Of Low Back Pain
Causes of Low Back
of the nucleus pulposus (HNP) occurs when the nucleus
pulposus (gel-like substance) breaks through the anulus
fibrosus (tire-like structure) of an intervertebral disc
(spinal shock absorber).
A herniated disc occurs most often in the lumbar region of the spine especially
at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the
lumbar spine carries most of the body's weight. People between the ages of
30 and 50 appear to be vulnerable because the elasticity and water content
of the nucleus decreases with age.
The progression to an actual HNP varies from slow to sudden onset of symptoms.
There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion
(4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3
and 4 are complete herniations. Pain resulting from herniation may be combined
with a radiculopathy, which means neurological deficit. The deficit may include
sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness,
reflex loss). These changes are caused by nerve compression created by pressure
from interior disc material.
Progression of Herniated Disc
The extremities affected are dependent upon the vertebral level at which the
HNP occurred. Consider the following examples:
Cervical - Pain in the neck, shoulders, and arms
Thoracic - Pain radiates into the chest
Lumbar - Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation and is serious
requiring immediate surgical intervention. The symptoms include bilateral leg
pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness
of the anal sphincter.
Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle
spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation
of a spinal nerve) may increase when pressure is applied to the affected spinal
A Lasegue test, also known as Straight-leg Raising Test, is performed. The
patient lies down, the knee is extended, and the hip is flexed. If pain is
aggravated or produced, it is an indication the lower lumbosacral nerve roots
Other neurological tests are performed to determine loss of sensation and/or
motor function. Abnormal reflexes are noted as these changes may indicate the
location of the herniation.
Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance
Imaging (MRI) provides more detail. The MRI is the best method enabling the
physician to see the soft spinal tissues unseen in a conventional x-ray.
live life in pain!
Wendover Chiropractic Clinic Location
A, 3410 West
Wendover Avenue• Greensboro, North Carolina 27407
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