Chiropractors can help people suffering from spinal disc problems such as a herniated disc or sciatica by identifying the cause of the problem and treating it naturally with adjustments and other therapies.
Please start by describing what a spinal disc is, and what it is surrounded by in the spine?
Dr. Gregg Rubinstein: Well, that’s a really good question and there’s a lot of stuff that goes on. So, we’re going to talk a little bit about the anatomy of a spine.
When you really think about it, your spine is a bunch of bones that are stacked up on top of each other and then they’re separated in between by a disc, which is kind of like a fibril cartilage disc. Now there are many different ways that people describe the discs. One of them, it’s really just a shock-absorber.
If you look at a disc, it’s kind of interesting, it has a nucleus kind of like the yolk of an egg and then there’s the outside which is the annular fibers. Now the fibers wrap around the nucleus and the nucleus is kind of like round, it’s almost like a little ball, and when you jump on and play, the ball will compress and it will absorb a lot of the forces in the spine, so the vertebrae actually don’t break.
However, inside the nucleus, there is some jellylike material, and if the disc gets beat up or the fibers that surround and hold that so-called egg yolk in there or the jelly inside the jelly doughnut, if those get weaker, they will bulge. And if it tears completely that inside material will actually bulge, or herniate, or pop out of its normal confines and it will get into the area where the nerves exit the spine. That’s what puts pressure and pain on it. That’s describing what the true herniated disc is.
The spinal disc is really just a tough, leathery kind of fibers that surround a soft nucleus that helps disperse the forces that the spine encounters. And they remain flexible so the spine can bend, twist and turn.
What is degenerative disc disease and what causes it?
Dr. Gregg Rubinstein: That one is almost self-explanatory. Degenerative disc disease is when the discs themselves start to degenerate obviously. But what causes it is typically poor mechanics. Again, I use a car analogy a lot, because there’s a lot of moving parts, but if the front end of my car isn’t lined up and I keep using it, the tire is going to wear funny and we’re going to start to see changes there. When the spine and the bones of the spine are not in good alignment, there’s uneven pressure on the disc because the bones aren’t stacked up perfectly straight. And when you have wear and tear and uneven pressure on the discs, the disc will malform and then it will actually stress the bones.
Because remember, that disc sits in between two bones and so when those bones misalign it will put pressure on the disc and then the disc can degenerate and the bones themselves could start to show wear and tear, such as bone spurring, laying down extra calcium so the bones look chalky white. You’ll also see some misalignment and misshaping of the bone over time and that’s most commonly called arthritis or degenerative disc disease. They’re almost synonymous.
How do you explain what a bulging disc is and how does someone know if they have one?
Dr. Gregg Rubinstein: Oh, those are two good questions. A bulging disc, how do you know if you have one? Well, sometimes there’ll be pain associated with it but sometimes there’s not. You have to do proper examinations and sometimes we’ll do x-rays or MRIs to make sure and confirm that it is a disc.
Very often people will have bulging discs and have a very specific set of symptoms, there’ll be pain on one side, they might get some numbness or tingling or radiation of the pain down the neck into the arm if it’s a cervical disc, or in the lumbar spine it might leave the lower back and go down the back of a leg. There are a lot of different presentations people can have bulging discs, but sometimes they actually can be asymptomatic.
A proper examination, using your imaging techniques, whether it be x-rays, CT, or MRI, will also give you a very good picture of the disc. So those are ways to kind of tell what causes the degenerative disc disease and how you would know if you had one.
What happens when a disc gets herniated, ruptured, or slipped? Can this be fixed naturally without surgery?
Dr. Gregg Rubinstein: Yeah, I’m not in love with the word fixed, because sometimes the case is if they’re really bad, they can only managed. Once the annular fibers, those are the fibers that surround the center part of the disc, and once those tear they don’t really have an ability to grow back. So sometimes if someone has an annular tear and the disc material is bulging out through there, it can take quite some time for that type of condition to heal.
But when you talk about a disc being herniated, that is the proper term. Ruptured and slipped discs are kind of misnomers or lay terms and they’re not really definitive. The difference is a bulge means that the disc is bulging, but the annular fibers haven’t torn, so that inside disc material hasn’t pushed past the confines of the disc and leaked out into the spinal canals. That would be the bulging disc hasn’t ruptured past it. When the disc is herniated or ruptured then the material is actually pushing out farther. It’s usually a more significant condition and is usually associated with more pain or discomfort.
Now, over time, is if you could maintain great alignment and there’s less pressure on the disc, it won’t be as irritated, it won’t swell as much, and it will be asymptomatic. However, sometimes these people will have some flareups of the disc problems and get some pain on occasion. You can see that they can flareup time to time, but over time, slowly the body will start to dry up the disc, the disc material will shrink and the body will break it down, and anything the body makes it can get rid of. So sometimes over time, they can heal naturally but it can be quite time consuming and take a long time. Where some people get a little impatient and then they opt for pain management or other types of surgical procedures to try and heal the disc.
Generally speaking we handle most of the cases. I would say about 85-95% of the cases that come in to me with disc issues, don’t require surgery and we can manage their cases naturally without using drugs or surgery.
Is sciatica considered a spinal disc problem and how is this diagnosed and treated?
Dr. Gregg Rubinstein: Sciatica very often can be related to the disc, but it’s not the only cause of sciatica, from discs. There’s a muscle called the piriformis muscle, which is one of the rotators in the hip. And in a certain percentage of the population, their sciatic nerve actually passes right through that muscle. And if that muscle can spasm, it can squeeze that nerve, and they can get sciatica.
You can have sciatica from a misaligned vertebra that’s putting pressure on the nerve. Or you can get sciatica from the actual discs expanding and blowing up beyond its normal positions where it actually puts pressure and touches the spinal canal, which contains the spinal cord, and the delicate spinal nerves as they exit the spine. That disc material can irritate the spinal cord or the spinal nerve. Either way, you’ll see some type of neurological problems. Typically, it’s diagnosed where the patient will have pain in the area of the pinch and then they’ll have like numbness or tingling or pain going down the back of the leg, along the sciatic path.
Now you can have neuropathies which sciatica is a form of neuropathy that goes down different parts of the leg, but the sciatic nerve is the biggest nerve in the body. It comes from L4 or L5 and a few other tributaries and it travels down the back of the leg, so that has a very prominent role. Typically, when L5 S1 gets herniated, that puts the most pressure in sciatica. It’s very common in that area.
The treatment in chiropractic is generally correcting the alignment, trying to get the pressure off the nerve, and make some more room for the disc. We use some distractive techniques and give the patient exercises to kind of open up the spine. Physical therapy is sometimes required and sometimes if it’s really bad, some people can need some medications to get over the hump. But those are the ways we treat most of them. It’s just kind of that chiropractic technique to help open up the spine, get the pressure off the nerves, reduce the pressure on the disc, and allow that body to start to heal.
To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call 917-534-6484 to schedule an appointment