Sciatica, Herniated Discs and Chiropractic
Spinal discs are the pads that sit between two adjacent vertebra, and act as shock absorbers for the spine. The disc has an inner portion called the nucleus, and outer portion called the annulus. Discs are prone to deterioration as we get older, and will lose its fluid content making it prone to tearing and injury. Intervertebral discs can also become injured from twisting and bending, excessive axial loads, or repetitive microtrauma. When a disc herniates, it moves from the middle of the disc to the outer part where spinal nerves usually are found.
This can cause a pinching or irritation and inflammation of the spinal nerve that often leads to back pain and/or pain down the leg. Sometimes the disc doesn’t compress a nerve, and the spinal disc itself causes pain due to the nerves in the disc triggering pain. Pain down the leg is referred to as sciatica, as the sciatic nerve is the large nerve that travels down the leg originating from the lumbar spine. Doctors refer to this as radiculopathy.
Herniated discs have also been referred to as ‘slipped discs’, bulging discs and protruding discs. Common symptoms include back pain, pain in the buttock, and pain down the leg. It can be very painful. Diagnosis is initially made by a detailed history and physical examination, and followed up with an MRI if the symptoms are not resolving. MRI is very helpful at showing where the herniated disc is.
Conservative Chiropractic care options include rest, proper diet and exercise, chiropractic care and physical therapy. Chiropractors will counsel patients on exercise and diet as well as utilize special tables referred to as Cox tables, that provide spinal disc decompression that reduces the disc herniation. I published a study that demonstrated herniated discs can become smaller or even resorb upon after chiropractic care as seen by MRI.
Hill Flexion-Distraction Table
Flexion-Distraction is a technique used to treat vertebral disc injuries and chronic low-back stiffness. We utilize both a Cox and Hill flexion-distraction table that flexes (bends) the patient’s back while distracting (stretching) the spine, and also goes back and forth in the long axis Y plane. This technique has been clinically proven to successfully treat disc issues such as bulging or herniated disc(s) , spinal stenosis, facet syndrome, and degenerative disc disease. Dr. BenEliyahu uses non-surgical spinal decompression for acute and chronic disc pain patients since it is much more focused in the injured disc and is effective for pain relief. We use the flexion-distraction technique as a method for maintenance or the occasional disc flare-up injury. The flexion-distraction technique is gentle and effective.
If all of the above treatment options do not help, epidurals and spinal surgery may be considered, and we will refer for these consultations when medically indicated. In general, 90% of patients with disc herniations and sciatica do not need surgery, but some people do. Spinal Surgery is usually minimally invasive as most surgeons will recommend microdiscectomy. However, sometimes ‘red-flag’ scenarios arise that would require immediate surgery such as loss of bowel/bladder function, severe muscle weakness in the foot referred to as ‘foot-drop’, and complete numbness/loss of feeling in the pelvis area or the leg.