What Is Disc Derangement?
Disc Injury Without Herniation?
In my first few months of practice I have come across several suspected cases of what is known as disc derangement. As a patient, it can be difficult to fully grasp, and comprehend what this means and how it differs from a disc herniation or a disc bulge. For this reason, I felt this would be an excellent topic to cover in this week’s post!
Disc derangement is a type of injury that is generated from irritation or tearing of the annular fibers surrounding the discs in our spine. Imagine the intervertebral discs as jelly filled donuts. When the bread surrounding the jelly (i.e. Nucleolus Pulposus) is injured, symptoms follow. The bread in this case represents what is known as a ligamentous tissue called the Annulus Fibrosus. Often times when someone hears the words ‘disc injury’ they assume this means that they have a herniated disc. It is crucial to understand that it is possible to injure the fibers surrounding the ‘Jelly’ without having a disc bulge or a disc herniation.
Derangement of annular fibers typically presents with local low back pain, and is thought to be one of the leading causes of all low back pain. Injuries to disc fibers are typically caused by repetitive forward bending, poor lifting biomechanics, or direct trauma to the back. Pain is often increased by forward bending and in some cases may even refer down into the gluteal muscles and legs. Coughing, sneezing, or bearing down in general may also increase symptoms. For this reason it can be tricky to differentiate disc derangement from a disc herniation or other injuries. However, there are key signs and symptoms that help distinguish and isolate one diagnosis from others. Without proper imagining it is nearly impossible to make a diagnosis with 100% confidence. Regardless, following a proper history and physical exam we are able to provide a treatment plan appropriately aimed at each individual’s clinical presentation in order to help him or her recover.
In the absence of red flags and suspicion of disc derangement, chiropractic manipulation along with other modalities have demonstrated excellent results for treating this condition.
At home exercises such as the Cobra, or other stretches that gently extend the spine are the typical starting point for home care. These exercises help alleviate pressure and tension placed on the annular fibers which in turn help facilitate healing. It is important to keep in mind that repetitive extension is not always the most appropriate bending pattern. While it is the most common directional pattern to help with disc derangement, providers should always make sure their care is individualized and specific to the patient in front of them. It is also important to avoid over doing these exercises during the initial phase on injury. Remember to take it nice and easy until the disc has had an opportunity to begin repairs.
Typically, annular fibers do not retain their pre-injury strength following a tear. Therefore, it is crucial for individuals to continue seeking care aimed at improving the mobility, health, and strength of their entire spine. While complete pre-injury status is not always achievable, our bodies are incredibly resilient! Taking the right steps to recover is essential following disc derangement to help prevent future injury, reverse the progression of a current injury, and to enable us to continue on doing the things we love.
If you are experiencing low back pain and are looking to get better, I encourage you to establish with a provider you trust. Low back pain can be frustrating but with proper information and guidance we can strive!
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