The bones (vertebrae) that form the spine in your back are cushioned by small discs. These discs are round and flat, with a tough, outer layer (annulus) that surrounds a jellylike material called the nucleus. Located between each of your vertebra in the spinal column, discs act as shock absorbers for the spinal bones. Thick ligaments attached to the vertebrae hold the pulpy disc material in place.
A herniated (also called a slipped or ruptured) disc is a fragment of the disc nucleus which is pushed out of the annulus, into the spinal canal through a tear or rupture. Discs that become herniated are usually in an early stage of degeneration. The spinal canal has limited space which is inadequate for the spinal nerve and the displaced herniated disc fragment. Due to this displacement, the disc presses on spinal nerves, often producing pain, which may be severe.
Herniated discs can occur in any part of the spine. Herniated discs are more common in the lower back (lumbar spine) especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. The second most common area is neck (cervical spine). The area in which you experience pain depends on what part of the spine is affected.
People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age. But currently even the people at the age group of 20’s are also getting affected because of their lifestyle and stress.
The progression to an actual Herniation varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
Causes A single excessive strain or injury may cause a herniated disc. However, disc material degenerates naturally as you age, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture.
Certain individuals may be more vulnerable to disc problems, and as a result may suffer herniated discs in several places along the spine. Research has shown that a predisposition for herniated discs may exist in families, with several members affected.
Herniated disc symptoms
Symptoms vary greatly depending on the position of the herniated disc and the size of the herniation. If the herniated disc is not pressing on a nerve, you may experience a low backache or no pain at all. If it is pressing on a nerve, there may be pain, numbness, or weakness in the area of the body to which the nerve travels. Typically, a herniated disc is preceded by an episode of low back pain or a long history of intermittent episodes of low back pain.
Lumbar spine (lower back):Sciatica frequently results from a herniated disc in the lower back. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that radiates from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected. This pain often is described as sharp and electric shock-like. It may be more severe with standing, walking or sitting. Along with leg pain, you may experience low back pain.
Cervical spine (neck):Symptoms may include dull or sharp pain in the neck or between the shoulder blades, pain that radiates down the arm to the hand or fingers, or numbness or tingling in the shoulder or arm. The pain may increase with certain positions or movements of the neck.
Thoracic spine:pain radiates into the chest.
Cauda Equina Syndrome:occurs from a central disc herniation and is serious requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.
Diagnosis Diagnosis is made by a Doctor based on your history, symptoms, a physical examination, and results of tests, including the following:
X-ray:Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
Computed tomography scan (CT or CAT scan):A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.
Magnetic resonance imaging (MRI):A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.
Myleogram:An x-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.
Electromyogram and Nerve Conduction Studies (EMG/NCS):These tests measure the electrical impulse along nerve roots, peripheral nerves, and muscle tissue. This will indicate whether there is ongoing nerve damage, if the nerves are in a state of healing from a past injury, or whether there is another site of nerve compression.
Though the management of herniated disk is controversial, the first step is bed rest. For those not responding to rest, surgical removal of the bulging disk followed by fusion of the vertebrae is the only option in modern medicine.
Ayurveda holds thatHerniated discis a result of vitiation of the three principal 'doshas' especially the Vata.
Treatment in Ayurveda is aimed at restoring the equilibrium through correction of the underlying functional in-equilibrium. Ayurvedic treatments for Herniated disc concentrate on bringing the aggravated vata back to the state of equilibriumand thereby to the state of health.Treatment comprises of three approaches, Elimination (Sodhanam) of the accumulated toxic products of digestion, metabolism and the disease process, Pacification (Samanam) and correction of the entities responsible for altered functioning and Rasayanam (Rejuvenation) of the bodily tissue to regain and maintain natural strength and vitality.
The strength of Ayurveda in the area of spinal ailments is globally appreciated. Since it addresses the root cause of the issue the results are better than surgical procedures.
The therapies like Abyanga swedam, Nasyam, Pathrapotala swedam, Choornapinda swedam, Pizhichil, Shirodhara, Kadeevasthy, Greevavasthy, Navarakizhi, Vasti etc. are done as per the necessity and condition. These therapies are directed towards relieving the inflammatory changes and herniation, releasing the spasms and nerve compressions in the affected area, strengthening the supportive tissues holding the spine/joints, nourishing entire spine & re hydrating the discs. Usually the treatment period is 3 – 5 weeks according to the severity of the disease.
In four to six weeks, the majority of patients find their symptoms are relieved without surgery. If patient can come for the treatment in early stages, even total cure without recurrence is also possible.