Understanding a Prolapsed/Herniated Disc of the Lumbar Spine

I have often heard people talk of a ‘slipped’ disc and the associated pain that it incurs. I became interested in this clinical issue when a client came for a Craniosacral Therapy session (and continued to come weekly for many months as it helped so much), and wanted to know more about the symptoms, causes and treatment options.

Prolapsed or herniated discs usually occur or develop between the ages of 30 and 50. Men are nearly twice as likely to be affected. About 5 percent of cases of severe lower back pain are due to a prolapsed or herniated disc.

Structure

Vertebral discs are unique structures in the body, which act as shock absorbers between the 33 vertebrae of the spine. They evenly distribute force and pressure applied to the spine, and act as joints to facilitate back movement. They also perform as ligaments, holding the vertebrae above and below together. So although we often think of the vertebrae as the main component of the spine, really the discs are just as significant.
 
On the inside, a disc is gel-like, made from a water-based substance called nucleus pulposus. The outer layer of the disc is constructed from a series of concentric rings made of collagen fibers (lamellae), collectively called the annulus fibrosis. Disc tissue is cartilaginous and gets less blood and nerve supply than other types of tissue. This means it takes longer to heal than other types of tissue such as muscle or bone.
 
The nucleus pulposis inside a disc is the main carrier of the body’s axial load, and needs to stay hydrated to do its job properly. It needs the fluid to retain its buoyancy to perform its shock absorbing function. At birth a disc is 80 percent water, and this steadily decreases with age. Dehydration can impair the integrity and flexibility of the whole disc, and cause splits in the annulus fibrosis, or outer casing of the disc.

Causes and Implications

Not all of my research sources classified hernias and prolapses as different conditions, however it seems to me that technically they are different.
 
Disc hernia is when the nucleus pulposus protrudes through the inner rings of the annulus causing a bulge on the outside of the disc. This bulge in the can press on a nerve root or nerves in the surrounding area and cause pain.
 
Prolapsed disc is when the annulus becomes damaged from straining of the back due to heavy lifting, impact, or bending awkwardly. It can also split or tear due to dehydration. The nucleus pulposus can then seep out in to the spinal canal, pressing on the nerve root, or even causing a chemical reaction that causes inflammation and pain.
 
A prolapsed or herniated disc in the lumbar region most commonly occurs in the disc between L4 and L5, or between L5 and S1.
 
In many cases of these kinds, pain and/or numbness or tingling travels down from the affected nerve root along the nerve pathways, usually down one side of the body. However not all herniated or prolapsed discs cause problems, as some herniations do not put any pressure on the nerve root.
 
Both situations can be caused simply by age, or from degenerative disc disease. Being overweight also puts additional pressure on the discs as they have more weight to bear. Smoking is another health issue, which can cause degeneration of the disc.

Symptoms

In most cases the symptoms of a herniated or prolapsed disc settle down within a few weeks.
 
In some cases symptoms persist and cause a great deal of pain and disruption to the lives of those affected.
 
The pain caused by a prolapsed disc in the lumbar spine can be more prominent in the buttocks and legs (usually one leg) than in the lower back, due to the pathways that the nerves follow down the body. It usually starts slowly and gets gradually worse, and most people experience it on one side of the body. The pain (or numbness, burning or tingling) can reach all the way down to the foot or even toe. The anal and genital region can be affected via the Perineal nerve. It is also not surprising that the most common cause of sciatic nerve pain is a prolapsed disc. The sciatic nerve is a bundle of nerves which emerge from the spine at L4, L5 and S1 and travel all the way down the legs to the heels. It is commonly considered to be the longest nerve in the body.

Allopathic (Western medical) treatment options

The main treatment recommended for this condition, even in conventional medicine is keeping active. It is also suggested that avoiding heavy lifting, turning or bending awkwardly, or sitting for long periods is beneficial.
 
Physiotherapy, osteopathy and chiropractor are also suggested, as is pilates.
Pain relief is recommended in more acute cases. These can be Analgesics (Panadol), Non-steroidal anti-inflammatory drugs (Ibuprofen), Codeine, Corticosteroids (can be injected into the spine to reduce inflammation) or muscle relaxants.
 
The last option for ongoing pain and disruption to life and well-being is surgery. About 1 in 10 cases of a slipped disc require surgery. Most operations are successful (over 80%) but there is a risk, as with any surgery, and the risk can be anything form making the pain worse, or creating a different pain, to paralysis. This is a difficult decision for many people faced with constant chronic pain, or the risk of feeling nothing.

Working specifically with lumbar disc herniation or prolapse within Biodynamic Craniosacral Therapy

Craniosacral therapy can help this condition, as I have experienced personally with clients. By encouraging the body to release some of the tension that it holds to protect itself around the damaged disc, some of the pain can be reduced in the surrounding muscles and all over the body. Making direct contact, or using dermatomes (nerve connections from the vertebrae) is a good way of getting more blood flow to the area to reduce inflammation. With blood comes nutrients and hydration, which is highly beneficial. It can also initiate nerve connections, which may have been damaged, therefore allowing more feeling, or helping to reduce numbness in the back, buttocks or legs.
 
On another level, BCST can help someone to see their body in a more positive way, as having constant pain can give us very negative feelings towards our bodies. It can help to support a renewed respect and gratitude for the health that our body does have, and it’s ability to heal itself to the best of its ability at the time.

Other therapies/approaches to consider are Osteopathy, Acupuncture, Physiotherapy, Bowen therapy and Chiropractic. 
 
If you are experiencing any of the symptoms listed above and have not been checked out please consult your Doctor.
 
For any further information on how BCST can help with this and many other spinal conditions please contact me or find a local therapist at http://www.craniosacral.co.nz.