Ouch! Your Aching Back: What is a Herniated Disc?
By Robert V. Duvall, DPT, MPT, ATC, MGFI
You’ve probably heard people say they have a "slipped" or
"ruptured" disc in the back. Sometimes they complain that their back
“went out.” What they’re most likely describing is a herniated disc.
This condition is a common source of back and leg pain.
Discs are soft cushions found between the vertebrae that make up
the spinal column (your backbone). In the middle of the spinal
column is the spinal canal, a hollow space that contains the spinal
cord. The nerves that supply the arms, leg, and torso come from the
spinal cord. The nerves from the neck supply the arms and hands, and
the nerves from the low back supply the butt and legs. The discs
between the vertebrae allow the back to move freely and act like
The disc is made up of two main sections. The outer part (the
annulus) is made up of tough cartilage that is comprised of series
of rings. The center of the disc is a jelly-like substance called
the nucleus pulposus. A disc herniates or ruptures when part of the
jelly center pushes through the outer wall of the disc into the
spinal canal, and puts pressure on the nerves. A disc bulge is when
the jelly substance pushes the outer wall but doesn’t completely go
through the wall.
What do you feel?
Low back pain will affect four out of five people during their
lifetime. The most common symptom of a herniated disc is “sciatica.”
Sciatica is best described as a sharp, often shooting pain that
begins in the buttocks and goes down the back of one leg. This is
most often caused by pressure on the sciatic nerve that exits the
spinal cord. Other symptoms include:
How do you know you have a herniated disc?
Your medical history is key to a proper diagnosis. A physical
examination can usually determine which nerve roots are affected
(and how seriously). A simple x-ray may show evidence of disc or
degenerative spine changes. An MRI (magnetic resonance imaging) is
usually the best option (most expensive) to determine which disc has
Why do discs herniate?
Discs are primarily composed of water. As we become older (after
the age of 30), the water content decreases, so the discs begin to
shrink and lose their shape. When the disc becomes smaller the space
between the vertebrae decreases and become narrower. Also, as the
disc loses water content the disc itself becomes less flexible.
While aging, excess weight, improper lifting and the decrease in
water in the discs all contribute to the breaking down of discs, the
primary cause of a herniation or bluge is uneven compression and
torsion that’s placed on the discs.
This uneven pressure is caused by imbalances in muscles that pull
the spine out of it’s normal position and then your body is forced
to function in what I call a physical dysfunction. Every human being
develops these dysfunctions over time and eventually they cause
enough damage to create pain.
The best treatment options
When it comes to treating a herniated disc, there are traditional
treatments such as ice/heat, ultrasound, electrical stimulation,
cortisone injections, anti-inflammatory medications and even
surgery. While these may deliver some relief, it will usually be
temporary if at all.
But the major problem with these traditional treatments is that
they can’t fix or heal a herniated disc as they do not address the
actual cause of the problem. For example, even if you were to have a
surgery and get some pain relief, the fact is the dysfunctions that
caused the disc to herniated in the first place are still there and
if not addressed, they will continue to place uneven pressure and
strain on the discs and sooner or later you will likely have another
problem with that disc, or others.
Without identifying and addressing the underlying cause of the
problem, which is the physical dysfunctions caused by imbalances in
muscles, you will likely continue to suffer with this condition and
the continuous flare ups for years.
Unfortunately, most doctors, chiropractors and physical
therapists don’t spend time or focus on identifying the physical
dysfunctions that are responsible for the condition so most people
end up jumping from one useless traditional treatment to the next
and suffer for months or years unnecessarily.
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About the author:
Dr. Robert V. Duvall, DPT, MPT, ATC,
MGFI, graduated from Shenandoah University’s Program in Physical
Therapy with a Master of Physical Therapy degree in 1998. He
recently received his Doctorate of Physical Therapy degree from the
Physical Therapy Program at Shenandoah University in December 2004.
For more information on herniated discs and how to treat them
effectively, read the latest Back Pain Advisory from The Healthy
Back Institute. You can get a free copy of it here: