What does the proverbial fallen tree have in common with a herniated, bulging, slipped disc? I can’t tell you how many times patients, friends, acquaintances have told me, I have a herniated (slipped or bulging) disc. And that’s why I have pain.
Whether I offer my opinion is another question, but if they do ask, here is what I ask. Does the MRI confirm that a spinal nerve is being ‘Impinged’ on?
What Does an Impinged Nerve Mean?
This is where the similarities of the Fallen Tree come in, because I think we all can agree that the fallen tree does make a sound when it hits the ground. The real question is whether someone is there to hear it hit the ground? If there’s no one there to hear it fall… big deal!
The same can be said about the herniated, bulging, slipped disc… is it hitting or touching a spinal nerve that’s causing the pain? According to evidence-based medicine about 50% of the adult population, typically those over 40 years of age have one, if not more herniated, bulging, slipped disc… and are Pain free, without symptoms!
The reason they are without pain has to do with the fact that the herniation or bulge is NOT Impinging or Touching a spinal nerve. Another words… No one is there to hear the tree fall! The bulging disc is not touching a nerve!
Is the Herniated, Bulging Disc Impinging on a Nerve?
Think of your disc like a Hostess Ding Dong or Cupcake, and the creamy white filling is similar to what leaks out (herniates or bulges) of your spinal disc.
It all depends on where the bulge or herniation is at! If the nucleus (the white creamy filling) bulges out the back… the side… or somewhere between the back and side of the disc. The real question is, does it imping or touch a spinal nerve, and confirm the probability that your pain is coming from a herniated disc?
- Let’s say, it bulges out 10 degrees off of dead center… and hits, touches, or impinges on a spinal nerve. There’s a very good probability that you are going to have associated pain and/or problems (sensory difficulties), to which surgical intervention may be necessary.
- However, what if the herniation or bulge is 20 degrees off of dead center… and doesn’t touch, interfere, or impinge on a nerve? (there’s no one there to hear the tree fall!) What it’s telling you is, you need to look elsewhere for the cause of your pain, because the nerve isn’t being impinged upon.
- What I’m trying to say is that simply having a herniated or bulging disc doesn’t automatically indicate your pain is a result of the herniation or bulge. If the herniation is NOT Impinging (this is the term, commonly used on medical reports) on a nerve. Your pain is more than likely coming from somewhere else.Searching for the Cause
When you’re trying to diagnose the cause, you need to also look at the clinical presentation (the exam findings) of the patient and the Objective findings (MRI, CT, etc).
Does your pain run into your arms/legs. Is it the whole arm or leg? Does the pain go down the front, the back of the arm/leg? Or only the front or back? Does it stop at the elbow/knee? Does it go to all your toes/fingers? Or is the pain only to these 2 or 3 toes/fingers?
- Are your reflexes still working? Do you have normal muscle strength for all the muscles that move your Ankles? Knees? Wrists? Elbows?
- Are there any sensory deficits? Does it feel the same on one side as on the other side?
- Do certain movements increase or decrease the pain? Numbness? Sensation?
- Does your pain increase/decrease with certain movements?
- Going from sitting to standing versus standing to sitting?
- Moving your arm or neck in certain positions?
Sprain/Strain and Muscle Imbalance
A good clinical workup will help determine the cause of your Pain. A number of aches and pains are caused by sprain/strain injuries, as well as muscle imbalances.
Sprain strain injuries can come about in so many different ways from lifting something heavy; weekend warrior activities; gardening; carrying too many grocery bags, etcetera.
What about Muscle Imbalance? This is something I’ve seen a lot, and the cause of so many unexplained aches and pains. Keep in mind, we weren’t designed to sit for hours; or sit with our head down, shoulders rounded and pulled forward… as we read our cell phones or computers for hours at a time. Let’s not forget the person, the mechanic, the hairdresser, the piano player who spends hours in certain positions… that leads to muscle imbalance.
Think of your muscles like guitar strings. They need to be wound a certain tension to play pretty music. The same is true with being pain free, your muscles can easily get wound too tight because of too much sitting; head down, shoulders rounded, knee’s bent, high heels, etcetera. This causes one muscle to become shorter (tighter) than it’s opposing muscle, which is getting stretched. That’s how you develop muscle imbalance and a major cause of aches and pains.
I’ll share more about how to correct some of these common aches and pains associated with muscle imbalance(s) and a couple of good DIY Do-It-Yourself tests and movements you can do to help restore balance.
