So now we know that a disc bulge is a normal variant associated with degenerative changes in the disc and that disc herniations are more painful and often caused by trauma. The symptoms for a bulge again can be minimal if any at all. Often when I send out for a MRI a disc bulge is present, but at an entirely different level than we are looking for. In other words the patient has right sided leg pain/sciatica and a disc bulge will be present at L2/L3 on the left side. This is known as being clinically insignificant and is not the cause of their current pain. A patient with a herniation will present with low back pain radiating into their glute and sometimes down the back of the leg and into their foot. If the disc herniation is in the cervical spine then neck and arm/hand pain would be present. They can also have numbness or tingling. The pain usually follows some sort of past trauma, and the symptoms are usually constant to a certain degree. Medications that have been tried usually include some sort of non steroidal anti inflammatory (nsaid) such as naproxen, ibuprofen, meloxicam or maybe a steroid such as prednisone. Most often muscle relaxers have been prescribed along with some sort of pain medication such as hydrocodone or even oxycodone. All of these can offer mild temporary relief, but the pain can flare up at a moments notice. It is very possible to have a stable herniation where there are long periods of no or very little pain. The patients history is very important in ruling out disc injury.
If in fact a MRI is ordered and we see a disc herniation, it can be displaced in several different locations and not always "pinching" the nerve. The picture below demonstrates the most common areas of disc displacement. The blue area is the called the paramedian or lateral recess and is the most common point of displacement. Patients with a herniation that falls into this category are good candidates for conservative treatment such as chiropractic, physiotherapeutic modalities (ems and ultrasound therapy)and a home exercise program. This course of treatment usually provides total relief and reduces the chance of future flare ups, but if no relief is found in a relatively short period (4-6 weeks) I will talk to the patient about the possibility of a referral for a series of epidural steroid injections (esi's). The red area is the foraminal portion and accounts for about 5-10 percent of all disc herniations. If the herniation is in this area, nerve compression can be an issue causing intractable sciatic pain (pain down the leg) and sometimes even muscle weakness. If this is the case, depending on the size of the herniation and the amount of nerve compression or displacement, I would refer out for a surgical consultation The green area is a very uncommon area for herniations. The disc can obviously displace right or left causing same sided symptoms.
Check out this article about the improvement of disc herniations with chriropractic care. /injury20.html
If you have any of the above symptoms and have questions or would even like a consultation please call Alexandria Chiropractic Center at 859-635-6666 and ask to speak with Dr. Kevin Crowley. And just in case I haven't bored you enough I will post a part four regarding disc pathologies and maybe even test you new found knowledge.