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.

How do I cure a sore back?

I recently received a question from someone on Klout.com asking the question, “How do I “cure a sore back”. Here is my response:

“How do I cure a sore back?”

It’s a difficult question to answer since there are multiple reasons for someone to have a sore back. Factors that may influence your lower back soreness may be:

Postural Strain

Staying in a stationary position for extended periods of time. For example, sitting for long periods of time. This is called postural strain.  To help with this, taking mini breaks from that position may help. http://drnotley.com/protect-your-spine-mini-breaks/

Inappropriate movement habits

If you are an athlete or are active then looking at your technique may be needed. Simply having someone help with your technique may be all that you need to take the strain off your back and allow your soreness to improve. A wonderful exercise that may be great for conditioning, like the burpee, may be detrimental to your back if done improperly http://drnotley.com/burpees-and-back-pain-my-thoughts/

Deconditioning

If you are not very active then developing general conditioning may be what you need.  I often see those who have back pain and they are very deconditioned but once they start getting active their pains diminish.

TRX suspension trainer and back pain: challenging the spine

Back Strength: Four for the Core

Unaddressed old injuries

If you have other injuries or an old injury these should be addressed. For lower backs we often need to look at spine posture during the actively, as well, as how the looking at the mobility or stability of the hips, knees, ankles and feet. If there are problems in these areas they can put added stress on the spine and cause pain.   What you may need if these is the case is exercises that will aid in increasing mobility of joints or stability.

Suboptimal health habits

Smoking (http://drnotley.com/chronic-pain-and-cigarette-smoking/), stress, and nutrition (http://drnotley.com/understanding-essential-fatty-acids/) can also cause back pain among other health issues.

Help from a professional

 Above, I have discussed approaches that require an active approach on your part.  These are very important because you are taking control of your health/pain which is very effective but there are passive methods that can be beneficial in the process.  Here are some examples

Pain referring to the back

Back pain/soreness may be as a result of other internal problems. For example, women have sore backs as a result of their menstrual cycle. A number of internal organ problems can result in back soreness.  A rule of thumb is that if you can’t find a position  or treatment that gives you relief or that there are no movements that cause added soreness then seeking out a medical doctor is warranted.

Conclusion

This is a round about way of saying that there are numerous ways to help a sore back.

Dr Notley

P.S. This list may not be all inclusive. If this pain persists seek out a Chiropractor, Athletic therapist, Physiotherapist, acupuncturist, or medical doctor.

Self Myofascial Release of the Shoulder: Deltoid

The deltoid muscle, capping the shoulder joint, is made up of three parts.  There is an anterior (front) part, lateral (middle) part and posterior (back) part.  It is used in all forms of movement of the shoulder

Action of the deltoid

The anterior deltoid flexes the shoulder forward while the posterior deltoid extends the shoulder.  The middle portion abducts the arm out to the side; assisted by the other two portions.

At least one part of the deltoid muscle is involved when performing shoulder press, pushups, bench press, chin ups and rowing activities.

Causes of pain in the deltoid

The deltoid can be a source of pain as a result of trauma or from over exertion. When experiencing pain into the shoulder the deltoid muscle is not the only possible cause of pain.  Possible causes include rotator cuff tears,biceps tendonitis, subdeltoid bursitis, shoulder impingement syndrome, and C5 radiculopathy.

How to release the deltoid

If all other possible causes of pain in the shoulder have been ruled out by a professional you may gain a benefit by just finding the tender point and holding pressure on it but I like to add a stretch to it. 

Anterior portion

The anterior deltoid is found on the front side of the shoulder.  Its main action is to aid in flexing the shoulder forwards. It originates on the collar bone and attaches onto the outer portion of the upper arm along with the other parts of the deltoid.  Underneath the anterior deltoid is the long head of the biceps tendon. When treating this muscle you might end up aggravating the tendon.

Standing facing a wall. Place the ball on the anterior deltoid.  Have your arm out to the side. Rotate your shoulder inwards so your palm faces outwards and then bend the elbow. Pin the muscle down and then rotate your body away from the shoulder. This helps take the stretch off the biceps muscle. 

Middle portion

The middle portion originates on the shoulder blade. It is active when lifting the arm out to the side (abduction). To stretch it you will want to adduct the arm. Place the ball on the wall and press the middle deltoid into the ball.  Take your arm and reach behind your back. Use your other hand to pull the hand further across the body and down towards your back pocket.

Posterior Portion

The posterior portion also originates on the shoulder blade. It is active in extending the arm backwards. To stretch you’ll have to flex the shoulder forwards. In this case you’ll be horizontally flexing or horizontally adducting the shoulder across the body

Facing away from the wall,  with your arm at shoulder height, place the ball between the wall and the muscle.  Rotate your body away from the wall. Use your other hand to help pull the elbow away from the wall.

Dr Notley

Winnipeg chiropractor and athletic therapist

Make sure to take a look at these related articles

https://drnotley.com/self-myofascial-release-of-the-shoulder-teres-major/

Self Myofascial Release of the Shoulder: Teres Major

Self Myofascial Release of the Teres Major Muscle

The teres major muscle is an important muscle that affects the shoulder and shoulder blade.  It originates near the inferior angle of the scapula (the bottom tip of the shoulder blade). It travels up through the armpit and attaches onto the humerus.  In the arm pit it runs right along side the latissimus dorsi muscle.

Activities that use this muscle

The teres major helps to adduct the arm, rotate the arm inwards and extend it backwards. It is most active when a resistance is added during these movements.  It is exercised during chin ups, pulldowns, and rowing activities. Other activities that use the teres major muscle are:

  • Wood chopping
  • Throwing a baseball
  • During the backward swing of walking/running
  • Holding the shoulder in extension (ie. reverse plank)
  • Adducting the arm behind the back
  • Pulling the steering wheel down
  • Typing with and old fashioned type writer

When this muscle is over used, beyond what it is capable of recovering from, it can become sore and refer to the back of the shoulder and down the upper arm.

How do you locate the muscle?

To locate the belly of the muscle put your hand on the back of your hand and place your opposite fingers onto the back side of the armpit. Push you hand into the back of your hand and resist.  You should feel the teres major and latissimus dorsi muscle tighten. Don’t worry which muscle it is you can treat both with the same movement.  

To locate the  attachment on the shoulder blade reach across with your opposite hand and feel the bony edge of the shoulder blade running almost vertically.  The upper two thirds of this edge is the teres minor. The lower to ⅓ is the teres major. Feel for a tender spot on the tip.  The body of the muscle is located on the back edge of the arm pit.

How to release the muscle

Place a ball onto the muscle.  To hit the belly of the muscle I prefer that you have it on the outer edge of the armpit, find a tender point and pin the muscle down.  Reach up towards the ceiling and feel added tension onto the muscle. If you externally rotate the shoulder (biceps facing backwards you will add a little more stretch to the area. 

To hit tender points near the bottom tip of the shoulder blade you’ll have to turn your body away from the wall. Perform the same movement as before.

*** Disclaimer *** This video and post is for educational purposes only. It is not medical advice. If you are in pain, please visit your local health care provider or contact Dr Notley if you are in #Winnipeg

Dr Notley – Winnipeg’s only dual credentialed chiropractor and athletic therapist

Self Myofascial Release of the Rotator Cuff – Infraspinatus

About the infraspinatus

The infraspinatus muscle is one of 4 muscles that make of the  rotator cuff muscles.

The infraspinatus muscle helps with external rotation of the shoulder (turning the front of the arm out to the side), horizontal abduction (moving the arm away from the body when the arm is out in front of you), and stabilizing the shoulder joint.

The muscle can be aggravated by catching yourself falling down the stairs by grabbing onto the bannister. Hard services in tennis, pitching a baseball, or during the follow through in a golf swing can also aggravate this muscle. Those that work with their arms out in front of them like musicians (violinist) and office workers are prone to irritating this muscle.

If this muscle is a problem you may experience discomfort with putting your hand behind your back and discomfort when brushing your hair or teeth.

Depending on where you touch on the muscle it may refer to the deltoid, the front of the shoulder  (along the lines of the biceps) and between the shoulder blade.

Locating the infraspinatus

To locate the muscle find the spine of the scapula; that bony ridge on the shoulder blade.  Place your fingers just below the spine. Most of the musculature below the spine of the scapula is the infraspinatus. (please refer to the video)

How to release the infraspinatus

Take a ball and pin the tender spot down. This can be accomplished by laying down on the ball or placing the ball between you and the wall. Reach across your body. Hold for 10 to 60 seconds.

*** Disclaimer *** This video is for educational purposes only. It is not medical advice. If you are in pain, please visit your local health care provider. If you are in Winnipeg go to the contact section to book an appointment with Dr Notley.