What is a Herniated Disc?


A Herniated Disc is a term used to describe an abnormality of the Intervertebral Disc. Specifically, herniation occurs when a tear develops in the outer layers (annulus fibrosis) which leads to the inner (nucleus pulposus) escaping outwards. It can be considered the first “degree” of the condition.

We can visualize each Intervertebral Disc as a Jelly-filled donut. The inside Nucleus Pulposis (jelly) is made of sugar attached to protein and acts like a giant sponge. The outside of the “donut” is called the Annulus, which is made up of about sixty tough rings of collagen.

Intervertebral Discs are separated from the bones (vertebrae) above and below by Vertebral endplates. These endplates are made of cartilage – the same cartilage that lines the hip and knee joints. This cartilage pulls in water and oxygen. The disc functions to provide load-bearing and range of motion.

The spinal canal is home to the spinal cord and dozens of nerve roots that branch off the spinal cord, exit the spine between Vertebrae and continue to the bodily areas they serve. Ninety percent of lumbar disc herniations occur either at L4-L5 or L5-S1. Chiropractic treatment is usually the same for different levels of lumbar disc herniations but is applied as specifically as possible.

Disc Bulge, Slipped Disc, Herniated Disc: What is the Difference?
Four Degrees of Herniated Disc:

Disc Bulge (protrusion) occurs when the nucleus pulposis presses against the outer disc wall and the disc bulges beyond its normal perimeter. The jelly-like material is still contained within the disc’s tough outer wall. This is also referred to as a Disc protrusion and back pain may occur due to disc protrusions that do not enter the canal or compromise nerve roots.

Disc Extrusion is means the disc’s outer wall finally tears, allowing the inner gel-like material to escape containment by the outer wall.

Disc Sequestration may occur if some of the nucleus pulposus leaks out of the disc and is then separated from the disc altogether. The portion of nucleus that has detached may exert pressure on nearby spinal nerves, causing symptoms of pain, tingling, numbness or weakness throughout the muscles and skin innervated by that nerve. It is also possible that the sequestered disc material will be broken down and resorbed back into the bloodstream.

The annulus has a very weak blood supply, so tears are slow to heal. Scar tissue laid down that is not nearly as strong as the annulus’ collagen fibres. In addition, blood vessels that grow into the torn fibres of the disc carry new pain fibres in with them and the nucleus contains elements that can cause inflammation, all of which can lead to dull aching lower back pain.

Rare but Dangerous Symptoms of Herniated Disc in Lumbar Spine:

Sensory abnormalities in the genitals, anus, or perineum often coupled with loss of bladder or bowel control, lower back pain as well as progressive loss of sensation or motor function in the legs are ominous signs and warrant urgent evaluation and treatment. A person with these symptoms should be taken to the nearest emergency department for consultation with a spinal surgeon.

This rare condition (Cauda Equina Syndrome) is a medical emergency, whereby there is pressure and swelling of the nerves at the end of the spinal cord which could lead to paralysis. Men ages 30-50 years of age are most at risk.

Good news:
Lumbar Herniated Disc Symptoms Are Usually Short-Lived
While a lumbar herniated disc can be extremely painful, for most people the symptoms are not long-lasting. 90% of patients with lumbar disc herniations will no longer have radicular symptoms within 6 weeks, even without substantial medical intervention. Symptoms may resolve themselves for three reasons:

The body attacks the herniation as a foreign material, shrinking the size of the herniated material and reducing the amount of inflammatory proteins near the nerve root.
Over time, some of the water from inside the disc is absorbed into the body, causing the disc to shrink. The smaller disc is less likely to extend into nerve roots, causing irritation.
Lumbar extension exercises may be able to move the herniated area away from the spinal discs.

A Herniated Disc does not necessarily follow and lead to the next stage and in fact, there are healthy spine habits people can learn to not only prevent Disc Herniations but also to help to heal them.

There is NO correlation between a person’s pain and areas of the herniated disc found on MRI studies. In fact, 15% of teenagers and 60% of people over 60 can show areas of disc bulges on MRI and they have NO pain. On the other hand, there are people with severe pain, yet their MRI studies are completely normal.

Dr. Horowitz works closely with a patient’s general medical practitioner in co-managing the best treatment options available and to determine if and when expensive diagnostic imaging is required. Surgery is not usually required and most cases of disc herniations can be treated conservatively.


At Toronto Orthotics Foot, Leg & Back Pain Clinic, Dr. Horowitz offers effective treatments for sciatica relief that’s related to Disc Herniation. Call at (647) 349-4909 for an appointment or ask Dr. Horowitz a question by submitting the form below: