With the exception of the first 2 vertebrae in the neck—the atlas (C1) and the axis (C2)—there is an intervertebral disc between each vertebra of the spine. Discs act as a shock absorber and a shock distributor, and provide flexibility.
Imagine if you jump up and down. What would happen to the stack of bony vertebrae that make up the spine without the cushioning and support of these discs?
Now, move your back from side to side. Again, you can visualize the give and take of the discs between the vertebrae. Without these discs, your spine couldn't function.
Intervertebral discs don't really "slip"—although the phrase "slipped disc" has come into popular usage to refer to bulging, ruptured, or herniated discs. Throughout this article, we'll refer to herniated discs, which is the more correct term.
Your discs are made up of the annulus fibrosus (the tough outer layer) and the nucleus pulposus (which contains a soft, gelatin-like center). When cracks occur in the outer layer of the disc, the material inside of the disc can begin to push out.
Numerous factors can cause a disc to herniate.
For example, there may be too much stress on the disc due to poor posture or from being overweight. In fact, a herniated disc can be caused by a combination of factors or a physical injury.
For many people with back pain caused by a back pain condition (ie, herniated disc), the problem starts off small and then gradually builds until you start to feel symptoms, such as back pain. In the picture to the right we see the various stages of disc degeneration.
For example, let's say you sneeze and feel a sudden, sharp pain in your back. Then that pain progresses into leg pain or sciatica. You may have had an underlying herniated disc, and the sneeze was what triggered it to progress. So, yes: a sneeze (or a cough) can herniate an intervertebral disc.
A chiropractor can help address back pain and other herniated disc symptoms. At your initial appointment, your chiropractor will go through your medical history, do a physical exam, and perform orthopaedic and neurological tests.
Your chiropractor will look for several things. These are important questions the orthopaedic and neurological exams can help your chiropractor answer.
- Are the reflexes intact? That is: are your nerves sending messages correctly? (The classic reflex test is when the doctor taps your knee with a small hammer and your leg kicks up.)
- Is there loss of muscle strength or signs of muscle wasting?
- Is there loss of sensation along the path of a nerve?
The chiropractor will also carefully look at your posture, and he or she may order an X-ray or MRI, if necessary, to help with the diagnostic process.
Even if you only have lower back pain, your chiropractor will examine your neck, too, for example. He or she wants to see how well your spine is functioning overall, and remember: What happens in one area of your spine can influence other parts of your spine and/or body.
After reviewing this information, your chiropractor can determine if you have an intervertebral disc injury. The type of disc injury you have will determine what treatments your chiropractor will use to address your symptoms.
Some patients are not good candidates for some types of chiropractic care treatments. For example, if you have cauda equina syndrome (a condition in which you lose control of your bowel/bladder with an accompanying intervertebral disc injury), then you will need immediate medical care as this is something that cannot be treated by your chiropractor.
In addition, if your chiropractor finds that you have advanced loss of strength, sensation, reflexes, and other unusual neurological findings, then he or she will refer you to a spine surgeon.
However, most intervertebral disc injuries are related to a herniated disc, and your chiropractor can provide you with various treatment options to address your pain and other symptoms.
To treat a herniated disc, your chiropractor will develop a treatment plan that may include spinal manipulation—also known as adjustments—and other chiropractic techniques to help ease your herniated disc symptoms. This will be an individualized treatment plan, but it may include manual therapy and therapeutic exercises.