Chiropractic Care For Herniated Discs? Ask Dr. Frank R. Stiso, Wall TWP NJ
Updated: Oct 11
If you've been told you have a herniated, prolapsed, or slipped disc, don't panic. First, let's understand what is happening.
Being told you have a herniated disc or protruding disk can be frightening. For many people, the first thing they hear is something like, “Your disc is herniated and it's pressing on a nerve.” Then comes the MRI, a report filled with unfamiliar medical terms, and sometimes a discussion about spinal surgery. It's understandable that a patient may become worried about what is going to happen to their back.
As the owner and operator of Stiso Chiropractic & Acupuncture in Manasquan NJ, I understands that feeling because I've been on the other side of that conversation myself.
In 1995, I was involved in a serious automobile accident and was rushed to the hospital. I was found to have three lumbar disc herniations, and I was told by the doctors in the emergency department that I needed disc surgery.
My father, Dr. Frank A. Stiso, had already spent nearly 30 years in chiropractic practice and was highly respected within the profession. I trusted his judgment completely. He disagreed with the recommendation for immediate surgery and believed that I should first be given an opportunity to respond to chiropractic care.
He treated me himself. Over time, the size of all three disc herniations decreased, my symptoms improved, and I avoided surgery. That was 31 years ago. I have now been practicing chiropractic since 2000 and have successfully treated thousands of patients with lumbar disc problems. So when someone sits in my office after being told they have a herniated disc, I don't just see an MRI. I understand the fear that can come with hearing those words. My first goal is to help the patient understand what is actually happening. Once you understand your spine, your disc and your symptoms, the situation often becomes much less frightening.
Let's Start With the Disc
A spinal disc is designed to absorb and distribute the tremendous forces placed on your spine every day. The discs sit between the vertebrae and provide cushioning while allowing movement between the bones of the spine.
The disc has a tough outer portion called the annulus fibrosus and a softer, gel-like center called the nucleus pulposus. The annulus surrounds and contains the nucleus. When the disc is healthy, the nucleus remains contained within the annulus.
The problems begin when the disc is subjected to more stress and compression than it can tolerate. This can happen suddenly, such as during a car accident or while lifting something heavy, or it can develop gradually from years of repetitive bending, lifting, poor mechanics and normal degenerative changes. Understanding this progression is important because a disc problem doesn't necessarily begin as a full-blown herniation.
What Happens When a Disc Is Compressed?
Think about what happens when you repeatedly squeeze an ice cream sandwich. The more pressure you place on it, the more ice cream move away from that pressure and travels outward. Your spinal discs behave in a similar way.
When a disc is compressed, the nucleus can push outward against the annulus fibrosus. At this stage, the annulus can still be intact even though the disc has begun to extend beyond its normal boundaries. This is commonly referred to as a bulged disc or "slipped disk".
A bulging disc is different from a herniated disc. With a bulge, the disc has extended beyond its normal margins, but the outer annulus has not necessarily torn and allowed the nucleus to escape. In my experience, this is an important stage because the disc has been injured and is under abnormal stress, but the nucleus is still contained.
This is one of the reasons I don't want patients to ignore a bulging disc simply because they haven't developed severe symptoms yet. A disc that is repeatedly subjected to excessive compression can become progressively weaker and more vulnerable to further injury.
If that process continues, the disc can lose some of its ability to withstand normal loads. Repeated injury and degeneration can also contribute to loss of disc material and disc height over time. As the disc becomes thinner, it can become less effective at maintaining the normal spacing between the vertebrae.
Eventually, a sufficiently stressed or weakened annulus can tear. When that happens, the nucleus pulposus has a pathway through which it can protrude beyond the normal boundaries of the disc. That is a herniated disc.
Won't The Nucleus Keep Leaking Out?
No. It is important to understand that although the tear has created a permanent canal for the inner disc material to escape, if you minimize the amount of pressure on the disc the inner nucleus material will stay inside.
Let's use this simple analogy to help visualize what I mean. Imagine a jelly donut. If you look closely at the side of the donut, you can usually see the small opening where the jelly was injected. Under normal circumstances, the jelly remains inside the donut.
Now place that donut on a plate and press down on the top of it. The pressure causes the jelly inside to move away from the force being applied. If there is an opening in the side, the jelly can begin to squeeze through that opening.
That's a simple way to visualize what can happen with a torn disc. The annulus represents the outer portion of the donut, and the nucleus pulposus represents the jelly inside. Once the annulus has been compromised, increased pressure on the disc can cause the nucleus to move through the damaged area.
The displaced material can move toward the spinal canal or toward the opening where a spinal nerve exits the spine. If it irritates or compresses a nerve root, it can produce symptoms such as pain, numbness, tingling, burning or weakness into the buttock and leg.
The important thing to understand is that the tear itself isn't necessarily what causes all of the pain. The symptoms can develop when the displaced disc material begins irritating or compressing nearby structures, particularly a spinal nerve.
To understand why a disc problem can cause pain down your leg, it helps to understand the anatomy around the nerves. The spinal cord travels through the spinal canal and gives rise to spinal nerve roots. As those nerves leave the spine, they pass through openings called intervertebral foramina. I often describe these openings to patients as doorways through which the nerves exit the spine. If a disc herniates toward one of these nerves, the displaced disc material can irritate or compress the nerve. That's when a problem that started in your lower back can produce symptoms somewhere else.
You may feel pain and/or numbness in your buttock, thigh, calf or foot. You may experience numbness, tingling, burning or an electric-type sensation. Some patients develop weakness in a particular muscle group or notice changes in their reflexes. When the sciatic nerve or the nerve roots that contribute to it are involved, patients commonly refer to these symptoms as sciatica.
Sometimes the leg symptoms can be much worse than the actual back pain. A patient may tell me, “My back doesn't even hurt that much, but my leg is killing me.” That makes sense when you understand the anatomy. The problem may be less about the amount of pain coming directly from the disc and more about what is happening to the nerve.
To Learn If Chiropractic Care For You, Call Our Office
Today to Schedule a FREE Consultation.
Why Can Coughing, Sneezing or Bending Forward Hurt?
This is another question I hear frequently. A patient will tell me, “Every time I cough or sneeze, I get a sharp pain down my leg.” Coughing, sneezing and straining can produce a rapid increase in pressure within the abdomen and spinal canal. When a nerve root is already irritated by a disc problem, that sudden change in pressure can aggravate the symptoms. This is one reason patients with certain types of disc herniation may experience a sharp increase in pain when they cough or sneeze.
Bending forward can also increase stress on the lumbar discs. Sitting for prolonged periods, lifting, bending and twisting can create additional mechanical stress on an already irritated area. This doesn't mean that everyone with a herniated disc will experience exactly the same pattern, but these are common complaints I hear from patients with lumbar disc problems.
Why Does the Direction I Lean Sometimes Make a Difference?
You may also notice that your body naturally wants to lean to one side when your back or leg is hurting. Some patients with certain lateral disc displacements feel better when they lean away from the painful side, while others may find relief in the opposite direction.
The reason has to do with the location of the displaced disc material and how changing the position of the spine changes the relationship between the disc, the spinal canal and the nerve. A disc displacement that is more lateral can produce a different mechanical pattern than one that is positioned more toward the center.
This is one of the reasons I don't treat an MRI alone. I want to know what the patient is feeling, what movements reproduce the symptoms, what positions relieve them, what the neurological examination shows and how all of that information fits together. The MRI is one piece of the puzzle, but the patient in front of me is the whole picture.
Can Herniated Disc Symptoms Go Away On Their Own?
The pain and other symptoms associated with a herniated disc can improve substantially, and in some cases they can disappear altogether. The displaced disc material can also decrease in size as the body gradually resorbs it. But there is an important distinction that I want my patients to understand: the disappearance of pain does not mean that the injured disc has returned to its original, healthy condition.
I've had countless new patients tell me, “I had a herniated disc years ago, but it went away" or "I throw my back out a couple times a year but it always goes away with rest, I know my body.” What they are describing may be the disappearance of their symptoms or the fact that the displaced disc material became smaller. Those are real changes, but they are not necessarily the same thing as the disc returning to the condition it was in before it was injured.
A herniated disc is an injury to the disc. When the annulus is damaged and the nucleus pulposus is displaced through that damaged area, the anatomy of the disc has changed. The body has a fascinating way of dealing with displaced disc material. When nucleus pulposus material moves outside of the disc, the body identifies that displaced material as abnormal tissue. Immune cells called macrophages can migrate toward it and engulf and break it down through a process called phagocytosis. These cells actively dissolve the disc material that is outside the disk. This may sound like your body is healing the disc because it is removing the herniation, however when this process ends you are left with a smaller disc. Every time you experience another injury, additional disc material can be pushed out, and this process can begin again.
Over time, repeated injury and degenerative changes can also cause a disc to lose height. As the disc becomes thinner, the openings through which the nerves travel can become smaller. This can eventually contribute to narrowing around the nerve and change the way the patient's back responds to activity. That is one reason why the back problem you experience at 50 may not behave exactly like the one you experienced at 30.
So Where Does Chiropractic Fit Into All of This?
This is where I want patients to understand that a herniated disc does not automatically mean you need surgery.
During a chiropractic adjustment, we can move the vertebrae in a way that reduces the amount of pressure it is putting in the injured disc below or above. By reducing the forces placed on the disc, we canDuring a chiropractic adjustment, we can move the vertebrae in a way that may reduce mechanical stress on the injured disc. By reducing the forces placed on the disc, we may help decrease irritation around the disc and nearby nerve decrease irritation around the disc and nearby nerve. The goal is to change the mechanical environment around the injured disc so that it has a better opportunity to settle down and recover.
One study followed patients with MRI-documented disc herniations who received chiropractic care and found that, on follow-up MRI, 63% had either a reduction in the size of their herniation or complete resorption of the herniated material. Another randomized study comparing chiropractic spinal manipulation with microdiscectomy found that, after one year, patients who received a chiropractic adjustment had outcomes that were not significantly different from those who underwent surgery. More recent research involving thousands of patients has also found that those receiving chiropractic spinal manipulation had lower odds of eventually undergoing lumbar discectomy.
Once Improved, What Can I Do to Prevent Future Injuries?
One of the things I enjoy most about treating disc patients is helping them understand what they can do to protect their back after they start feeling better. Getting someone out of pain is only part of the process. I also want patients to understand how they can reduce the likelihood of another episode.
That may include strengthening the core muscles that support the spine, improving flexibility, learning proper lifting mechanics and understanding which activities place excessive stress on their particular back. I also educate patients about what I call spinal hygiene, the everyday habits that help maintain a healthy, functional spine.
A patient who has experienced a disc herniation should understand that another exacerbation is possible. Remember, the tear is still there and the disc is susceptible to this happening again in the future. Heavy lifting, repetitive bending and twisting, prolonged sitting, poor mechanics or another injury can place additional stress on an already vulnerable disc. That's why I don't want patients to think of treatment as simply getting rid of today's pain. I want them to learn how to manage their spine for the rest of their lives.
I often tell my patients that the human body is a lot like a house. The screws don't tighten themselves as the years go by, the windows don't become less drafty and the roof doesn't repair itself. A house requires maintenance if you want it to continue functioning at its best. Your body does too. This is where supportive chiropractic care comes. The goal is to maintain the improvements achieved during your chiropractic treatment program. That is why I recommend regular chiropractic check-ups and additional treatment when needed.
Research shows that supportive chiropractic care can be useful after the initial problem has been brought under control. In a randomized controlled trial of 328 patients who had responded well to an initial course of chiropractic care, those receiving scheduled maintenance care experienced fewer days of bothersome low-back pain over the following year compared with those who returned only when their symptoms returned. https://pubmed.ncbi.nlm.nih.gov/30208070/?utm_source=chatgpt.com
What About Surgery?
There are certainly situations where surgery is appropriate, and some patients ultimately need it. But there is an important difference between knowing that surgery is available and assuming that surgery must be the first thing you do. If an appropriately selected patient tries conservative care, including chiropractic treatment, and does not get the result they need, surgery can still be considered. The reverse is not always true.
Once a patient has undergone a laminectomy, discectomy or spinal fusion, the anatomy and biomechanics of that portion of the spine have been changed. Depending on the procedure, this can significantly limit the types of chiropractic procedures that can safely be performed afterward.
That doesn't mean that someone who has had back surgery can never receive chiropractic care. It means that the treatment options can become more limited. For that reason, I believe patients should understand their conservative options before making an irreversible decision about their spine.
Remember, I'm a Patient Too.
I know what it is like to hear that you have multiple disk herniations that are permanent and will be a concern for the remainder of your life. I know what it is like to have doctors tell you that you need surgery. And I know what it feels like when someone you trust takes the time to explain what is happening and gives you confidence that there may be another path worth exploring. That is what my father did for me back in 1995, and that experience has stayed with me throughout my career.
Since beginning my practice in 2000, I have treated thousands of patients with lumbar disc problems. I've seen patients come into my office frightened because they have been told that their MRI looks terrible. I've also seen those same patients improve, regain their confidence and get back to the activities they enjoy.
Every patient and every disc is different, and no treatment can guarantee the same result for everyone. But if you have been diagnosed with a lumbar disc herniation, disc protrusion, disc extrusion, sciatica or lumbar radiculopathy, don't panic and don't assume that surgery is automatically your only option.
Take the time to understand what is happening in your spine. Understand what your MRI actually shows and how it relates to your symptoms. Most importantly, understand that you may have more than one option.
Before you have surgery, consider having a consultation with an experienced chiropractic physician to determine whether conservative chiropractic care may be appropriate for you.
Sometimes the best first step is simply understanding what is happening and finding out what your options are.
Stiso Chiropractic. Acupuncture & Massage
1903 Atlantic Avenue, Manasquan NJ 08736