Disc herniation can be caused by an accident or trauma involving a large amount of force on the spine. It can also be caused by repetitive stress such as poor posture which puts pressure and tension on the spinal discs, causing them to herniate over time.
Before we talk about the causes of disc herniation, can you explain what the purpose of a spinal disc is and what it means to become herniated?
Dr. Luke Stringer: Absolutely. So essentially, a disc is between two vertebrae, two bones within the spine, obviously that’s all the way from the top of your neck, all the way to the bottom of your spine. And the disc is essentially, imagine a jelly donut. So, the bread of the donut is the collagenous tissue on the outside the disc, and the jelly inside the donut is this fluid within the central part of the disc. Its job is to act like a shock absorber between the bones. A really important job of a disc is to separate the bones enough so there is a lot of room for the nerves to come out of the nerve canal. And obviously, healthy discs that are full of fluid, nice and spongy, nice and malleable, allow the spine to move, flex and rotate, and absorb a lot of force. For example, if you’re running from the floor up, or if you’re sitting and gravity is coming down, discs are really, really important to separate those bones and keep space for the nerves.
Now, essentially a herniation, you have different types of disc pathology. That just means issues within the disc. The first thing that happens when a disc is under pressure from poor posture, for example, you start to lose this space from poor alignment, that creates a disc bulge. That’s where the disc fluid starts to bulge into the nerve canal. And then when a disc herniates, essentially what it means is the collagenous tissue on the outside of the disc essentially starts to crack and break. So instead of keeping a fluid in the central part of this where it should be, that fluid starts to shift out away from the central part of the disc, and it can shift into the nerve canal, for example.
And then, obviously, there are different types of herniations, or should I say different severities of herniation. Without getting too technical, it’s all based on the amount of damage within the collagenous tissue, how badly damaged it is, and also how much fluid is coming out of the disc. For example, a bulge and a herniation is on the lower end versus dissection and/or prolapse is obviously when a disc is completely damaged and more often than not needs surgery. So yeah, it’s super important. The less herniated the disc you have, the better.
Can excessive strain, force or traumatic injury cause a herniated disc?
Dr. Luke Stringer: Yeah, absolutely. And there are different types of trauma, right? And alluding to your question, a traumatic injury, for example, a car accident, you’re driving down the road or at a stop sign, someone rear ends you at 50 miles an hour, that’s going to create a massive amount of force that is going to be absorbed predominantly by the spine. This is obviously going to damage the soft tissue, muscle, ligaments, tendons, and it can absolutely damage the disc enough to herniate, dissect, or even prolapse.
But to the early part of the question, can excessive strain cause a herniated disc? Absolutely. Now, what is strain? Could it be a lifting injury? You may have poor lifting form, or you’ve gone to lift and it’s creating damage in a disc. That can absolutely happen. Or it can be repetitive stress, which over time creates stress and strain within the disc. For example, you’ve got really poor neck posture. Your head is out in front of your chest, you’ve lost your neck curve, you’re putting too much pressure to the front of the disc. Well, repetitively over time, that stress and strain and tension is going to break that joint down and break the disc down, which can cause disc pathology, bulges, herniations. Absolutely, there are different ways and different types of trauma and strains that can absolutely damage the discs within the spine.
Can the aging process cause herniated discs?
Dr. Luke Stringer: Yeah, it’s a great question. And we talk about this a lot with our patients. We all degenerate in our lives, but how quickly is up to us, right? So, if spine is in alignment and the joints are moving well, that should keep the disc stimulated. And when the spine moves, you stimulate the disc, and that’s how the disc creates osmosis and fills full of fluid. So, there’s no reason why just by aging, we should break down and have a herniated disc.
Now, what happens as we age? Well, obviously as we age, the fluid in the disc essentially dissipates and there’s less fluid within the disc, which creates the disc to become more brittle because it’s not full of fluid. And obviously, as we age, we do experience changes, just because when we’re a geriatric and gravity is playing his toll on the spine, over time you are going to see the degenerative changes, but how severe is up to us based on alignment, function and, obviously, traumas.
So just by aging, discs do not need to herniate. But by aging, can it lead to issues within the disc and a joint? Absolutely, due to dehydration in the disc, degenerative changes in the joint. And those two things are going to create pathology and issues within the disc. But just by aging, it doesn’t necessarily mean your discs are going to herniate. But by aging, that can happen as a by-product, yeah.
Are some people genetically prone to disc herniation?
Dr. Luke Stringer: I’ve yet to see any research that backs that, that genetics play a role in disc herniations. Now, does that completely rule it out? No. There are conditions out there that can be genetically based, for example, just really hypermobile joints, or too much elasticity in the collagen within the joint. So, the joint moves too much due to that condition, then, yeah, the disc is going to have more stress and tension on it than a joint that’s moving within normal limits. So, that can make you prone to more disc herniations.
That question is a tough one to answer. I’m unaware of a genetic condition that creates herniations within a disc. However, there are spinal conditions and soft tissue conditions that are genetic, that can create issues in the joint, which can lead to more propensity of disc herniations, absolutely. But just because your old man blew out his low back working in a factory for 40 years doesn’t mean that that’s going to happen to you. There’s a lot that goes into it. Again, alignment, joint function, the type of stress that you put in the joint and the disc in the day-to-day.
Are there any other causes of disc herniation that we have not discussed?
Dr. Luke Stringer: I don’t think we haven’t discussed a specific cause, but let’s discuss posture. Because essentially, posture is the window to your health. We practice downtown, the South Loop in Chicago, and obviously we’re speaking to the local community on the importance of good posture, and spine alignment optimizes function within the nervous system, and gets our discs to function optimally.
So, if we’re in poor posture, for example, we should have a 40-degree curve in our lower back. Because we’ve been sitting at a desk for 10 years, 40 hours a week, that curve is now at 20-degrees. We lost 50% of the curve within our lower back, which is quite common to see within the corporate athlete. Well, what happens is because the curve is designed to absorb force at the back of the joint, well, because we have less of the curve, the weight, instead of being absorbed in the back of the joint where all the extra bone is, it’s now going to migrate to the middle of the front of the joint. So then when we’re seated in a flex position leaning forwards, the weight is now not all being absorbed in the back of the joint where it should be, it’s being absorbed in the front.
So obviously, as we repetitively do this over time, if the front of the joint in our lower back is now absorbing more force than the back, this is going to increase pressure in the disc. By being seated and sitting in a flexed position, so leaning forwards, that’s poor posture. And research is pretty clear, you can increase pressure within the joint by 300%. So, by repetitively doing this day to day, that can absolutely lead to issues in the disc, herniations, and degeneration in the spine. I think that’s an important piece that we also need to discuss.
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