It’s probably safe to say that most people have at least heard of a herniated disc. This term is often used colloquially to explain lasting back or neck pain, but most people don’t understand what the condition actually is, what caused it, and what treatment options are currently available. However, if you or someone you love has recently been diagnosed with the condition, it can be extremely helpful to gather a little information, learn about the condition, and plan for the future.
While at first, it may be a little confusing, if not overwhelming, to learn that you have a herniated disc, in many instances, this can actually be welcome news. When someone visits their doctor because they are experiencing chronic back or neck pain, they are obviously looking for answers. And while no one wants to learn that they have a degenerative spine condition, such as a herniated disc, learning the cause of the problem is the first step toward finding lasting pain relief. The trick lies in expectation management. Ultimately, it is up to you how to process your new diagnosis. With the right attitude, a positive approach, and a little hard work, overcoming your symptoms is not only possible, but it can usually be expected. This condition is extremely common, there are a surprisingly large number of treatment options available, and oftentimes, living with chronic pain does not have to be a way of life.
The Anatomy of a Herniated Disc
Before we begin to talk about what causes a herniated disc and how it is treated, it can be helpful to have a brief overview of the anatomy of the spine and the role that the intervertebral discs play in regular, daily movement. In many ways, it’s easy to lose sight of how much we really rely on the spinal column. Even the subtlest of movements require a countless number of anatomical elements to work in unison, where the failure of just one aspect can have a snowball effect and cause significant problems throughout the body.
Let’s start by taking a look at what an intervertebral disc actually is.
In the back and the neck, adjacent vertebrae that make up the spinal column are cushioned and separated by thick, spongy pads that act – more or less – like shock absorbers for the spine. Without these discs, the vertebral bones would grind together painfully, all the pressure on the spinal column would be placed on the bones themselves, and to be frank, walking upright would not be possible.
In order to be both extremely flexible and highly resilient, each disc has two main components:
· Annulus fibrosus – The annulus fibrosus is the outer shell or wall of the disc. Made mostly of fibrous material and cartilage, the annulus fibrosus gives the disc its shape and is built to withstand an unbelievable amount of pressure. Anytime you jump, walk, run, or stand up, pressure is placed on the discs, and it is because of the annulus fibrosus that the disc can withstand the pressure and return to its original shape.
· Nucleus pulposus – Encased within the annulus fibrosus is an inner gel-like material that is known as the nucleus pulposus. This nuclear material is made mostly of water and collagen and is responsible for giving the disc its flexible property and height. When pressure is placed on the disc, the nucleus pulposus can shift within the disc to better distribute the weight.
To put it another way, an intervertebral disc is similar to a bean bag chair. When someone sits on one of these chairs, the pellets in the bag shift to absorb the weight of the person, ensuring too much pressure isn’t placed on any one part of the bag. A similar effect holds true with an intervertebral disc, except when the source of the pressure is removed, the disc returns to its original shape.
The Role of Nerve Compression and the Difference Between a Herniated and Bulging Disc
A herniated intervertebral disc occurs when a tear develops in the annulus fibrosus, which allows the nucleus pulposus to seep into the spinal column. While this may sound like a devastating problem, merely having a herniated disc isn’t actually as dire as you may think. In fact, most of us will experience a herniated disc at some point in our lives and won’t even know it. The difference between having a herniated disc and experiencing the chronic symptoms that we normally associate with this condition lies with nerve compression – or the irritation, impingement, or compression of a spinal nerve.
It probably goes without saying that the spine is one of the most highly innervated, crowded areas in the body. In addition to the spinal cord, countless nerve roots and spinal nerves are tightly packed into this relatively small area. When herniated disc material extrudes into the spinal canal, it can come in contact with one of these nerves. It is this nerve irritation that causes the symptoms of a herniated disc, which we’ll discuss in detail later.
First, it’s important to make a distinction between a herniated and bulging disc. These two conditions, while often used interchangeably, are in reality quite different. Where a herniated disc is marked by the rupturing of the disc wall, a bulging disc, on the other hand, remains structurally intact. This condition can develop either as a result of excessive pressure on the disc, which causes the disc wall to extrude beyond its normal boundary between the vertebrae, or because the disc wall has weakened. When the disc wall becomes thinned, inner pressure from the nucleus pulposus can also cause the disc wall to bulge.
It is important to make a distinction between these two conditions because, while they may cause similar symptoms, they will require different treatment regimens, can have different causes, and may have different outcomes depending on the patient.
Now that we have a basic understanding of what exactly an intervertebral disc is and what happens when the disc ruptures, it will be helpful to take a look at the various causes and risk factors that may make a person more susceptible to developing the problem.
Causes, Risk Factors, and Degenerative Disc Disease
Perhaps the most interesting part about herniated discs is that one of the leading causes of this condition is nothing more than the natural aging process and the onset of a condition known as degenerative disc disease.
As we grow older, the spinal anatomy gradually begins to deteriorate. This phenomenon is entirely normal and explains the loss of flexibility and minor aches and pains that most of us accept as part of the aging process. Over the years, wear and tear from regular use tends to take its toll on the intervertebral discs, which can eventually cause them to become worn, bulged, or even herniated. Some degree of this degeneration is unavoidable and to be expected, but should disc deterioration become severe, the patient is said to have degenerative disc disease and medical attention will typically be warranted. The differentiation between normal disc degeneration and even a single herniated disc from the onset of degenerative disc disease is important because the latter is normally a result of wholesale degeneration of one more of the intervertebral discs and will not typically heal or get better on its own.
That said, growing older isn’t the only cause of herniated discs. In fact, while people who have reached middle age are more prone to developing disc problems, there are a number of factors that can greatly increase the likelihood of an individual developing the issue much earlier in life than what might normally be expected. Generally speaking, doctors agree that any activity or factor that increases the burden on the spine greatly exacerbates the risk for that person developing a herniated disc or other degenerative spine condition at some point in their life.
A few examples of notable risk factors and activities that may accelerate the onset of herniated discs include:
· Trauma to the intervertebral discs – An individual who has recently been in a car accident and suffered whiplash, for example, may develop disc problems as a result of the jarring effect that the accident had on the anatomical components of the spine. In reality, anything from a gunshot wound to a short fall can cause disc problems. What’s more, even if the accident doesn’t immediately lead to a disc rupture, it may leave the disc weakened and more prone to rupturing down the road, long after the injury has seemingly healed.
· Repetitive mechanical movements – As in the case of a traumatic injury, repetitive mechanical movements can also eventually lead to disc problems, which is one reason that athletes who participate in high-impact sports or those with physically demanding occupations are far more at risk for disc problems than an average person. Once again, this stands to reason. The toll of participating in activities that require constant bending, twisting, heavy contact, and other uncomfortable and borderline unnatural movements, such as football, hockey, gymnastics, or any of a variety of jobs, can lead to stress fractures in the vertebrae and/or damage to the intervertebral discs.
· Obesity – While most of us understand that being overweight is a significant health concern that can lead to an increased occurrence of heart and lung problems, the damage that excess body weight can have on the lower back is also a noteworthy problem. The spinal column is a carefully calibrated part of the body that is equipped to support the weight of the body in a healthy individual. However, when this region is tasked with also bearing the burden of additional fat, pressure increases on the disc, basic movements become more labored, and degeneration will naturally accelerate.
· Living a sedentary lifestyle – Even if the individual is not overweight, being inactive is a risk factor because the muscles and ligaments that support the back and neck also bear much of the burden that is placed on the region. When an individual is sedentary, this musculature has a tendency to weaken and eventually atrophy, which causes additional strain to be transferred to the spinal column and intervertebral discs.
· Other notable factors – Having poor posture is another notable risk factor for herniated discs because years of improper spinal alignment while walking, sitting, or lying down can take its toll on the discs. Alcohol abuse, nicotine addiction, and other environmental factors are also common accelerants of disc degeneration.
One caveat to identifying the risk factors for a herniated disc, however, is that this is an inexact science. One of the mysteries of disc deterioration is that some people will develop the condition despite their best efforts to ensure the health of their spine, while others will remain oblivious to the potential risks, live a lifestyle that should accelerate the deterioration of the spine, and still never feel any ill effects. It may seem unfair, but it is an unfortunate part of aging.
All of that said, what exactly can a person suffering from a herniated disc expect?
Symptoms and the Location of a Herniated Disc
Without a doubt, chronic pain located near the site of the disc degeneration is the most frequently experienced symptom of a herniated disc. This pain can vary in intensity from patient to patient but it is usually dull, throbbing, and persistent in nature. This is called chronic pain and if left untended it can last for weeks or months with little relief. Additionally, when extruded disc material impacts a spinal nerve, a variety of other symptoms can develop. Some of the most common symptoms of nerve compression – which are known collectively as radiculopathy – include:
· Muscle weakness
· Numbness and tingling in the extremities
· The sensation of heat or pins-and-needles
· Diminished reflexes or neuropathic response
· Traveling or radiating pain
The single most important variable in determining the symptoms that an individual may experience as a result of a herniated disc is the exact location of the disc degeneration. Nerve compression caused by a herniated disc in the cervical spine, for example, may cause symptoms in the neck, shoulders, arms, hands, fingertips, and throughout the upper body, while the same condition in the lower back can lead to similar symptoms in the buttocks, hips, thighs, legs, calves, feet, toes, and throughout the lower body.
Diagnosing the symptoms of a herniated disc isn’t always easy, though, and this is especially true when the condition results in the compression of a nerve. The brain sends and receives a variety of motor and sensory signals throughout the body by way of the spinal cord and the complex infrastructure of nerves that branch off of it. When the regular function of one of these nerves is interfered with, the muscles innervated by that particular nerve may be affected, causing symptoms to develop in parts of the body that seem unrelated to the origin of the problem.
Consider the sciatic nerve, for example. This nerve is the longest and widest in the body and originates in the lumbar spine before traveling through the buttocks, legs, and calves, eventually culminating near the toes. When a herniated disc compresses this nerve in the spinal canal, the most common symptom is chronic leg pain (usually contained in just one leg). The problem is that many people experience this leg problem and then focus on managing the symptom (the leg pain) while remaining unaware of the actual cause of their discomfort (the sciatic nerve compression).
The important thing to understand about the symptoms of a herniated disc is that they can ostensibly originate at any level of the spine but they are without question most normally experienced in the lumbar and cervical regions. This makes sense because these two segments of the spine are both extremely flexible and under significant and constant weight burden. The cervical spine, for example, is made of the seven smallest vertebrae in the spinal column and must provide the mobility we expect from our neck while supporting the weight of our skulls. Similarly, the vertebrae in the lumbar spine may be the largest in the spinal column but also must support the majority of the body’s weight and allow for the bending, twisting, extending, and flexing that we require from the lower back. This is why lower back and neck pain are so prevalent and why herniated discs are far more likely to develop in these areas of the spine than any other.
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