herniation.

"disc bulge"

Figure 3

The black fibrous-looking material surrounding the blue circle is the disc itself. The blue circle is representing a mucoprotein jelly, called the nucleus pulpous, and is designed to further the ability of that disc to absorb shock.  What often occurs is that disc itself, the fibrocartilaginous material, can weaken and start to bulge backward toward or even into the nerve root area. That’s called your disc bulge (see Figure 3).

The disc bulge is present in about 30% of the population. Studies have been done which have taken 100 people who have no back pain at all and had them scanned by MRI machines. The results showed that 30% of the people studied who reported no pain or symptoms actually had large disc bulges or disc herniations in their spine.

If you do have sciatica or a disc herniation, the difference between them and you right now is simply inflammation and that inflammation is what is driving your pain. The bulge in the disc can exist for quite a long time causing some low grade back pain that comes and goes, gets better, gets worse. Each time it will come back a little sooner and a little worse. This is classic for the development of a disc problem in your spine.

"Disc Herniation"

Figure 4

What can eventually happen, if that goes on long enough, if that inflammation we spoke of continues beyond a certain point, is that you will start to get some radial tearing in the disc material or the fibro cartilage itself. The nuclear matter starts to bulge outward and that is when we start to consider it a disc herniation (see Figure 4).

In some instances what will happen is the outer material of the disc itself will actually tear through and rupture and that jelly can leak outward or even pieces of the disc itself can break off and then start to transit up and down the spine cord area floating around and causing all kinds of trouble. That is called a disc rupture.  So we have three terms: the initial bulging, the herniation, and finally the rupture of the material.

How do you know if you are suffering from something that’s related to nerves, muscles, or discs? If you have a disc problem, you are probably going to have a sharp, linear or line-like pain that radiates down the back of the leg into the calf or down the arm into the hand area, or even into the shoulder blade area.  Again, it’s probably pain that’s come and gone for a long time. The longer the pain is there, the worst it gets, and it continues to become an issue a little sooner each time.

The bottom line when you get into this situation is that the disc is inflamed. You may feel like it’s a muscle problem, which is normal because the muscles actually contract and splint to protect the body. The muscles may actually pull you into antalgic postures where you will be pulled to one side or the other.

One of the things you need to understand is that just because you are stiff, immobile, and have a muscle spasm; it does not necessarily mean that this is a muscle problem. The muscle spasm may be the result of the disc herniation itself, and this is your body’s attempt to protect you from it.

Without treatment, these conditions often progress and worsen. You may experience progressive pain, progressive neurological deficit, or you may lose motor control. Ultimately, you may end up requiring spinal surgery of the neck or lower back.

At Wake Forest Chiropractic, we have three goals when you visit our office to seek treatment of these conditions.

  1. Pain relief
    1. We will work to make you comfortable and functional so that you can continue with the normal activities of your life.
  2. Restore the function of the spine
    1. Restoring the function of the spine will allow you to move so that the structures are not creating pressure on the nerves.
  3. Strengthen the spine and the musculature
    1. Strengthening the spine and the musculature will help to make sure that you don’t end up with a chronic situation and have to experience the condition and treatment over and over.

Once the inflammation and swelling has been reduced, you can function with a disc bulge or a disc herniation in the spine because the disc is no longer impacting the spinal nerve. And the good news about getting older is that the discs will tend to dehydrate and toughen up as you age. Therefore, even if you’ve had a disc herniation, come close to surgery, or have had to undergo care for this condition, it does not necessarily mean that you a “bad back” or that you will eventually have to have surgery.  What it means is that you need to get the discs to a point where the inflammation is under control and they can toughen up naturally as the years go on, and then you should be able to manage your activities without fear of further injury.

If you would like further information on disc conditions and sciatica, please go to our website, http://wakeforestchiropractic.com. To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

February 23, 2010
© copyright 2010 Wake Forest Chiropractic. All rights reserved.

Back Pain

Back pain, particularly low back pain is the most common musculoskeletal condition for which patients present to their doctors.  It can be caused by mechanical or non-mechanical conditions and comes in two forms: complicated and uncomplicated.  Mechanical back pain is associated with joints, connective tissue, nerves and discs. Non-mechanical back pain can be associated with visceral disease, tumors, cancer and infection.  Complicated back pain includes sciatica which is leg pain that can be accompanied with numbness and weakness.  This is usually associated with a disc herniation.  Uncomplicated low back pain does not include sciatica and is usually related to joint, muscle or tendon inflammation.  Although, it can be cause by an inflamed disc that has not yet herniated.

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Back and Neck Pain, Causes and Solutions

What is Causing that Back or Neck Pain

Learn more: Watch the video or read the article below

There really are two types of pain that we will experience when we feel back or neck pain. The first is mechanical pain, and the second is non-mechanical pain. You can see a breakdown of the causes of each in the following lists:

Potential Causes of Non-Mechanical Back or Neck Pain:

  • Infection

  • Tumor

  • Cancer

  • Other Diseases

Potential Causes of Mechanical Back or Neck Pain:

  • Joints

Dr. Phelan describes jointsA joint is the point of contact between elements of an animal skeleton whether movable or rigidly fixed together with the surrounding and supporting parts (as membranes, tendons, or ligaments).

  • Ligaments

Dr. Phelan describes ligamentsLigaments are a tough band of tissue that serves to connect the articular extremities of bones or to support or retain an organ in place

  • Nerves

Dr. Phelan describes nerves

Nerves are any of the filamentous bands of nervous tissue that connect parts of the nervous system with the other organs.

  • Discs

Dr. Phelan describes discs in thespine

A disc is any of the tough elastic discs that are interposed adjoining vertebrae and that consist of an outer fibrous ring enclosing an inner pulpy nucleus.

  • Muscle

Dr. Phelan describes muscles
A muscle is a body tissue consisting of long cells that contract when stimulated and produce motion.

  • Tendon

Dr. Phelan describes tendonsA tendon is a tough cord or band of dense white fibrous connective tissue that unites a muscle with some other part (as a bone) and transmits the force which the muscle exerts.

  • Bursa

Dr. Phelan describes what a bursa is

The bursa is a small, thin, watery sac between a tendon and a bone.

When going to see a provider of any kind, whether it’s a medical doctor or a chiropractor, the first thing that we have to do is determine what type of pain you are experiencing. Once we’ve safely eliminated the non-mechanical pain category as a source of your pain, we can start to focus on the origin of the pain itself. We will check the potential sources for your pain, which may be caused by one or more of these sources. All of these sources are capable of producing pain, either by themselves or in concert with any of the others.

Your top priority should be to receive an accurate diagnosis. Dr. Phelan is an outstanding diagnostician, and he will provide you with the most conservative plan possible to help you to heal as quickly as possible. When treatment plans require services outside of spinal manipulation, physiotherapy, exercise, ergonomic lifestyle changes, or massage, then Dr. Phelan will provide you with a referral to another highly qualified physician.

If you’re interested in speaking with us about back or neck pain, please go to our website, http://www.wakeforestchiropractic.com.  If you would like to make an appointment, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.

Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587

November 14, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Images are courtesy of the US Library of Medicine and the US National Institutes of Health