Herniated Disc

Symptoms (complaints) of a herniated disc

A herniated disc can cause very different symptoms. The milder forms make symptoms like back pain, more severe forms of pain can lead to radiating pain and in the worst case even cause symptoms with paralysis. You feel like you’re on the dog, on your back or on your neck.

A herniated disc is also not painful in many cases. Several studies have demonstrated this. Boden and his team were able to show, for example, that herniated discs were present in 4.5 percent of supposedly healthy, twenty-year-old men who applied for fighter pilot training. Furthermore, that in about twenty percent of under sixty year olds who were entirely symptom free could be diagnosed with one (Boden et al. 1990, Janen et al. 1994). It often only becomes painful when a nerve is being squeezed by the herniated disc. If the prolapsed disc tissue presses on one of these, pain results, either pain that radiates or sciatic pain. The sciatica, which is all the nerves that exit from the lower lumbar spine and then together form a thick nerve, even if the exit points on the spine are different.

Structure of the intervertebral disc

The intervertebral disc is rubbery soft buffer between the lumbar or cervical vertebrae and allows the spine to move. In the center of the disc is a hard spherical nucleus, the nucleus pulposus, on which the lumbar vertebrae ride. This core can give a little and bounce. The disc envelope, in turn, can yield significantly in all directions of motion. In a healthy intervertebral disc, this envelope resets itself, like a foam, when movement in one direction is reversed.

The disc has no blood vessels to nourish it. Rather, it functions like a sponge. Under load, the disc contracts and is squeezed out; under unload, it separates again and absorbs fluid from the adjacent vertebrae for nourishment.

How does a disc break?

If the muscle tension is too high, the intervertebral disc remains compressed, even in a relieved position. As a result, the possibility to feed oneself is already significantly limited. This compression is among the causes of wear. By strengthening the muscles, the sponge is compressed even more. The sponge can now no longer unfold at all, but remains compressed. Nutrition is now hardly possible. The disc figuratively starves and begins to show symptoms such as pain.

Misconception muscle development in the herniated disc

Now you start actively building muscles to make your back stable. You compress the intervertebral disc even more, so that nutrition is almost no longer possible, because now even the last remnant of sponge function is switched off. However, since the affected disc is then stable again and there is also no more friction pain, you feel this as a relief. But the problem is only superficially improved. In reality, there is even more wear and tear on the disc. This is because if you move the spine under the increased muscle pull, there will be increased shear forces, which will increase the damage.

It is the movement of the disc in the back or neck under compression by the shortened muscles that really damages the disc. The strong muscle pull and subsequent downward pull grinds the intervertebral discs and articular cartilage and lumbar vertebrae like a mortar. Exercise is not good until the pressure has been taken out of the muscles first.

Herniated discs develop over years and burst in a second

A herniated disc does not develop overnight. The precursor is considered to be disc protrusion (see below for more on this), a protrusion of the disc that can be seen in pictures. And disc protrusion does not occur spontaneously either; it is in turn preceded by disc degeneration (disc wear, discosis), which is occasionally also visible on MRI images.

Now, how does a disc get damaged and become symptomatic, so what are the causes of wear and tear? Both in public opinion and, unfortunately, again and again in many specialist books and articles, a slipped disc is regarded as something, one could almost say, fated or even God-given. Many patients believe they simply have bad discs or have inherited the disposition to them from their parents. There may be some truth in this, but the remaining 99 percent is everyone’s own fault, because most of the wear and tear on the intervertebral disc is your own fault. There is simply too much sitting, as has been described in detail above, and so the bruising of the intervertebral discs is accepted.

It is not the pressure from above that damages the intervertebral disc, but the muscle pull from below

The majority opinion has established itself that the intervertebral discs are damaged by a pressure from above, for example, by overweight or by heavy lifting. This may indeed contribute to disc wear in some cases, but much more crucial is the permanent bad posture, sitting, and the resulting shortened muscles that pull the vertebrae forward and downward and crush the discs.

Does the disc still spring after a herniated disc?

In this context, I repeatedly hear the question of whether the intervertebral disc can still buffer and absorb shocks after a herniated disc, i.e. when the core of the intervertebral disc has already fallen out. In my experience, an intervertebral disc no longer buffers long before the disc herniates. In this respect, it is not directly the incident that has made buffering impossible, but the underlying muscle shortening. The intervertebral discs were no longer able to absorb shocks long before the incident. That’s why it broke – and not the other way around!

Treatment (therapy) of a herniated disc

The treatment of herniated discs depends on the onset of symptoms. Local pain can be treated by self-treatment, physiotherapy, heat and massage. All these measures lead to a loosening of the tissue. This allows more space around the herniated disc and reduces pressure on the nerves, this applies to the lumbar, thoracic and cervical spine.

In treatment, it may still be necessary to use decongestant medications, either as tablets, infusion, or by injection. Targeted treatment with injections is the best method in this case, when under X-ray or computed tomography the herniated disc is immediately washed around. Thus, in 80-90%, 1-3 treatments succeed in completely abolishing the symptoms.

When is surgery necessary for a herniated disc?

Only a few herniated discs then require surgery. Either if the pain comes back anyway or if there is paralysis. Of course, it is also possible that the symptoms do not disappear at all, in which case surgery must be performed to relieve the nerve. The operations are usually simple, and in some cases they can be performed minimally invasively. However, the main problem with the operation is not the operation itself, but the time afterwards. Since the operation itself does not eliminate the causes of disc degeneration, but only removes the herniation itself, it is necessary to subsequently make the muscles elastic again and keep them permanently elastic.

What (almost) everyone does wrong with a herniated disc and what you should not do

Unfortunately, most people don’t do that. They either continue as before, not changing their behavior, or they strengthen their muscles, further squeezing the discs. The correct treatment would be to apply prolonged pressure to the muscle insertion on all the muscles involved, e.g. elasopressure. This restores the full elasticity of the muscle. This elastic muscle must be stretched daily from then on to maintain elasticity. Only in this way is it possible to safely remain permanently pain-free. If you also want to do muscle strengthening as a treatment afterwards – no problem, but it should always be the last step after the other two.

Table of contents