You go to your family doctor with low back and
leg pain and ask about seeing a chiropractor. "Oh, no," says the doctor," they'll try to pop it back into place
which will not only be painful, but make matters much worse." Is this true? What is the chiropractic
approach to treating a "slipped disc"?
Chiropractic is conservative care, which means it is non-surgical and drugless.
In treating low back "slipped discs," most spine experts agree that conservative care should be tried before
surgery is considered, except in severe cases.
Chiropractic care has a long history of successfully providing conservative care for disc conditions - and
no, chiropractors don't try to "pop a disc back in place".
What is a "slipped" disc?
The disc is a circle of cartilage between each vertebra in the spine that acts as both a shock absorber
and a shock distributor. If you jump up and down, imagine what would happen to the stack of bony vertebra that make
up the spine without the cushioning of the discs. Move your back side to side. Again, you can visualize the give
and take of the discs between the vertebrae. Without discs, the spine simply could not function.
Discs don't really "slip". Instead, they bulge, herniate, or rupture. Saying a disc has "slipped" does
suggest that something has "slipped out" and is not where it's supposed to be, which is what happens in disc
Discs are made up of concentric circles or rings of fibrous material with a tough gelatinous center. When
cracks or fissures occur in the fibrous rings, the gelatinous material in the center can begin to push out. A
number of different factors may cause the disc to "slip".
Can a sneeze cause a "slipped disc"?
The low back "slipped disc" is almost always the result of a process. As is often the case with joint and
back injuries, the problem starts small and then builds until it becomes symptomatic. It's a little corny to talk
about "the straw that broke the camel's back," but it gets the point across. For example, a
patient sneezes and experiences sudden back pain that then proceeds to leg pain. However, the sneeze didn't cause
the disc to "slip," but represents the final "straw" in a much longer process. Factors that precede the pain and
symptoms of disc injury include disc dehydration, unusual stress on the disc secondary to disturbed mechanics, and
too much load on the disc.
Discs depend on water to keep their height and perform efficiently. When we're young, discs have their own
circulation that helps keep them hydrated. As we get older, this circulation ends and the spine must move so that
water can be drawn into the discs. If discs become dehydrated and lose their height, they become more vulnerable to
cracks and fissures.
Discs are integral parts of our body's mechanical system that allows us to move. Chiropractors are
especially interested in seeing how injuries in one part of the body relate to the mechanical system of the body as
a whole. Chiropractors look at injuries specifically, but they also try to determine in what way an injury is the
outcome of disturbances elsewhere in the body.
The spine functions as a whole, so if we have mechanical disturbances in one part of the spine, even as
far away from the low back as the neck, it can influence conditions in another area of the spine. Imbalances in the
pelvis, problems in the sacroiliac joints, low back facet fixations, as well as joint restrictions in the midback
and the neck, can contribute to the process of disc degeneration and eventual injury.
Disturbed mechanics from lack of muscular support or muscular imbalance are important because discs can
come under more stress from weak abdominal muscles, or too much weight around our abdomen. The resulting
hyperextension can cause a wedging of the discs.
The opposite condition, hyper-flexion, is caused when we round our low back because of weak back muscles
or poor sitting habits. This causes stress on the disc in the opposite direction. Finally, if we put too much load
on the back over a period of time, or occasionally in one dramatic episode, we can add another significant
A "slipped disc" most often occurs when a number of these and other factors act together to cause disc
injury. For example, a middle-aged accountant who sits for long periods, suffers from disc dehydration, and has
poor mechanics from weak abdominals, then lifts a heavy piece of furniture and experiences acute low back and leg
pain. Or perhaps many months after lifting the piece of furniture, he experiences no pain at all until he sneezes.
Bingo. A slipped disc!
How do chiropractors diagnose what went wrong?
What has happened to our poor accountant who now is experiencing acute back and leg pain? Apparently the cracks and
fissures in his disc, the dehydration, the poor mechanics, the lifting - and perhaps even the sneeze - has caused
the disc to slip just enough to press against the nerve that exits next to the disc. This has caused inflammation
of the nerve, which can then cause pain along the path of the nerve into the leg.
How does the chiropractor determine whether this is a "slipped disc"?
Careful history taking, vital signs, and orthopedic and neurological testing are standards of practice
in chiropractic offices. Are the reflexes intact? Is there loss of muscle strength or signs of muscle
wasting? Is there loss of sensation along an area supplied by a particular nerve? These are vital questions that
the orthopaedic and neurological exam can help answer.
Chiropractors utilize other diagnostic procedures that are unique to chiropractic and establish the
foundation for a program of care. Chiropractors look carefully at posture and perform a postural analysis of the
patient. They use techniques such as motion and static palpation to determine exact areas of restrictions in spinal
joint motion. They palpate muscles and perform muscle testing, as well as perform tests for pelvic balance and
determine whether there is a "short leg".
X-rays of the low back are taken, or the chiropractor might send the patient to an x-ray facility for
these films. Depending on the findings, the chiropractor may call for an MRI or other imaging study of the
Chiropractic Care of Low Back Disc Conditions
After analyzing this information, the chiropractor determines if the patient has suffered a disc injury.
The crucial diagnostic question is, "what type of disc injury has occurred?" It is the answer to this question that
will determine the chiropractic approach to treatment or referral.
There are some patients who are not good candidates for conservative chiropractic care. For example, if
there is suspicion of a cauda equina syndrome in which loss of bladder control accompanies a disc injury, this is a
medical emergency not treated by chiropractic.
If there are unusual neurological findings with advanced loss of strength, sensation, and reflexes, the
chiropractor will refer the patient to a spine surgeon (spine specialist) prior to initiating conservative
Most disc conditions do not fall into these more extreme categories. The great majority of disc injuries
involve some degree of bulging of the disc. The "slipped" disc can be a slight, even temporary, push against the
nerve or the spinal cord, or it can be a more definite mild, moderate, or marked bulge. Frank herniated discs occur
when a fragment from the central part of the disc breaks completely through the fibrous rings.
Whatever the category of disc bulge, the low back pain, leg pain, and muscle spasms require
examination and, in most cases, a period of conservative, non-surgical care prior to any consideration of surgical
What is the chiropractic approach to conservative care of the disc?
First we should address a misconception. Chiropractors do not attempt to "pop a disc back in place" with
forceful adjusting or manipulative techniques. There is a form of disc insult to a nerve with low back instability,
often resulting in a quite dramatic lean of the low back with spasm that responds well to traditional chiropractic
adjusting. However, all other disc conditions are treated in chiropractic with a gentle program of low-force
Another misconception is that chiropractic care involves a few quick treatments, again usually seen as
popping the back, which will fix the disc. Instead, chiropractors who treat disc conditions integrate their low
force adjusting techniques in an organized protocol of evaluation and treatment.
Throughout a program of chiropractic care for disc conditions, patients are asked questions regarding
their progress. Evaluation of progress using neurological and chiropractic tests based on comparison with the
initial findings are essential aspects of this chiropractic protocol.
If a patient is not responding to conservative care using this protocol, the chiropractor will refer the
patient for imaging studies and spine specialist consultation.
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