Chiropractor evaluating patient's back pain

Chiropractor evaluating patient's back painSpinal disks are the pads that sit between vertebrae and act as shock absorbers for the spine. When a disk herniates (sometimes referred to as a slipped disk, bulging disk or protruding disk), the soft center of the spinal disk pushes through a crack in its tough exterior casing and into the spinal canal. Some herniated disks show no symptoms, while others push on spinal nerves and can cause pain, numbness or weakness.

Disk herniation is commonly caused by gradual, age-related wear and tear or disk degeneration. As you age, your disks become more prone to tearing or rupturing when strained. Other causes of disk herniation can include using the muscles in your back instead of your legs to lift heavy objects, as well as twisting or turning while lifting, or even a traumatic injury such as a fall or blow to the back.

Common symptoms of herniated disks include back pain, pain in the buttock, and pain that radiates down the leg, also known as sciatica. This is caused by pinching or irritation and inflammation of the spinal nerve by the disk.

Diagnosis of herniated disks is made by a detailed medical history and physical examination by your doctor and imaging tests, typically an MRI, which can show the location of the herniated disk as well as any nerves that might be affected.

Conservative non-surgical and non-invasive care options are usually the first recommended course of treatment. This includes rest, anti-inflammatory medication, proper diet and exercise, chiropractic care and physical therapy. Physical therapists often provide rehabilitation exercises to strengthen the core, and some who are specially trained, can perform McKenzie therapy which is a specialized treatment to relocate the disk. Chiropractors counsel patients on exercise and diet as well as utilize special tables referred to as Cox tables, that provide spinal disc decompression to reduce the disk herniation.

If non-invasive options do not provide relief, minimally invasive spinal injections, such as epidurals can help. These are performed by an interventional pain management specialist and help reduce pain and inflammation in the spinal nerves caused by the herniated disk.

Ninety percent of patients with disk herniations and sciatica do not need surgery. If non-surgical treatment options do not provide relief, spine surgery, which is typically minimally invasive, may be considered. If your pain persists or worsens and is poorly controlled with minimally invasive measures, surgical intervention might be the right treatment. However, if your symptoms include a loss of bowel or bladder function, severe muscle weakness in the foot referred to as “foot-drop” and complete numbness in the pelvis area or the leg, surgical intervention may be recommended immediately as opposed to less invasive measures.


David J. BenEliyahu, DC, DAAPM, DABCSP is the Administrative Director of the Back & Neck Pain Center at Mather Hospital.