Let’s consult with Dr. Jeffery Citrin, experienced disc injury chiropractor in St. Louis, MO.
There are a lot of different terms used to describe disc injuries in the back. The terms “pinched nerve“, “herniated disc” and “bulging disc” are all used to describe a situation in an injured back that is similar yet slightly different too. It seems that even experts in the health care field have trouble deciding exactly what each of these terms mean and how to best describe them. When you add the many different terms for disc problems in the back (torn disc, ruptured disc, slipped disc, disc disease, collapsed disc, disc protrusion) it only makes things all that more complicated. One thing is for sure the person that experiences any of these will most likely be in some pain and that pain will get worse if something is not done about it.
So instead of worrying about exact definitions or terms it is best to describe a disc injuries nature with an accurate medical diagnosis. This type of diagnosis will identify the pain area and other symptoms that accompany that pain.
Here are the three important steps of any medical diagnosis. These steps are combined to make an accurate diagnosis about each patient that a doctor examines.
1. Analysis of the patient’s medical history
2. Performance of a physical exam
3. Order diagnostic tests (if necessary)
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Causes of Disc Injury Pain
Physicians identify spinal disc problems in one of two different ways:
- Pinched nerve
It is not always the disc in a person’s back that is causing the pain but rather the inner material of the disk itself leaking out and irritating a nerve that is in the area. The pain that results from this is called radicular pain and it may in fact radiate to elsewhere in the body; an example of this is when low back pain radiates to the leg (sciatica). This problem is most often described as a herniated disc.
- Disc pain
Disc pain itself results from a degenerative condition in the disk; in other words, the lower back and leg pain that a person is experiencing is caused by the spacing of one or more discs in their back. This type of pain is commonly referred to as axial pain and this condition is often referred to as degenerative disc disease.
Both these pain sources can occur anywhere in the spine but they tend to be more common in the lower back than they are anywhere else on the spine. The reason for this is that the lower back has more force and torque acting on it on a regular basis than any other area of the spine.
It is important to note that terms such as pinched nerve, bulging disc and herniated disc refer to the results that are found on a CT scan or MRI. Such tests are important to the diagnosis but they are far less relevant than the patient’s actual symptoms and the findings of their doctor’s during the physical examination.
A sound clinical diagnosis centers on determining what is causing the patient’s symptoms, such as the neck or back pain they are experiencing. Here are the four steps involved for making a clinical diagnosis about a pinched nerve or degenerative disc problem.
Physical examination by a Chiropractor is Recommended
For determining the cause of back and leg pain a doctor will normally do the following tests during a physical examination:
- Nerve function in certain parts of the leg or arm
This will involve using a reflex hammer to tap certain areas of the body. It is done because if a person has a small reaction or no reaction to a tap in a certain area it could mean the patient has a compressed nerve root.
- Muscle strength
When checking to determine a herniated disc problem in the spine of a patient the doctor will normally do a neurological exam to test muscle strength. The doctor will want to view the patients muscle structure to check for any abnormalities such as twitching, atrophy or abnormal movement.
- Pain with palpation or motion
The treating physician will also palpate (touch) certain body areas to give them an idea of what is causing the patients pain. . Palpating (touching) certain structures can give some idea of what really is generating pain. For example:
– Pain while touching the sacroiliac joint may indicate a sacroiliac joint problem.
– Pain while straightening out a leg can indicate a pinched nerve.
– Pain while putting pressure on the lower back may indicate a degenerative disc.
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Reviewing of the symptoms
This step will include the patient indicating where the pain is, the seriousness of the pain on a scale from 1 to 10 (ten being the most severe) and what makes the pain worse or better if anything.
3. Review of medical history
Many conditions that involve the back have hereditary associations. That is why it is important to view the patient’s medical history and determine if other family members have or have had similar conditions. It will also include looking at such things as medicines the patient is currently taking, previous ailments, drug allergies and more.
Diagnostic tests
After the doctor gets an idea of what is causing the patients pain they may then order tests to confirm their diagnosis or determine the extent of a problem. These diagnostic tests might consist of:
– CT scan
Also known as a Computerized tomography scan. These are similar to x-rays because they produce images that will display a cross section of the spine.
– MRI scan
Also known as what is called a Magnetic Resonance Imaging test. These allow a doctor to be able to assess such things as the health of spinal nerves and the size, water content, alignment and configuration of the discs in the patient’s spine.
– Discography
These are usually only done if surgery is a consideration to solve a patient’s back pain. This test can help identify which disc in the patient’s back is most likely causing the pain problem. There is a lot of debate among medical professionals as to the relevance of this test.
It is very important to note that the results of these test findings are not a diagnosis by themselves because many people over the age of 30 will have some degree of disc problems in their spine and never have any pain associated with those problems or require medical treatment. As was mentioned, these tests are usually done just to confirm or expand upon the diagnosis of what the doctor already thinks is the problem.
Disc or Pinched Nerve Treatments
– Surgery
Once the doctor has performed all 4 of the steps that are necessary they can then decide what the best course of treatment is for the patient. This is why it is so critical that the attending physician accurately diagnose the underlying condition that is causing the patient’s pain. That is the only way they can establish an effective treatment to help the patient; this is especially important for those patient’s that are considering surgery to help ease there.
As far as surgery is concerned it is almost always elective and usually only considered when all the less invasive treatments have been exhausted. Surgery only is used to treat such diagnosis as a herniated disc or a degenerative disc condition.
Here are the types of surgeries that may be done for these types of back ailments:
– Microdiscectomy
This surgery is used on herniated discs. It involves removing the portion of a disc that is pressing on spinal nerves. Once this pressure is gone the nerve should no longer be painful and the patient can assume normal activities once they are healed from the surgery.
– Spinal fusion
This is used in cases where the patient has been diagnosed with degenerative disc disease. The goal with this surgery is to fuse unwanted disc space together to remove any motion that is created an irritation and leading to pain. This is also known as Lumbar Spinal Fusion Surgery.
Surgery is never recommended in the following cases:
When it is done purely as an exploratory procedure
When the attending physician is not sure that degenerative disc disease or a herniated disc is highly likely to be the cause of the patient’s pain. Back surgery has some severe risks so you never want it to be done in cases where it is a best guess scenario.
This all makes surgery a very complicated decision and that is why it is only used at the patient’s discretion and mostly in cases where a patient’s quality of life is suffering greatly.
None Surgical Treatments for Back and Sciatica pain
Don’t despair though if surgery is ruled out for you; physical therapy, chiropractic care, massage and other non-invasive treatments have had great success lessening or eliminating a patient’s back and leg pain. These all-natural treatments also speed healing by promoting good nerve flow and energy flow throughout a body.
Take chiropractic care for instance. They use manual manipulation to try and get such things as slipped discs back into a position where they are no longer causing pain. This excellent outpatient only therapy often starts working with the very first treatment session.
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