A precursor to a herniated disc is a bulging or protrusion of the disc. However – and this is good to know – not every bulging disc has to turn into a herniated disc. In the case of protrusion, the intervertebral disc bulges under the pressure of the muscles.
Illustrations of the spine (2) def. Page 2 Fig. 21
Figure 30 Particularly when the hip flexor muscle is pulled, the intervertebral discs are squeezed, resulting in protrusion of the discs. (Stefan Dangl)
Bulging discs are clearly visible in imaging procedures such as MRI. The doctor will then usually tell you that a protrusion is not that bad, as there is no herniated disc yet. Although this is true, it is only half the truth.
Intervertebral discs are like flat tires
Imagine you have a half-flat car tire and drive to a garage. Then the mechanic there will tell you to pump air into it. However, he will hardly tell you that a half-flat tire is not so bad, but rather point out the risk of further damage to the tire. A responsible doctor should act in exactly the same way. If he then advises you to strengthen your muscles, he may be responsible, but not good, as this is known to only increase the problem. That would be like the mechanic advising you to simply drive more slowly. This does not solve the actual problem.
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The following example illustrates this well:
If we take a photo of one of our car tires, it looks as expected: In the middle is the rim, around it is the rubber tire filled with air. If we send the photo to a workshop for inspection, we will be told that everything is fine. The situation is similar with the intervertebral discs: a radiologist will also certify that everything is normal after an MRI.
Legend to the picture
| Not to be seen | What we see | Not to be seen | ||
| Muscle tension | Intervertebral disc in MRI | Car tires | Weight on the loading area | |
| Without gauze shortening/without weight | ||||
| Slight muscle shortening/low weight | Protrusion of the intervertebral disc | |||
| Severe muscle shortening/much weight | Herniated Disc | |||
Illustrations spine (2) def. Page 1 Fig. 20
Figure 31 Only the two middle columns show what can be seen on MRI images or similarly in a car, namely the result of the cause. The cause in the gray boxes (increased muscle tension on the left or weight in the boot/load compartment) cannot be seen. (Stefan Dangl)
If we now load a ton of stones into the trunk and take another photo, the tire will be a little flat and bulge out to the side. The mechanic says: Inflate the tire! The doctor, on the other hand, thinks that it is not that bad yet, as it is only a protrusion and not yet a prolapse. Why doesn’t he recommend pumping up the intervertebral disc? Because the possibility simply does not exist. And why doesn’t he advise you to take the stones out of the trunk? Quite simply: because he can’t see them in the photo! Muscle tension is not visible on MRI images, so the doctor can only indirectly conclude that it must be present. He will not warn you because he has generally learned that a bulging disc is not yet a prolapse – and is therefore not broken. You can’t even blame him, he acts according to the textbook. The illustration above makes it easy to understand the process. The column on the far left shows the muscle tension, which is unfortunately not visible in imaging procedures such as MRI. The intervertebral disc is shown in the column to the right; in fact, the intervertebral disc in the second row, which is exposed to increased tension, is not very different from the one in the first row. The difference is much clearer with car tires.
If we now load five tons of stones into the trunk and document this photographically, we can see that the tire is flat, even burst. If we send the photo to the garage, the mechanic will ask us to buy a new tire. So you drive to the garage, change the tires – and the problem persists. After all, you still have the five tons in the trunk. The equivalent of changing a tire in the context of an intervertebral disc problem would be an operation. So you have an operation – and continue to suffer pain. After all, you have done nothing to reduce the muscle tension in the corresponding region. So why are you surprised?
Of course, not every intervertebral disc operation is to be discouraged. In some cases, it can even be extremely useful to remove a herniated disc with an operation. However, no disc surgery will eliminate the problem that led to the herniated disc, the exorbitantly increased muscle tension. The muscle tension that crushed the disc is still there after the operation. Nothing has been changed. If you don’t change anything, the disc will continue to be crushed, and then the next one, and the next one, and so on. Transferred to the car, this would mean that you would have to reduce the load in the trunk of your car in order to be successful.
