Your Guide To Slipped Discs, Disc Herniations, Disc Bulges, Disc Protrusions and Disc Extrusions
Do you have a disc bulge that is causing you incredible pain in your lower back?
Does your disc bulge give you sciatica or pain down your leg?
Have you wondered what’s going on in your lower back to cause all this pain?
In this issue of Bodi Empowerment I go over what’s going on with your disc bulge, the cause of your pain and what kind of treatments are best for you. In other words I act as guide to help you decide what to do.
Disc herniations, or disc bulge occur when the disc that is found between vertebrae in the spine is damaged. Most of the time the damage occurs in stages.
Here are the four stages of a disc herniation or disc bulge:
- Disc Bulge
- Disc Prolapse
- Disc Extrusion
- Disc Sequestration
Think of the disc like a flat hard onion with strawberry jelly inside. The jelly is the nucleus while the onion layers form circular layers of hard cartilage called the annulus.
If you were to damage the annulus (onion) enough the disc gets to a point that when you bend forward, you pinch the front of the onion so it starts to bulge the onion at the back by pushing the nucleus (jelly) backwards.
This is called a disc bulge. For most of you there is no pain but for some of you there can be considerable lower back pain and even sciatica from this small disc bulge.
A disc protrusion is like a disc bulge that comes out even more in one focused spot. The disc pushes out as if you had your finger inside a balloon and pushed out.
Most of the layers of the onion (annulus) have been damaged but the jelly (nucleus) is under considerable pressure. The jelly (nucleus) squeezes through the layers of the annulus (onion) with the few intact layers of the onion (annulus) and a the PLL (posterior longitudinal ligament) holding the jelly from spilling out. The disc is still contained by the annulus and PLL ligament. ie the balloon hasn’t popped.
Disc Protrusions usually cause quite a bit of lower back pain and often times sciatica. Many of you, with disc protrusions, on the other hand, have absolutely no pain. There is no clear reason. A study found that 40% people with no pain what so ever had disc protrusion confirmed by MRI (Magnetic Resonance Imaging Machine) 
The trick is not to let your doctor diagnose you based on just a MRI. An MRI that shows a disc protrusion by itself is not a diagnosis. It’s what a normal person with no pain can have. Make sure there is other evidence!
Disc Extrusion is a disc bulge so large that it breaks through the last layers of the onion (annulus) and the PLL ligament pushing into the area of the spinal cord. ie. The balloon has popped. If you have an extrusion you likely have a tremendous amount of pain leg pain and usually some lower back pain.
Surprisingly when a group of normal people with no pain were scanned with an MRI 18% were found to have disc extrusions (severe disc herniations). 
When you have a disc extrusion chances are the extrusion is likely causing your pain as it’s so large.
A disc sequestration occurs when a piece of your jelly (nucleus) that breaks through the onion (annulus) and the PLL ligament has now broken off and moved away further into the spinal cord area. When you have a disc sequestration you have a tremendous amount of leg pain and with some lower back pain.
Smaller Is Better
Disc Herniations or slipped discs are better if they are smaller, right? You will have less pain right? Yes except when they give you pain. Remember all those normal people with no pain with all kinds of slipped discs. They had disc bulges, disc protrusions, and disc extrusions and even disc sequestrations with no pain.
On the other hand, even with a small disc bulge you can get a lot pain and even sciatica with no pressure on the nerve. So smaller isn’t always better.
Bigger Is Better
Sometimes bigger is better. Most people like you with a disc extrusion and sequestration have lots of pain. The fact is these painful extrusions while more painful usually shrink with time. It takes about a year but with the shrinking of the herniations the pain does decrease.[2-5]
Disc Herniation (Slipped Disc) Treatments
#1 Stop Aggravating Yourself
Half the problem why people don’t get better is that they continually aggravate their lower back and their slipped disc. By learning to lift properly, sit properly and even standing over the sink while brushing your teeth properly can help you avoid the pain.
Even Yoga exercises such as the downward dog can aggravate the lower back, Pilates and even your basic abdominal crunch has been shown by Dr. Stuart McGill to increase the pressure in the disc beyond it’s safe limit.
If you want to find out how to stop aggravating your lower back, click the link below.
#2 Exercise For Disc Herniations / Slipped Discs
For a complete instructions on exercises for slipped disc click the link. Best Exercises For Your Slipped Disc
#3 Chiropractic Adjustments
A major research paper showed that people that have had lumbar disc herniations who have failed at least 3 months of medical management, including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture, should consider chiropractic spinal manipulative treatment, followed by surgery if unsuccessful. 
I would also add that I would try 3 different chiropractors as the competency level varies from person to person. Like any profession including medical doctors and physiotherapists there are the good ones and bad ones.
Acupuncture has been found to be helpful for Slipped Discs in the neck and the lower back.[7-8]
In a study of two different groups getting treatment for lumbar disc herniations, the group getting chiropractic manipulation had 76.5% of the people improve while the group getting the nerve root injections improved by 62.7%.
After a period of a month the chiropractic spinal manipulation group had a 60% reduction in pain compared to the nerve root injection group, which had a 53% decrease in pain. Keep in mind the nerve root injection group seemed to be worse to start with compared to the spinal manipulation group.
Epidural injections are also helpful for lower back pain and the radiating pain down your leg.
There are two types of surgery available for slipped discs. Discectomy and spinal fusion. Discectomy involves cutting out the piece of the disc that is protruding out and pushing on the spinal cord or nerve.
Disectomy is relatively simple compared to spinal fusion. You have a much better chance of success with discectomy if your MRI shows that your disc herniation is greater than 7 mm thick and correlates well with your neurological exam, and nerve conduction studies. If your lower back pain is greater than your leg pain discectomy will not likely work very well for you.
#2 Spinal Fusion
Spinal Fusion removes the disc herniation, jelly (nucleus), and most of the annulus (onion). Bone from pelvis is than transplanted where your disc was so that the two vertebrae become one.
What Treatment Should You Do?
You should do at least 3 months of therapy when you have a slipped disc before even considering surgery or injections. Start by not aggravating your lumbar disc. You need to modify how you bend forward, lift and even how to pick-up your socks.
If you have trouble sleeping at night you can take pain killers to help you get a better sleep. Don’t stay in bed though. When you have excruciating pain you should only have bed rest for a maximum of two days total.
Next try chiropractic or physiotherapy with someone that also does acupuncture. Make sure it’s not with somebody that knows how to do 20 acupuncture points. Be patient with them as disc herniations can be difficult to deal with.
Attend regularly 3 times a week for at least a month . Make sure they change the treatments to find what works best for you. If they keep doing the same thing each visit but you are improving that is fine, but if you aren’t improving than it’s time to find a new chiropractor.
If you don’t get any better after a month change to a different chiropractor. I recommend trying 3 different chiropractors as different chiropractors have different training.
If you plateued or haven’t improved at all than it’s time to get a nerve root injection or a epidural injection. Make sure it’s with a person that does this every day. An emergency room doctor or family physician only does this procedure once in while. It’s better to get someone more experienced.
When conservative care has been completely exahausted than it’s time to consider surgery. Discectomy is more conservative than spinal fusion and recovery is much quicker. You should consider disectomy surgery if you have :
- Foot drop that is getting worse.
- Any other neurological symptoms that is getting worse like your reflexes, sensitivity
- Bowel or Bladder Symptoms (loss of your poo and pee function). : This is an emergency you should go to the hospital right away.
- If you have a disc protrusion or that is 8 mm or larger that correlates well with a neurological exam, and Nerve conduction tests.
- Leg pain is worse than your lower back pain.
Beware of the surgeon that wants to operate on a small disc bulge. There are too many unnecessary surgeries in the USA especially spinal fusion.
Spinal fusion is considered when your lower back pain is worse than your leg pain
Tell us what you think in the comments below and like us on Facebook. This Toronto Downtown Chiropractor will answer all questions in the comments section.
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2. Maigne JY, Rime B, Delignet B. Computed tomographic follow-up of 48 cases of nonoperatively treated lumbar intervertebral disc herniation. Spine 1992; 17:1071-1074.
3. Ikeda T, et al. Pathomechanism of spontaneous regression of the herniated lumbar disc: histologic and immunohistochemical study. J Spinal Disord 1996;9:136-140.
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7. Wu, Yao-chi, Jun-feng Zhang, Yi-jun Sun, Cheng-fei Huang, Ping Shao, and Gui-zhen Liu. “Clinical study on electroacupuncture for cervical intervertebral disc herniation.” Journal of Acupuncture and Tuina Science 11, no. 6 (2013): 371-374. – See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1249-acupuncture-found-superior-to-drug-for-neck-disc-pain#sthash.vD0pNepM.dpuf
8. Wang HeshanNon-Surgical Therapy For Prolapse of Lumbar Intervertebral Disc. The Journal of Traditional Chinese Medicine
9. Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back pain and lower extremity pain: a systematic review. Pain Physician 2009;12:163-188.
10. Carragee EJ, et al “Clinical outcomes after lumbar discectomy for sciatica: The effects of fragment types and annular competence” J Bone Joint Surg Am – 2003; 85(1):102-108
11. McMorland G et al.Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative & Physiological Therapeutics 2010; 33: 576-584.
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