Herniated discs are a commonly encountered – often concerning – complaint in a chiropractor’s practice.
The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in people in their third to the fifth decade of life, with a male to female ratio of 2:1 (Fjeld et al, 2019).
The estimated prevalence of symptomatic herniated disc of the lumbar spine is about 1-3 percent of patients who experience any painful condition.
The prevalence is;
most significant among 30-50-year-olds
patients between 25-55 years old have an approximately 95 percent chance of herniated discs occurring either at L4-L5 or L5-S1 (Jordan et al, 2009)
Disc disease is the underlying aetiology in less than five percent of patients with back pain (Schwarzer et al, 1995).
A herniation is more likely to occur posterolaterally, where the annulus fibrosus is thinner and lacks structural support from the anterior or posterior longitudinal ligaments.
Due to its proximity, a posterolateral herniation is more likely to compress the nerve root. On the other hand, spinal cord compression and clinical myelopathy can occur if there is a herniation of a large midline disc.
According to Alexander et al, 2022 - localized back pain is a combination of the herniated disc pressure on the longitudinal ligament, and chemical irritation due to local inflammation.
Disc injuries – similar to most injuries – exist on a spectrum of severity. The severity of the injured disc can and does influence the prognosis of the injury.
Management of disc herniation is at times a challenge for any chiropractor. Patients are often in significant discomfort when presenting – and are looking for guidance and advice.
In a paper authored by Chiu et al, 2005 – in which they looked to determine the probability of spontaneous disc regression among each type of lumbar herniated disc – they observed the following:
The rate of spontaneous regression was found to be 96% for disc sequestration,
70% for disc extrusion,
41% for disc protrusion,
13% for disc bulging.
The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs.
More recently, Wang et al, 2020 completed a meta-analysis on the regression of symptomatic lumbar disc herniations. What they found was an overall incidence of regression of the LDH by 63%.
What was also highlighted in this study was that regression is likely to take place at 4 months post onset of injury – and can in some cases take up to 10.5 months.
Chiropractic care is an effective and safe form of care for disc herniations (Santilli et al 2006 and Snelling 2006, Jordan et al 2008) and carries with it low risk (Oliphant, 2004).
A chiropractor should bear in mind the likelihood of spontaneous regression of the disc herniation, whilst appreciating and communicating the an appropriate time frame that this may take.