Vertebral Disc Injury: What is it, what are the grades and how can we treat this injury?

By Mo Mommersteeg

What is a Vertebral/spinal Disc?

Between each vertebra/bony segment in your spine is a fluid filled, cartilaginous vertebral disc. The purpose of the vertebral disc is to support and act as a shock absorber for your spine, and allow movement and pliability within your spine. There are a total of 23 vertebral discs within your spine, from the top of your neck to the bottom at your sacrum. Each, absorbing load and minimising damage to our spine.

A vertebral disc is composed of two parts, the outer layer, the annulus fibrosis and the inner jelly like sac, the nucleus pulposus.

How does a disc change over time?

As much as we don’t like to admit it at times, we are always aging and our bodies are ever changing. This is also true for our vertebral discs. When we are born our discs consist of approximately 80% water, making them quite gel- like and squishing, ideal to create space and absorb forces to our back. However, as we age, our discs begin to dehydrate and lose the ideal shock absorbing ability. This can cause our discs to decrease in height, decreasing our joint space and possibly making our spinal joints feel stiffer. So how do we combat this, well, as stated above we cannot escape the aging process, but we can assist our bodies to age in a healthy way. The best way to help your discs stay hydrated and lubricated is through MOVEMENT. Continuing to prioritise movement through our spine, increasing blood flow and resilience in our discs.

What is a disc bulge or Herniation?

There are 4 main types of disc injuries that are classified.

1.       Disc Bulge: When a disc bulges, it means the inner nucleus material is starting to bulge and place pressure on the outer rim of the annulus fibres. This is commonly due to minor tearing or weakening in the annulus fibrosis. The inner gel- like nucleus does not fully spill out through the annulus fibres, but remain in tact. A bulging disc can still place pressure on adjacent descending nerve roots, causing nerve pain.

2.       Disc Herniation: This has also been called a ruptured disc, slipped disc. It is the next step up in severity from a bulge. At this point, the annulus fibrosis has fully torn/ ruptured, causing the inner nucleus gel to push outwards. This can at times place pressure on the nerves or spinal cord.

3.       Disc Protrusion: This is a more advanced Disc herniation, causing more inner nucleus tissue to exit through the annulus fibrosis space, entering the spinal canal or IVF, pressing on spinal cord or nerves.

4.       Disc Sequestration: This is the most severe disc injury. It is classified by the above findings of fully torn annulus fibrosis with exiting nucleus pulposus matter. However, the nucleus pulposus rupture is so significant it starts to drip or fall down the spinal canal and may even break into fragment. This severity of disc injury will most likely require orthopaedic surgery.

What is Degenerative Disc Disease? As explained above, it is a common aging condition where our discs begin to lose fluid and height, causing them to lose their ability to shock absorb. The space between your vertebra decreases and can causes stiffness. In the clinic, we like to call this Spinal wear and tear, from life experience. The best thing for this, is to keep moving and keep your spine lubricated!!

How can we treat disc injuries?

We, and the research highly recommend treatment that involves both manual therapy and active rehab and safe movement.

Depending on the severity of your disc injury manual therapy can include;

1.       Soft Tissue Therapy/ Massage: This will promote blood flow to the affected areas and release reactive tight muscles. Adjacent musculature will commonly tighten or go into spasm as a form of protection for the injury site.

2.       Dry Needling: This is a very commonly used and effective technique for disc injuries. This will promote blood flow deeper to the targeted tissue and site, while also releasing tighter surrounding soft tissue.

3.       Sports Taping: In acute patients, sports tape can be used to assist in recovery, reduce pain and support the area.

4.       Spinal Adjustments or Mobilisations: Our therapists choose to be conservative when adjusting around a hot or acute disc. They will commonly use spinal distraction techniques and joint mobilisations to gently promote movement, and relieve pressure off of the disc.

5.       Rehab and Movement: Please always seek advice on what you can do for exercise or movement when you are healing from a disc injury. Our practitioners will immediately try to incorporate safe, pain-free movement withing the spine, but also activate adjacent supportive muscles, like your core, glutes, legs, neck muscles, etc. Our goal is to train the body to be supportive to this injury but become more resilient.

If we believe that your injury is too severe for our treatment, or we are not seeing the results we would expect, we will commonly seek a second opinion. Our goal is to ultimately get you and your body the treatment it needs. At times, that surpasses manual therapy and may require more severe intervention.

Other treatment options can include:

1.       Cortisone Injection

2.       Orthopaedic referral for spinal surgery

3.       Nerve Ablation – Used to burn affected nerves from disc bulge.

Disc Injuries are one of the most common causes for patient’s to see their GP or an allied health professional. If you are suffering from back pain and think it could be caused from a disc injury, please do not hesitate, seek out professional help. We highly recommend starting with a manual therapist before severe medication or surgical intervention.