Intervertebral discs are fibrocartilage structures that lay between vertebrae to act as cushions. They’re composed of an outer layer of tough cartilage that surrounds softer cartilage in the center. Over time, the disc will experience wear and tear, becoming stiff and dehydrated. These changes can cause the outer layer of the disc to either bulge out evenly all the way around, or unevenly around its circumference. A disc herniation is the result of a crack in the outer layer of the cartilage, allowing some of the inner cartilage (nucleus pulposus) to protrude out of the disc (also known as a slipped disc). The protrusion of the disc can cause irritation of the neighboring nerve root, causing pain that can remain in the low back, or travel down the track of the nerve root resulting in sciatica. Symptoms of disc herniation and bulging are often sharp and burning, occasionally traveling down the leg into the feet. Disc bulging pain is more often localized to the low back, where herniation can travel down the leg. Unlike a disc herniation, a disc bulge isn’t as likely to cause low back pain or neck pain. However, the presence of a disc bulge does not always guarantee low back pain; whereas, a disc herniation which is much more likely. In severe cases, disc herniation can cause neurological symptoms such as: change in sensation in the arms or legs, weakness, and muscle wasting. Common causes of disc bulge or herniation are gradual degeneration of the disk or from an injury like a slip and fall or a car accident. Repetitive twisting and turning activities may lead to disk degeneration, and poor posture while lifting can cause disk damage. While disc bulges and herniations are often seen on magnetic resonance imaging (MRI), determining their clinical relevance is done through a thorough history and examination. One treatment option for patients with diagnosed disc herniation or disc bulge is chiropractic manipulative therapy. Research has shown that “A large percentage of acute and importantly chronic lumbar disc herniation patients treated with chiropractic spinal manipulation reported clinically relevant improvement”1. Following ruling out contraindications through a thorough history and examination, chiropractic manipulative therapy, deep-tissue laser therapy, non-invasive spinal traction/decompression therapy, trigger point release, instrument assisted soft tissue mobilization, myofascial therapy, therapeutic exercises, cupping therapy, or any combination of these modalities.
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