Robert Hayden, DC, PhD, FICC
Jenny called the clinic about three weeks ago and asked what we could do for disc herniations. She was collecting information on behalf of her husband, Eric, who has a disc bulging in his neck. Although Eric did not complain much, Jenny noticed that he was not using his right arm unless he was forced to do so, and his facial expression betrayed him. Eric was the primary breadwinner for a large family, so Jenny was motivated by some very practical issues as well as, I am sure, love for her spouse.
First, there is a lot of confusing terminology about disc herniations and disc bulges. We are talking about the same entity. A disc is a piece of cartilage between two vertebrae that acts as a spacer and a shock absorber. In the center of it is a liquid nucleus, surrounded by cartilage arranged in layers like onion skins. If the cartilage tears, the liquid in the nucleus will follow the tear so that the outer layers of the disc will “bulge,” or “herniate.” If that bulge happens to hit a spinal nerve that exits the spine at that level, you may feel pain, tingling, or numbness in whatever part of the body is served by that nerve. If the nerve is squeezed hard enough, it may become damaged to the extent that muscle weakness occurs in whatever muscle is served by that nerve. In any of these cases, it is more serious than a pain in the “tush,” as one of our recent patients calls it.
The treatment of choice for a bulging disc is spinal decompression. It is safe and effective, and it has been documented very well in randomized controlled trials, the pinnacle of scientific research.
I am not a fan of WebMD because I have seen demonstrably false information posted there for apparently political reasons. It is reprehensible to mislead people for the sake of financial gain. However, what they say about spinal decompression is actually quite good:
"Spinal decompression works by gently stretching the spine. That changes the force and position of the spine. This will take pressure off the spinal disks, which are gel-like cushions between the bones in your spine. Over time, negative pressure from this therapy may cause bulging or herniated disks to retract. That can take pressure off the nerves and other structures in your spine. This in turn, helps promote movement of water, oxygen, and nutrient-rich fluids into the disks so they can heal."
Spinal decompression works by decreasing the pressure inside the disc, which creates a vacuum effect. So essentially, the herniated portion is literally sucked back to the center. How cool is that?
In 1962 a chiropractor by the name of James Cox had a disc patient who just did not do well with the techniques then available. Dr. Cox’s father was an osteopath. The younger Cox went through many years of osteopathic literature and found a technique they had abandoned inexplicably. Dr. Cox has been researching and developing flexion distraction/decompression manipulation as we know it today ever since. More than half of all chiropractors now use this technique, and some have chosen to seek certification from Dr. Cox.
Clinical research suggests that flexion distraction/decompression manipulation reduces a disc bulge on average in 12 visits over 29 days or less. 91% of patients found relief in less than 90 days in that study, so they did not require more expensive and higher risk interventions. Other studies find this approach superior to medical conservative care, particularly physical therapy. Flexion distraction patients needed less care and had less pain in the year following a study than did physical therapy patients.
In my experience with flexion distraction, not only do the vast majority of our patients get well, but they will go back to work so they can continue to pay exorbitant taxes. Even seniors with spinal stenosis (which may involve multiple disc herniations) respond well with this technique. We can use it with equal facility in cervical, thoracic, and lumbar herniations. I have used the technique with confidence in complex situations such as pregnancy, abdominal aneurysms, osteoporosis, and other otherwise daunting conditions because there is no compressive force exerted on bones that may be quite mature or fragile.
So, Jenny, there is much we can do. Along with decompression, we can ease Eric’s pain with physiotherapy techniques such as some special kinds of electrotherapy, ultrasound, or even laser. We can show Eric some rehabilitative exercises, and we will show them to you, too, so you can be sure Eric does them.
Well, seriously, I typically show exercises and stretches to the spouse so he or she can assist. That keeps the spouse from feeling helpless while the patient is in discomfort. You could say it gives Jenny something to do with her hands.
Epilogue: Eric began care with decompression twice a week. The pain, numbness and tingling in his right arm, forearm, thumb and index finger are receding. He is recovering the use of his extremity and he is sleeping through the night. He has also not missed work, and that has taken the pressure off Eric’s disc and Jenny’s spirit. Who could predict that decompressing a disc could improve family dynamics? I love my job.