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You go to your family doctor with low back and leg pain and ask about seeing
a chiropractor. "Oh, no," says the doctor," they'll try to pop it back into
place which will not only be painful, but make matters much worse." Is this
true? What is the chiropractic approach to treating a slipped disc (sometimes written as slipped disk)?
Chiropractic is conservative care, which means it is non-surgical and drugless.
In treating low back slipped discs, most spine experts agree that conservative
care should be tried before surgery is considered, except in severe cases.
Chiropractic care has a long history of successfully providing conservative
care for disc conditions - and no, chiropractors don't try to "pop a disc back
in place".
What is a "slipped" disc?
The disc is a circle of cartilage between each vertebra in the spine that acts
as both a shock absorber and a shock distributor. If you jump up and down, imagine
what would happen to the stack of bony vertebra that make up the spine without
the cushioning of the discs. Move your back side to side. Again, you can visualize
the give and take of the discs between the vertebrae. Without discs, the spine
simply could not function.
Discs don't really "slip". Instead, they bulge, herniate, or rupture. Saying
a disc has "slipped" does suggest that something has "slipped out" and is not
where it's supposed to be, which is what happens in disc injuries.
Discs are made up of concentric circles or rings of fibrous material with a
tough gelatinous center. When cracks or fissures occur in the fibrous rings,
the gelatinous material in the center can begin to push out. A number of different
factors may cause the disc to "slip".
Figure 1. Spinal Anatomy
Does a sneeze cause a "slipped disc"?
The low back "slipped disc" is almost always the result of a process. As is
often the case with joint and back injuries, the problem starts small and then
builds until it becomes symptomatic. It's a little corny to talk about "the
straw that broke the camels back", but it gets the point across.
Figure 2. Disc Degeneration
For example, a patient sneezes and experiences sudden back pain that then proceeds
to leg pain. However, the sneeze didn't cause the disc to "slip," but represents
the final "straw" in a much longer process. Factors that precede the pain and
symptoms of disc injury include disc dehydration, unusual stress on the disc
secondary to disturbed mechanics, and too much load on the disc.
Discs depend on water to keep their height and perform efficiently. When we're
young, discs have their own circulation that helps keep them hydrated. As we
get older, this circulation ends and the spine must move so that water can be
drawn into the discs. If discs become dehydrated and lose their height, they
become more vulnerable to cracks and fissures.
Discs are integral parts of our body's mechanical system that allows us to
move. Chiropractors are especially interested in seeing how injuries in one
part of the body relate to the mechanical system of the body as a whole. Chiropractors
look at injuries specifically, but they also try to determine in what way an
injury is the outcome of disturbances elsewhere in the body.
The spine functions as a whole, so if we have mechanical disturbances in one
part of the spine, even as far away from the low back as the neck, it can influence
conditions in another area of the spine. Imbalances in the pelvis, problems
in the sacroiliac joints, low back facet fixations, as well as joint restrictions
in the midback and the neck, can contribute to the process of disc degeneration
and eventual injury.
Disturbed mechanics from lack of muscular support or muscular imbalance are
important because discs can come under more stress from weak abdominal muscles,
or too much weight around our abdomen. The resulting hyperextension can cause
a wedging of the discs.
The opposite condition, hyperflexion, is caused when we round our low back
because of weak back muscles or poor sitting habits. This causes stress on the
disc in the opposite direction. Finally, if we put too much load on the back
over a period of time, or occasionally in one dramatic episode, we can add another
significant factor.
A "slipped disc" most often occurs when a number of these and other factors
act together to cause disc injury. For example, a middle-aged accountant who
sits for long periods, suffers from disc dehydration, and has poor mechanics
from weak abdominals, then lifts a heavy piece of furniture and experiences
acute low back and leg pain. Or perhaps many months after lifting the piece
of furniture, he experiences no pain at all until he sneezes. Bingo. A slipped
disc.
To continue this article, click on Part 2 or Part 3.
Part 2: Chiropractic Treatment: Slipped Discs
Part 3: Chiropractic Care and Back Pain: Techniques
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