The source of pain lies within the contents of the corresponding intervertebral unit. Pain occurs either due to direct mechanical pressure on the nerve root by the bulging disc tissue or triggered by the inflammatory process, to which the nerve responds when it is exposed to the foreign tissue of the disc material.
The cause of the disease however lies outside of the intervertebral unit. Herniation of the disc occurs due to variety of abnormal neuromuscular interactions in the whole body (not just a spine) that lead to repetitive overloading and resulting shearing forces that impact spinal discs.The causes of those abnormal forces are numerous. To name a few:
In most patients with herniated discs those factors coexist and interact.
There is a variety of other factors that may contribute to the chronic pain caused by the herniated disc, such as improper medical treatment in the very beginning of the disease, negative attitude and reckless behavior patterns, non-compliance with treatment protocols, depression, poor coping strategies, etc…
As it is so logical that treatment of the symptom and not the cause will fail, the treatment of the herniated disc must address the causes of the spinal overload which lead to pain and to the herniation.
Based on scientific studies and clinical experience, we know that some types of disc herniations dissolve with time. Symptoms from herniations, which do not dissolve, can be successfully eliminated if axial (vertical) compression on the spine is decreased.
The effect of decreasing axial compression of the spine would be the drastic reduction of pressure on intervertebral discs and spinal nerves, and normalization of biomechanics of the spinal joints and muscles of the affected segment. This allows for cessation of the inflammatory reaction around the nerve pinched by the herniated material of the disc.
Neuromechanics should be addressed as improper nerve/interface gliding can be inflammatory perpetuator. Gait( walking) mechanics should be addressed as gait and breathing are the two most important basic movement patterns.
Eventually, when spinal loads are properly redistributed by rehabilitative exercises, soft tissue physical therapy techniques, joint mobilizations/manipulations and variety of other conservative methods, the inflammation around the nerve is further decreased, the nerve root finds its way around herniated or protruded disc material and the pain disappears.
Herniated disc treatment should be based on careful clinical evaluation of all causative factors and their interactions. As all of the above-mentioned factors come from variety of structures and control systems within the neuromuscular complex, it requires a clinician who is intimately familiar with how different structures and control systems interact within human body.
Since disc herniations always result from multilayered pathology, herniated disc treatment and rehabilitation of patients should be either done by a multi-factorial group of physicians and therapists who understand each other’s language and practice within the same facility, or by a clinician who is familiar with structural and functional diagnostics and has proficiency in a variety of treatment techniques.