Ruptured Disc! Herniated Disc! Extruded Disc! Oh my. You flinch at the sound of these terms because you have experienced the pain or know someone who has. The appropriate term for these types of herniated discs is "non-contained disc."
The non-contained disc may cause back but usually pain into the extremities (one or both legs). This disc condition causes you pain because its nucleus pulposus (the center of the disc) has escaped through tears in the anulusfibrosus (the outer layers of the disc) and found itself in the spinal canal where it isn’t supposed to be. The anulusfibrosus no longer contains the nucleus pulposus.
The non-contained disc irritates the spinal nerves with a chemical reaction or with pressure. Normally, the nucleus pulposus' fluid has never been in the spinal canal, and when it does enter, it causes a chemical reaction around the nerve to cause pain into the pelvis and leg.The nucleus pulposus' fluid chemically irritates the spinal nerves just by its mere presence in the canal, and, if enough of it escapes into the canal, its mass presses on spinal nerves causing pain into the leg.
Check out this description of a non-contained disc herniation correlated with imaging.
Non-contained discs (aka free fragment or extrusion) may be managed well conservatively. Non-contained lumbar disc herniations show better non-surgical relief than contained discs. (1) MRI helps in visualizing and monitoring the disc and nerve root changes while care is administered. (2) Nine of 11 non-contained discs shrunk 50% to 100% non-operatively. (3) Larger non-contained discs reduce the most. (4) Research notes spontaneous resorption of intradural disc material via macrophage and angiogenesis (the process of new blood vessels forming) within the disc. (5) As a matter of fact, free fragments (non-contained discs) absorb and decrease in size more than protruding (contained) discs. When the non-contained fragment moves, an even greater reduction in size is seen. (6) Phagocytes and cytokines play a role in helping resorb the non-contained disc. (7, 2)
A thorough, clinical examination that may include imaging is important to your recovery.
Lumbar Spine Exam Description
In-office, Manchester Chiropractic & Sports Injuries use Cox Technic Flexion Distraction and Decompression to lower the pressure in the disc and aid in the absorption of the free nuclear material that is irritating the nerve. Cox Technic also aids in the healing of the torn anular fibers and drives out chemicals that irritate and inflame the spinal nerves.
Graphic Animation of Cox Technic - Lumbar Spine
The disc is pressing on the nerve. Note that as the disc herniation reduces, the pinched nerve is relieved.
This is an animation of the goal of Cox Technic Flexion-Distraction and Decompression: reduced irritation of spinal elements enough to relieve pain and help you regain your quality of life. The amount of decrease in size of the herniated disc necessary for pain relief varies from 0% to 100% for each individual patient.
Cox Technic Protocol I - for severe pain or pain that extends below the knee
Cox Technic Protocol II - for pain that is in the low back and stays above the knee
Time to Improvement
You must understand that it takes three months for a torn disc to heal well enough to allow you to return to daily activities like prolonged sitting, bending, lifting, twisting, etc. The first three to four weeks of concentrated treatment, therapies, and at-home care are designed to allow the best opportunity for the disc to heal quickly. This three month window does not mean that you must be treated continually throughout this time period, but means that you must be cautious and aware of your spine's healing. Recognize that even though the pain is gone, healing is still taking place and could be hindered if you do something to aggravate the process.
In the 1000 cases study of patients undergoing care for their back pain, 91% reported maximum improvement in 90 days of care and 70% of patients in less than 30 visits.
At Home Care
At home you will want to avoid sitting for long periods of time, wear a support brace if recommended, take nutritional supplements that help rebuild disc cartilage, sleep on a supportive mattress, sit in an ergonomically designed chair, avoid constipation which just forces you to use pressure that your spine doesn't need, and modify your daily activities as needed.
Exercise is important to your recovery and prevention of future pain.
It is important to start exercises as soon as possible, not vigorously, but gently.
Do only exercises recommended.
Do exercises only to your tolerance.
Clinical Case Reports
Contact Manchester Chiropractic & Sports Injuries for gentle, relieving care of your lumbar spine non-contained disc herniation.
- Cox, JM, Feller JA, Cox JA: Distraction Chiropractic Adjusting: Clinical Application, Treatment Algorithms, and Clinical Outcomes of 1000 Cases Studied. Topics in Clinical Chiropractic 1996; (3)3:45-59, 79-81
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page. Content is reviewed by Dr. James M. Cox I