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Can a Disc Slip?

This is one of the most common things patients come in saying that they have. The problem is..... it doesn't actually exist. So where does the term come from. My opinion is the term is actually a colloquialism. Which is a term that is not formal or literary but instead is used is familiar conversation. The term exists, although the condition doesn't, in large part because the term is familiar. How it got started I don't know, but it is stuck in our lexicon at this point so lets dive into it.

1. A slipped “disc” doesn’t actually slide anywhere.

The tissue that we call the disc is the cushioning material between the bones of the spinal column, or vertebrae. It’s made up of a ring of tough collagen that surrounds a jelly-like substance called the nucleus pulposus. If there is a break in that outer ring, some of the jelly-like substance can escape and compress a nerve. Here is an image with the normal types of disc disorders. A disc is one of the most metabolically demanding tissues in the human body.......but there is a problem they don't have there own blood supply, in fact there are the largest structures in the body without one. So how do they feed themselves...... through a process called imbibition that creates vasomotion. When the spinal bones are moving and positioned normally every time you walk, bend, or move in general the spinal bones "bounce." That bounce creates a negative pressure inside the disc that draws in water and nutrients essential to the health of the disc. I have told patients the disc is comparable to a new born baby (demanding all the attention and food in the house....but cannot feed itself.)

2. Injured discs can resolve on their own, but we can do more to help facilitate the process and work to prevent it from recurring.

The majority of disc herniations improve on their own within six weeks to three months, as the body releases enzymes to clear away the herniated piece and the pressure on the nerves goes away.

Here at Pointes Chiropractic in St Clair Shores I use the Cox Flexion Distraction Technic on the state of the art Cox 8 table. I have obtained certification in the use of this technique for the cervical spine, the thoracic spine, the lumbar spine, and the extremities. This technique is listed by 65% of the Chiropractors in the country....but only about 1% of them are certified in it's use. The founder, and namesake, of the technique Dr. James Cox DC still personally certifies us in it's use. The certification must be maintained with continued learning and practice at seminars he runs. The technique is gently applied and must be done without any increase in discomfort. We actually treat the injured disc directly without drugs or surgery. Some techniques treat the area and the disc is left to secondarily heal on it's own, not so with the Cox Technique.

Why spinal manipulation? Spinal manipulation is the manual movement of the spinal vertebrae to restore normal range of motion, relieve nerve compression and irritation, relieve pain, and restore a state of well-being to the patient. Cox® Technic Flexion Distraction does just that.

In the lumbar spine, Cox® Technic

  1. Increases the disc space height 17%

  2. Increases the nerve opening sizes in the spine through which spinal nerves pass from the spinal cord to the body by up to 28% in area

  3. Intradiscal pressure reduction which reduces nerve irritation inside the disc and reduces nerve pressure on exiting nerves from the spine that cause arm and leg pain. This drop in pressure has been measured as high as 192 mm reduced pressure inside the intervertebral disc.

  4. Restores normal range of motion to the joints of the spine

  5. Establishes nerve conduction from the extremities, spinal joints and intervertebral discs to the spinal cord and brain that have a sedating and pain relieving capability. (afferentation)

In the cervical spine, Cox® Technic

  1. Lowers C4-C7 intradiscal pressures as much as 96 to 1583 mmHG pressure depending on the level.

    • (Gudavalli et al, Evidence-Based Comp Alt Med 2013, Article ID 954134 and Gudavalli MR, Potluri T, Carandang G, et al. Cervical intradiscal pressure changes during manual distraction. WFC 12th Biennial Congress, April 10-13, 2013, Durban, South Africa)

  2. Provides relief satisfaction for patients

    • (Gudavalli MR, Salsbury SA, Vining RD, Long CR, Corber L, Patwardhan AG, Goertz CM. Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain. Trials. 2015 Jun 5;16(1):259. doi: 10.1186/s13063-015-0770-6.)

  3. Restores normal range of motion to the joints of the spine

  4. Establishes nerve conduction from the extremities, spinal joints and intervertebral discs to the spinal cord and brain that have a sedating and pain relieving capability. (afferentation)

These techniques create the imbibition and vasomotion we referred to above. Essentially with the Cox Technic we are force feeding the "baby" (the disc) a weeks worth of meals in a matter of a few minutes. By decreasing the pressure inside the disc whatever is out...comes in. That includes any bulges/herniations/etc.. but also the nutrients essential to its healing and continued health.

A Cry in the Medical Literature for Spinal Manipulation

"I'm a chiropractor..." What does the other person say in reply? Something like "Oh doc, I have back pain..."? Chiropractic and back pain seem to go hand-in-hand. And spinal manipulation for back pain relief is effective.

Researchers and authors call for spinal manipulation as conservative care for lower back pain relief and other spinal conditions's relief. Here is a sampling of published articles calling for spinal manipulation, directly or indirectly:

  • Spinal manipulation is recommended by the American Pain Society and the American College of Physicians for primary care of low back pain. (Chou)

  • Back schools (for short-term improvement), and short courses of manipulation/mobilization can also be considered. The use of physical therapies (heat/cold, traction, laser, ultrasound, short wave, interferential, massage, corsets) cannot be recommended. We do not recommend TENS. (Airaksinen)

  • 5 to 10 sessions of spinal manipulative therapy administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up. (Dagenais)

  • Spinal manipulation is safe and recommended for acute low back pain. (Bigos)

  • Canadian Spine Surgeons Want Spine Surgery Candidates, Not Back Pain Sufferers

  • Canadians wait years for spinal surgeons appointments which they don't need. MRIs show spinal abnormalities that make family doctors refer unnecessarily. Lots of money is spent on unnecessary tests and doctor visits. Canada tries to set up a better system to train family doctors to better know who needs surgery and who doesn't. (Priest)

  • Life Threatening Complications and Costs Increase with Increased Rate of Complex Fusion Procedures (Deyo)

  • Disability after Fusion Is High, Fusion Rates Increase (Juratli)

  • Chiropractic patient back pain care less expensive than medical doctor care. (NC study) (Phelan)

  • Chiropractic patient back pain care initiated with a DC cost 40% less than care started with a MD. (TN study) (Liliedahl)

  • NEW - American College of Physicians recommend spinal manipulation is appropriate as first line care of acute, subacute and chronic low back pain. (Qaseem)

  • In the JAMA, a review reports that spinal manipulation for acute low back pain provides beneficial moderate relief with minor musculoskeletal side effects. (Paige)

  • NEW - Chiropractic spinal manipulation is popular today with more clinical trials being produced as well as guidelines recommending its use for back pain. (Deyo editorial)

Spinal manipulation has a place in spine pain relief. Spinal manipulation is non-surgical, non-invasive, effective, and less costly. Chiropractic is at the forefront of spinal manipulation delivery, with nearly 94% of spinal manipulation being delivered by chiropractors (though other healthcare providers are encroaching as its effectiveness is documented). Cox® Technic physicians are poised to be successful in back pain relief with this flavor of spinal manipulation.

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