Question
I have just been diagnosed with disc degenerative disease in all of my lumbar discs but L5/S1 is herniated with tear and protruding fragments. the orthopedic surgeon that i went to suggested that i see a chiropractor, do pain management with shots or surgery. i just wonder how a chiropractor can help me in this case.

Answer
Dear Gloria,

Chiropractic physicians often get great results in treating disk herniations.  All chiropractors are trained in school to adjust the spine in a manner to reduce the stress on the disk and alleviate pressure. This in turn helps to elimnate pressure and inflammation around the nerve roots that exit the spine, and increases the circulation in the affected area to allow for dispersing the local inflammtory mediators and increasing oxygen and nutrition delivery for repair.

Furthermore, there are many specialized devices in use today that specifically target the disk in a conservative manner to alleviate pressure, re-establish hydration to the disk tissue, and allow for a better scar formation in the outer portion of the disk so that pain can be reduced.  Such devices are:   cox flexion tables and technique, flexion-distraction tables, lumbar posture pumps,and decompression devices...most chiropractors utilize one or more of these technologies in their offices. Moreover, improved nutrition for inflammation reduction, and specialized exercise programs should be utilized to help progress you along while reducing pain and increasing healing.

Spinal manipulation (adjustments) have been proven effective in pain control due to the neurological stimulation of the spinal cord and brain.  This produces mechanical stimulation of the tissue which down regulates pain transmission.  The physiology and neurology of the spinal adjustment is actually very complicated, but I will give you a short but highly detailed version:

A normal spinal column should be in a constant state of motion.  It moves in response to breathing, heartbeat, blood circulation, cranial rhythms, and other body movements.  Neither the spine nor the connective tissue that supports and surrounds the spine should ever be stagnant.  This constant normal motion is what helps to circulate the cerebral spinal fluid that protects the spinal cord and brain. This motion is also responsible for the hydration/nourishment of the discs which cushion the spine from gravity.  

When an area of the body, (specifically the spine), is not stimulated through movement, the underlying chronic muscle becomes tense, cutting off capillary circulation to the area.  As this circulation decreases, the makeup of the soft tissue becomes less fluid or sticky.  The muscles, ligaments etc?become a matted mess of connective tissue over time.  This is how adhesions and scar tissue form.  The resulting mass of hardened tissue can be felt through the skin, and is frequently painful.

This type of build-up can be improved upon or even reversed by the intervention of manipulative techniques.  The immediate effect is to transform the physical nature of the tissue matrix.  The greater fluidity of the tissue will allow for greater movement patterns as well as the return of capillary blood flow to the tissues.  Exercise and stretching will also aid this process.

The science behind the chiropractic adjustment or manipulation is rooted in the neurological and mechanical.  Chiropractic Physicians apply specific forces to the spine and other joints in the body in order to stimulate the central and peripheral nervous systems, as well as re-establish normal movement patterns at fixated joints.  While the hardened, sticky tissue matrix is being softened through manipulation, there are also important signals being transmitted to the brain via specialized receptors in the joint capsules, muscles, and ligaments.  These are mechanoreceptors, (transmitting pressure and velocity signals), and proprioceptors, (transmitting positional awareness).  These impulses are beneficial and serve not only to inform the brain of changing mechanics and tissue densities, but also to block the function of nociceptors, (which transmit noxious or pain signals).

The Basic NeuroAnatomy & NeuroPhysiology Behind the
CHIROPRACTIC ADJUSTMENT:

No signal that goes from the body to the brain can bypass the spinal cord!

A spine that is not moving freely changes neurological input.

Hypermobility of segments above and below the area of fixation, leads to changes in receptors located in the facet joints (mechanoreceptors). As this happens, you get an increase in Nociceptive (pain) impulses (Nocere is Latin for 揟o Injure? to the brain.

The brain then sends back a signal to spasm the muscle to guard against further injury. This equals a full nerve response (arc) of the body to the brain and back to target tissue.

Receptor types:
Pressure receptor: light touch
Mechano receptor: hard pressure (muscle becomes activated)
Nociceptor: push harder and it hurts = possible tissue injury (body wants to get away from it)

Mechanoreceptors down-regulate Nociceptors (not vice versa). This is why we rub our elbow when we hit the 搉ot so funny bone? The rubbing sensation competes with the pain signals to the brain.

How pain travels:
(Ascending):
-   Nociceptive (pain) imput thru Lamina 2, the 2nd layer in the white matter (AKA: Substantia Gelatinosa
-   Crosses cord at that level (contralateral)
-   Goes up thru the AnteroLateral System =Anterospinal thalamic  and Lateral spinal thalamic to the
-   Thalamus (control center for heat, hunger, thirst)
-   Sent to higher brain for interpretation to the
-   Cortex
  -Parietal cortex (pain)
  -Limbic system (what is pain without suffering. Ties it in with emotions)
(Descending):
-   Sends signal back to:
-   Hypothalamus
  ...to Pituitary to raise cortisol, adrenaline (stress hormones)
  ...to Locus Ceruleus to
-   Sympathetic Nervous System, which affects:
-   Viscera, including endocrine glands (why people are sick to their stomach with pain) and how we affect stomach complaints, heart palpitations, infertility, etc. with adjustment.
-   Immune organs (bone marrow, thymus)- how chronic pain increases stress and lowers immune response and  how we affect immune system with adjustment
-   Blood vessel diameter (perfusion)- how pain increases blood pressure and how we can affect blood flow to target organs, blood pressure, even potentially no need for Viagra? J
-   Annulus of disc, muscle spindles to cause muscle spasm, which is how adjustment can help with muscle relaxation and pain.

The Adjustment:

?  A high amplitude (quick) low force thrust sends in mechano receptor information to inhibit nociception
?  Affects stretch receptors in the muscle spindle and golgi tendon
?  The adjustment happens at the Facet: which is highly innervated and a source of pain
?  And at the facet, gas is released from the synovial flud (the 損op攨 this gas diffused back across membrane in approx 15 min. Why you can pop your fingers over and over) The pop is the side affect of the adjustment and not the treatment
?  Affects the Disc, which is Innervated (has nerve supply)!! Discovered by Bogduk, MD, PhD. He likes to say,揑n God we trust, all others bring research?br>
The disc and facet are both innervated by the Posterior Primary Rami= branch of the Sinu Vertebral Nerve.
The skin on your back innervated by nerves that travel by way of the dorsal columns (gracilus, cuneautus) in the spinal cord

The disc and facet ONLY respond to high threshold input?ie: Adjustment (mobilization, done by PT抯 and DO抯, does not affect same response)?this is why drop table and instrument adjusting works (quick, high amplitude, vibratory percussion)

The neurology of the adjustment:
?  Goes thru Lamina 7 and stays ipsilateral (same side) up the Lateral Cerebello-Thalamic tract to Cerebellum
?  Also goes up thru Dorsal Columns (cuneatus and gracilus= sensation) to the Cerebellum (controls all movement, besides eye, in body and counts for 50% of all neurons in the brain!)
?  Then sent to the Vestibular Nucleus (why the chiropractic adjustment affects people with complaints of dizziness, vertigo, hearing loss?DD Palmer, the Father of Chiropractic, in fact thought he had discovered the cure for deafness with his first adjustment)
?  This connects with the eye as well as the muscle that affect tone, posture, and segmental movers = skeletal and smooth muscle: this is why patients with stomach problems, digestive problems or other organ problems get better with chiropractic adjustments. (The main segmental movers are Multifidus, the #1 muscle which controls the facet and disc and the Rotatores muscle. This is why working on core stability thru rehab decreases pain))
?  From Cerebellum also to Thalamus (remember, now we are sending mechanoreception in there to compete with nociception. Brain can抰 interpret both.

1.   Mechanoreception can block nociception, not vise versa
2.   Mechanoreception coming up ipsi and contralateral side of the cord = a higher activation (double) to the Thalamus

?  Stimulates Parietal Cortex (Pain) and Limbic System (Suffering)
?  Now sent to the Hypothalamus which down-regulates pain/symptoms to pituitary and Locus Ceruleus systems

This is a higher level of control, not just at the cord level or reflex arc
Ex: Cord level = moving your hand from a hot stove
Ex: Brain level= moving hand consciously away from someone who is squeezing your hand too tight.

Also, most importantly:

Descending Inhibitory Pathway in brain:

?  Signal sent to Peri-Aquaductal Gray surrounding the Aquaduct of Sylvius
  The Opiate Receptor is found here! This inhibits pain.
?  Seretonin is released from the Raffe Magnus Nucleus. This is a 揻eel good?hormone. (Why many patients state they feel 揾appier?or 搇ighter?or just 揼ood!?after an adjustment)
?  Then down to the Descending Reticular Formation (pain control mechanism that is a continuation of the Peri-Aquaductal Gray)
?  Then down to the Dorsal Horn (posterior aspect of spinal cord) where GABA is released, whish is another inhibitory neurotransmitter ?(Conversely, Glutamate is an up-regulator?this is why MSG, Mono-Sodium Glutamate, is an EXCITOTOXIN... and why you shouldn't eat McDonald's and other fast food or feed your newborn children baby formula: Caseine, another neurotoxin in found in synthetic formula. Also Aspartame, found in artificial sweeteners, is a neurotoxin. Read "Excitotoxins" by Russell Blaylock, M.D. Neurosurgeon)

**This reduces over-activation of neurological structures by inhibiting pre-synaptically and post-synaptically at Lamina 2** (So, it is affecting the signal before it can be relayed and before it can ascend to Thalamus? ie: blocked at two places, thereby blocking at cord level and brain level.)

This is why chiropractic care can be so powerful, particularly the upper cervical adjustment, because the input is sent directly to the vestibular nucleus.

Wind up:
Happens at the synapse, where arborization (new growth) of pain fibers arc around the synapse at Lamina 2.
Scar tissue as it heals grows new nerves = unmyelinated C fibers = Increased pain!
(free nerve endings are like multiple people poking at you)
Tearing up adhesions and nerve afferents with the adjustment, rehab, and massage can be painful, but it is worth it.

Receptor field enlargement:
Happens at receptor site
As area becomes more stimulated, grow more receptors (neuroplasticity)
Like learning to ride a bike (laying down pathways)

Pruning:
?  Babies are born with more synapses then they need. For example: Prune 50 to 10 as they learn more effective pathways for learning
?  Teenagers are telling the truth when they said they didn抰 hear you even though you抳e told them something 100 times. Their auditory pathways aren抰 fully matured until the age of 18
?  Can prune pain fibers as well
?  Idiot Savants/ Autistic (Agenesis of the Corpus Colossum). Therefore, there is no inter-linking pathways between the lobes of the brain and no pruning. This is why they have an amazing capacity for memory, but no social referencing to put it together

Explains why chiropractic can help these symptoms:
Why AIDS patient抯 T-cells go up and viral load goes down
Why Cancer patients notice an improvement in their health
Why spinal adjustments helps stimulate the immune system
Why spinal adjustments in kids helps Colic, Bedwetting, Asthma, decreased illness, etc.
Why spinal adjustments can have far reaching affects on the body

**We don抰 treat AIDS, cancer, colic, bedwetting, asthma, etc.?
We treat the musculoskeletal system with physical means which down-regulates the abberant neurological signals!!**

Chiropractic physicians are highly trained doctors with thousands of hours of educational training.  You might be suprised how effective chiropractic care can be in managing disk pain.  Don't just take my work for it, do some additional research and check out a few local chiropractic offices.  Ask your family/friends/co-workers for a referral to a chiropractic physican they trust and find out for yourself!  Hope this helps Gloria.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net