The disk is the cartilage pad between each vertebra. There are 24 vertebrae in the spine: seven neck vertebra (cervical), twelve mid-back vertebra (thoracic) and five low-back vertebra (lumbar). A disk herniation (“protrusion,” “prolapse,” “slipped disk”) occurs when a tear within the disk allows the soft inner portion (nucleus pulposus) to squeeze beyond the margin of the disk and compress or inflame the adjacent spinal nerve. This almost always results in leg pain (sciatica) if the herniation is in the lower back or shoulder and arm pain (“pinched nerve”) if the herniation is in the neck.
Most disk herniations in the lower back involve the bottom two disks: L4-5 and L5-S1. Nerve compression may result in pain, tingling or numbness that extends from the buttock down the back of the thigh and possibly into the foot. There may be weakness of the leg or loss of the ankle reflex. Pain may be constant and made worse by sitting, forward bending, coughing or sneezing. Cervical (neck) disk herniations usually involve the lower neck (C5-6 or C6-7). Pain or numbness may extend to the shoulder blade or down the arm to the hand. There may be weakness in the arm or hand and you may feel there is a “toothache” in the side of your neck or shoulder. You may feel some relief by elevating your arm or putting your hand on your head.
An MRI (magnetic resonance imaging) study can confirm the presence of a disk herniation. However, it must be understood that an individual may have a disk herniation without symptoms and back pain may be due to other causes. Several studies have shown a surprisingly high percentage of the general population walking around with disk herniations and no symptoms directly related to the herniation. Therefore a symptomatic disk herniation can only be diagnosed by carefully correlating the symptoms, physical examination findings, and the MRI study. Otherwise a person with a painless disk herniation may have their symptoms incorrectly ascribed to the disk when their pain is due to other causes.
The majority of disk herniation sufferers do not require surgery and can be treated with conservative chiropractic care. Treatment may involve the use of a lumbar support brace, trigger point therapy for pain control, low force chiropractic adjustments and a graduated exercise program. We have been able to help approximately 75%-80% of our patients with acute disk herniations recover without surgery.