Disc herniation versus Disc Bulge

What is the difference between a disc herniation and disc bulge

You just received your MRI results and it says that you have a disc herniation or disc bulge. I’m sure this might be worrisome to you. So what does this mean? 

First of all, these terms are often used interchangeably but, in reality, there is a difference between the two.

Anatomy of the disc

https://youtu.be/pDGXX5OwQ2Y

The discs are spacers found between two vertebrae.  They are responsible for movement between the vertebrae; flexion, extension, rotations and lateral bending. 

They are made up of the following parts

  1. Annulus fibrosus – It consists of strong fibrous layers of criss-crossing fibers that firmly attach to the vertebrae above and below.  It is responsible for holding the two vertebrae together and pressurizing the inside of the disc.
  2. Nucleus pulposus.  This is found in the inner core of the disc. It is of jelly-like consistency.  The nucleus really likes water.  It absorbs water when we lay down. This is why we are taller in the morning. That excess water is squished out when we stand up and move around. 

Disc herniation

As you bend forward the pressure on the front of the disc causes the jelly like nucleus pulposus to creep backwards.  With repetitive flexion or flexion and rotation activities fissures can form  and the layers of connective tissue can separate in the annulus fibrosus (known as delamination). The nucleus can then work it’s way down these fissures.  Over time these cracks and fissures can extend out to the periphery of the disc which causes the nucleus to herniate out into the space where the nerves/spinal cord are located.  This is a disc herniation.

Think of it like a jelly filled donut.  Take a bite on one side of the donut and the pressure squirts the jelly out the hold.  If the hole for the jelly wasn’t there the jelly would be contained and not squirt out. 

Interestingly though, when it comes to an intervertebral disc, vertical pressure down on the disc won’t cause the jelly to herniate out but bending forward can.

Disc bulge 

Disc bulges are typically age related.  As we age, the discs have less ability to hold onto water. Less water causes the disc to decrease in height and bulge outwards. 

Think of this like a deflated tire. When a tire’s pressure is less than optimal the  car will sit lower and sides of the tire will bulge out.  If the bulge projects backwards towards the spinal cord. 

Both of these situations may cause back pain when there is nerve irritation (due to chemical irritation or physical compression).  But at the same time, there are numerous people walking around right now with disc herniations or bulges who experience no pain at all.  Their herniations or bulges may be of similar size and shape as yours. So what this means is your disc herniations or bulges may just be incidental findings. 

Be aware that most disc issues get better. Even the worst disc herniations resolve; as a matter of fact they are the most likely to resolve. 

So what can you do? 

Be assessed by a chiropractor, athletic therapist or other professional who can determine what factors aggravate or relieve you.  Seek someone who gets you active, guides you towards self care and makes lifestyle modifications  to manage pain and return you to an active healthy life.

Self Myofascial Release to the Muscles on the Back of the Neck

There are a number of muscles that reside in the back of the neck.  They are mostly covered by the trapezius.  Some of these muscles of the neck travel straight up the spine while others travel diagonally up and towards or away from the centre of the spine.  Many of these muscles start in the upper part of the thoracic spine and either end up in the neck or end up on the back of the head.

The main action of these muscles is to extend the neck and if they attach onto the skull they aid in extension of the head. Because some of these muscles travel diagonally they will also aid in rotation of the spine.  Therefore, when releasing these muscles, a rotation of the neck will provide a little more stretch.

Depending on the muscle involved pain can be referred to the neck, the top of the skull, behind the eyes.

These muscles can become over worked from head forward postures or from lifting heavy weights off the floor while hyperextending the neck.  Straining the neck to lift the weight up. These muscles are often associated with upper cervical joint dysfunctions and a hypomobile thoracic spine.  It is also important to check the muscles of the front of the neck as well.

There are a number of ways to release these muscles.  Acupuncture,  Active Release Techniques, dermal traction (cupping) instrument assisted soft tissue manipulation,  along with changing movement habits.

Self myofascial release of the muscles on the back of the neck.

There are a couple of ways to release these muscles on your own. You can use a ball or half ball help you with this.  Look up slightly and place the ball anywhere  from the base of the skull or down the back of the neck.  You can even extend this down into the upper back.  You will have press down through the trapezius muscle. Once you have made contact with the muscle bring your chin down towards your chest.  You will feel tension pulling on the ball resist this tension by directing your pressure in the opposite direction.

To get a little more out of this movement slightly turn your head left or right and feel the tension.  When turning make sure you maintain contact in the same spot.  Feel the tension and hold for 30 seconds to a minute twice a day.

Self myofascial release of the medial pterygoid

The medial pterygoid is a muscle of mastication (chewing).

It attaches onto the jaw near it’s angle but can’t be easily touched from out side of the mouth because there is bone is in the way.

Most of this muscle is found on the inside of the mouth just behind the bottom molars.

The action of this muscle is to close the jaw and to shift the jaw to the opposite side.

When it is a problem the ability to open the jaw is restricted.
and it can be quite tender to touch.

Pain can often be felt in the mouth but also around the TMJ.

I’m going to show you to methods to methods to treat this muscle. But remember that this muscle can be quit tender to do not be overly aggressive.

Method One

Slide your index finger down the inside of your cheek. The pad side is against the cheek and the nail said up against the molars. When you get to back of the molars you will bump into bone. Open your jaw and slide your finger in to the inner side of that bone . The muscle is right there. Apply mild to moderate pressure and wait for it to relax. Hold until it relaxes. Perform once 1 to 2 times a day.

Method two

Though not direct, this method helps treat the distal part of the muscle. As you can see, the muscle ends up at the angle of our jaw. Take your thumb and tuck it underneath your jaw at this point. Use the pad of your thumb to contact the tender point o this muscle. You will have an easier time getting into this spot if your tuck your chin down. Hold until it relaxes. Perform once 1 to 2 times a day

when trying to contact the muscle from the outside you need to be aware that there are salivary glands near here as well. If you feel like you are starting to salivate that tender spot may be the salivary gland.

Self myofascial release of the Temporalis Muscle

The temporalis is the muscle that you feel  over your temples when you clench your teeth and as you chew.

The muscle can be tender to touch and can refer to the upper teeth, over the eyebrow and on the side of the head and sometimes to the temporomandibular joint (TMJ).

It is responsible for closing the jaw (when both contract), moving the jaw from side to side (when one contracts) and a little bit of retraction (pulling the jaw backwards)

It is often affected by excessive gum chewing, jaw clenching, trauma to the muscle and head position.

In my practise I often use  active release technique (ART) or acupuncture to specifically treat this muscle in addition to addressing the causes of this muscle being over worked

To perform your own self treatment of this muscle (self myofascial release) take your thumb or a ball (the smaller the ball the more focused the pressure can be).  Pin the tender point down.  You don’t need to crush the muscle to do this.  Mild to moderate discomfort is fine. Since this muscle fans out from its insertion, once you have pinned the muscle out direct the ball/thumb  in different direction.

To add a stretch to it simply open up your mouth.   If you deviate your jaw to the other side you will add a little more stretch the the muscle.

Dr Notley

 

Why do I hurt? DIMs vs SIMS

When you are injured the degree of pain is not proportional to the degree of damage. There are more variables that are involved than tissue damage. The body, brain, interprets how dangerous the situation is. It looks at the present situation (ie, physical, emotional, environmental, psychological variable), past injury situations, and it looks at the future consequences of the injury. It evaluates the situation and then outputs what degree of threat it is.

One person may stub their toe and just keep on going. Another person, who had previously broken their toe, may be writhing in pain.

For some, they may tend towards anxiety, depression, or they may catastrophize the situation. This increases the danger and thus more pain will be experienced. A draw back to this is that these “Danger in Me” thoughts cause people to avoid what they need to do. This slows their progress in rehab, reducing their enjoyment and quality of life.

My job, with my athletes, is to reduce the anxieties or worries of their pain. Also, I am to help put themselves in situations where they can work the injured area in a “Safe in Me” environment. Building themselves up to the point where they can enjoy their sport, activity or life again.