Disc Herniations & Bulges
Between each vertebra in your spine lies a disc that acts as a shock absorber and allows for movement to take place. The outer portion of the disc is made of collagen, known as the annulus fibrosus, and the inner layer is a viscous fluid, known as the nucleus pulposus. As a disc degenerates one loses the water component as the nucleus dries up. Disc degeneration is a progressive process with disabling potential due to pain. Age, mechanical pressures, genetics, inflammatory and biochemical changes can all act as triggering events in this condition. With nutritional compromise, repetitive loading or natural aging the disc loses its natural matrix turnover balance and more matrix degradation and less matrix rebuilding takes place. Often times, inflammation creates irreversible biophysical changes (even after the stimulus is removed) and spontaneous recovery may not occur.
Disc degeneration can lead to herniations, where the components of the nucleus pulposus comes in contact with the vascular system of the epidural space. Substances within the nucleus as well as the resultant inflammatory components can irritate nearby nerves and create substantial pain that may radiate into one’s legs. Before this stage, one may experience local back pain with the tearing of the outer annulus.
Fortunately, this process is often self resolving within 6-8 weeks, but aggressive chiropractic treatment is suggested so that this does not progress into a chronic stage.
The problem with nerve compression is the inflammation and restricting blood flow to the nerve. Also, large herniated fragments resolve better than smaller ones.
There is a good prognosis with nonoperative care with larger extrusions or sequestrations and in those who experience a 50% reduction of leg pain within the first 6 weeks.