Types of Disc Injuries

by Long Van, D.C.

There are several types of disc injuries, including degenerative disc disease, thinning disc, disc bulging, and disc herniation, which includes protrusion and extrusion. We shall explain the differences among these types of disc injuries later.

But first, what is a disc?

The Disc

“Disc” is short for the 23 intervertebral discs separating the 33 vertebrae of the spine. The vertebrae is a series of small bones forming the spine or backbone. These discs exist to absorb shock, keep the vertebral column stable, and “give the vertebrae ‘pivot points’ to allow movement.” 1

A disc has two parts: the elastic outer shell or rings of cartilage called annulus fibrosis, and jelly-like contents called nucleus pulposis. Imagine a doughnut with jelly in the hole. A healthy disc can handle a lot of stress, but some types of pressure can damage the shell and push out its contents.

Symptoms of Disc Problems

The symptoms can differ depending on the location and seriousness of a broken disc. Many patients who have positively scanned for damaged discs have demonstrated no symptoms.  That implies that there are usually no symptoms whatsoever. General indications could, however, include:

      • Back pain
      • Pain spreading down the legs
      • Pain worsening when bending over or sitting down for a long time
      • Pain worsening when coughing or sneezing
      • Numbness or pins-and-needles in the arm or leg

Different Types Disc Injuries

The Disc Injuries

Degenerative Joint Disease

Causes. Children’s discs are robust and moist but the water content in the discs, which stores oxygen and nutrients, decreases with time, lending to thinner and harder discs as people age. This wear and tear on the spine brought about by aging causes degenerative joint disease.

Symptoms. The symptoms range from none at all to pain so severe the individual is unable to perform any kind of activity. The most common early sign is pain and weakness in the back radiating to other areas such as the buttocks and upper thighs. There may be tingling and/or numbness in the legs or feet. There may be flareups of intense pain. And pain can worsen with sitting, bending, lifting, or twisting.

Degenerative joint disease can lead to osteoarthritis.

Bone spurs. Because the discs separate the vertebrae bones from each other, when these discs thin through time, friction between the bones increase, leading to growths called bone spurs around the discs.

Bone spurs or osteophytes are projections along the edges of the bone. They grow where bones meet each other—in the joints and in the vertebrae or bones of the spine. On the knee, bone spurs cause pain the knee when extending or bending. On the spine, bone spurs can press on the spinal cord or its nerve roots, causing weakness or numbness in the arms or legs. On the hip, bone spurs can cause pain while moving the hip reducing the range of the hip’s motion.  

Thinning Disc

Causes. As with the other disc injuries, thinning disc is associated with the natural process of aging. With the passage of time, intervertebral discs become smaller and less flexible as their fluid content start to dry up, and the outer shell weaken and turn brittle. Less fluid and a weak outer shell result in pressure from the vertebrae above and below the disc, potentially leading to a bulging disc, herniated disc, or degenerative discs.

Symptoms. Thinning discs do not exhibit serious symptoms, but because it can lead to more serious disc diseases such as bulging and herniated discs, when this happens the individual may experience symptoms associated with these injuries. Complaints characteristic of thinning disc and related ailments include localized pain in the back or neck, muscle weakness, tingling pain, and numbness in legs, and radiating nerve pain.

Disc Herniation

Disc herniation occurs when a disc’s outer shell weakens or cracks. A weak or cracked disc wall allows the jelly-like material or nucleus pulposis to leak out into the spinal canal. This displaced material usually involves 25% or less of the disc circumference. Herniated discs are more likely to cause back or leg pain as they can compress nerves leading to nerve pain, numbness or muscle weakness, or generate a strong inflammatory reaction.

Causes. Studies have shown that some people are biologically more prone to disc herniations. However, trauma to our bodies caused by heavy lifting, twisting, car accidents, or sports mishaps often cause disc herniations. An accumulation of small injuries over many years can also result in disc herniation.

Categories: Disc herniation has two categories: protrusion and extrusion.

Protrusion

In a protrusion, the leaked-out jelly-like material possesses a sizable connection to the disc space, making it look more like a “bump”.

Extrusion

With an extrusion, the jelly-like material flows out of the disc creating what looks like a pouch or an outpouching, with a narrow stalk linking the pouch to its main body.

Bulging Disc

A bulging disc is when the disc is compressed evenly and bulges out on all sides. With bulging discs, there’s no significant damage to either the outer shell or the jelly-like material.

Causes. Like degenerative disc disease and disc dessication, bulging discs can be attributed to aging although they come with different levels of severity. The loss of water content in the jelly-like material due to aging makes the discs stiffer, flatter, and more damage prone.

Apart from aging, individuals with a family history of spinal disc problems may inherit this disc injury. And any kind of minor or major stress, trauma or injury to the body can cause a bulging disc, to include:

      • Repetitive lifting, bending, driving, and standing
      • Improper lifting techniques
      • Contact sports or similarly stressful athletic activities
      • Car accidents or similar severe trauma
      • Excessive drinking or smoking
      • Poor posture

As pointed out earlier, disc problems hardly have any specific symptoms or have little or no symptoms at all. If there are any, individuals will experience some kind of pain, muscle weakness, or numbness in the area of the bulge. Men are more likely to have bulging discs.

Treatment

Treatment of disc injuries vary, of course, according to the specific disease. After a consultation and proper diagnosis with your doctors, they may refer you to any of the treatments below.  These treatments may be used individually, or in combination.

Physical Therapy

This includes exercises, stretches, and other strategies that strengthen core muscles to help take the pressure off your back, relieve pain, improve posture, improve range of motion, and avoid movements or positions that may trigger symptoms.

Back Braces

Medication

Medication, like all of the other treatment options are there to relieve the person from pain and other symptoms of disc injuries. This includes nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve).

Chiropractic

Chiropractic treatment focuses on improving spinal motion and reducing inflammation; and if you do not have advanced disc degeneration, it can focus on improving the function of the discs. To achieve these, chiropractors may use the various techniques in spinal manipulation, various manual therapies such as therapeutic massage and trigger point therapy, laser therapy, ultrasound, interferential electrical stimulation, among others.

Diet

As with any disease, diet is important in a complete treatment. If a person is overweight, diet is even more important in their daily treatment regimen.  An overweight body puts more stress on the spine than is normal, and will worsen the disc injury. Drinking plenty of water will certainly help hydrate the discs. Food with high calcium content prevents loss of bone mass and thus supports spine health. Vitamin C food helps develop collagen that in turn helps cells regenerate tissues during the healing process. Iron foods strengthen oxygen intake and helps produce myoglobin that keep muscles in good condition as they provide spine support. Vitamin A boosts the immune system and helps the body repair damaged tissues and form bones.

Injections

Injections serve to alleviate pain.  Where over-the-counter medication fails or is insufficient, steroid injections may be administered to help reduce pain and inflammation.

Surgery

As a last resort, corrective surgery may be recommended to patients who do not respond to conservative and/or natural treatment options.

There are other treatment options out there, including the relatively new Stem Cell Therapy method that aims to regenerate functional cartilage. But whichever treatment path one wants to take, it is important to:

      1. Be diagnosed by a doctor;
      2. Try natural and/or conservative treatment first, especially if the injury is not severe;
      3. Be well informed about all the treatment options;
      4. In other words, see a doctor.

References:
“Back Pain—Disc Problems” Better Health Channel; last accessed 5/24/2019
“Fragmented Disc Treatment: The Non-Invasive Method in Malaysia,” Chiropractic Specialty Center; last accessed 5/24/2019
“Bone Spurs,” Mayo Clinic; last accessed 5/24/2019
“Bulging Disc,” Braceability; last accessed 5/24/2019
“Bad Posture,” Braceability; last accessed 5/24/2019
What is the difference between a disc bulge and a herniation? By George Rappard, MD and Anand JoshiMD, MHA, Know Your Back; last accessed 5/24/2019
“Understanding Disc Dessication,” Healthline; last accessed 5/24/2019
“How can disc dessication be treated?” By Nicole Galan, Reviewed by William Morrison, MD, Medical News Today; last accessed 5/24/2019
“Chiropractic Care for Degenerative Disc Disease,” by Ron Grassi, DC MS ACFEI; last accessed 5/24/2019
“Eat Your Way Away From Degenerative Disc Disease,” North American Spine; last accessed 5/24/2019

Related Articles:
Understanding Intervertebral Disc Disorders by Kristy Donnelly, D.C.
Is Chiropractic Care Safe for Cervical and Lumbar Disc Herniation? by Kristy Donnelly, D.C.

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Dr. Long Van
Long Van, D.C. joined the team at Absolute Injury and Pain Physicians in 2008. He has experience in helping the human body function properly through the natural approach, and enjoys reading up on new information concerning medical conditions and associated treatments available.
Dr. Long Van

Author: Dr. Long Van

Long Van, D.C. joined the team at Absolute Injury and Pain Physicians in 2008. He has experience in helping the human body function properly through the natural approach, and enjoys reading up on new information concerning medical conditions and associated treatments available.

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