A herniated disc occurs when the soft, jelly-like center of an intervertebral disc pushes through a tear in the outer ring, potentially irritating or compressing nearby spinal nerves. This condition, sometimes called a slipped disc, can cause pain that radiates into the limbs, known as radiculopathy. A chiropractic adjustment, or spinal manipulation, involves applying a controlled force to a joint to improve motion and function. This article explores how chiropractors determine the appropriateness of adjustments and the modified, gentle techniques they use when treating a compromised spine.
Determining Suitability for Care
A chiropractor’s first step is a thorough evaluation to establish a precise diagnosis and determine the safety of any intervention. This process begins with an in-depth patient history, focusing on the location, intensity, and nature of the pain. They specifically note if pain worsens with movements like sitting, coughing, or sneezing, which strongly suggests a disc-related issue.
The physical assessment includes a detailed neurological examination to evaluate nerve function, which is critical when a disc is suspected of compressing a nerve root. The chiropractor tests specific reflexes, assesses muscle strength, and checks for sensory changes across the skin. Weakness or numbness in a specific pattern helps pinpoint the exact nerve level affected by the herniation.
Diagnostic imaging, such as X-rays or Magnetic Resonance Imaging (MRI), confirms the diagnosis and assesses the severity of the disc injury. X-rays show bone structure, while an MRI provides a clear image of soft tissues, allowing visualization of the herniation’s size and location. Only after this comprehensive clinical picture is established can a treatment plan be safely developed, potentially involving modified adjustments or alternative therapies.
Types of Modified Treatment
When a patient with a herniated disc is suitable for manual therapy, the chiropractor almost always employs modified, low-force techniques instead of traditional high-velocity, low-amplitude (HVLA) adjustments. These techniques stabilize the area and reduce nerve irritation without putting rotational stress on the injured disc. They focus on gentle mobilization and decompression to create a favorable environment for the disc to heal.
The primary modified approach is the flexion-distraction technique, performed on a specialized table that gently stretches and flexes the spine. This controlled, rhythmic movement creates negative pressure within the disc, which can encourage the retraction of herniated material. The technique also increases the height of the intervertebral disc space and enlarges the nerve opening, decompressing the irritated nerve root.
Another gentle option is instrument-assisted adjustments, often utilizing a small, handheld mechanical device like the Activator. This instrument delivers a quick, low-force impulse to a specific joint or vertebral segment. Since the force is highly controlled and non-rotational, it allows adjustment with minimal risk of aggravating inflamed disc tissue. This precise method is helpful for patients who are highly sensitive or have an acutely painful disc condition.
When Adjustment Is Not Recommended
While chiropractic care benefits disc issues, specific circumstances exist where spinal adjustment is not advised due to significant health risks. These absolute contraindications require immediate referral to a medical specialist or emergency care. The most urgent is cauda equina syndrome, a neurological emergency characterized by sudden, progressive loss of motor function in the legs, bowel or bladder incontinence, or numbness in the “saddle area.”
Other structural conditions also make spinal manipulation unsafe, as the force of an adjustment could worsen the condition. These include an acute spinal fracture, severe instability, or the presence of a tumor or active infection in the spinal column. Severe osteoporosis also poses a risk, as bone fragility increases the chance of fracture from even a gentle manual thrust.
If a patient presents with a highly acute, inflammatory stage of disc injury where movement is excruciating, the chiropractor will delay adjustment. Initial treatment focuses on rest, pain management, and non-manipulative therapies to reduce inflammation. The chiropractor must recognize these “red flags” and ensure the patient receives the appropriate medical attention before reassessing for modified treatment.
Alternative Chiropractic Therapies
Chiropractic care for a herniated disc extends beyond spinal manipulation, offering non-manipulative therapies used independently or alongside modified adjustments. Spinal decompression therapy is a non-surgical treatment utilizing specialized tables to gently stretch the spine and create negative pressure within the disc. This therapeutic traction relieves pressure on compressed nerves and promotes the flow of nutrients and oxygen into the disc for healing.
Rehabilitative exercises are a crucial component, focusing on strengthening the core muscles that support the spine. Chiropractors often prescribe specific protocols, such as the McKenzie Method, which uses targeted movements to shift radiating pain away from the limbs and toward the spine. This reduces nerve root irritation and improves long-term functional stability.
Soft tissue work, like myofascial release, addresses muscle tension and spasms that commonly occur around an injured disc. Therapeutic modalities such as low-level laser therapy (LLLT) or therapeutic ultrasound can also be applied to reduce localized inflammation and accelerate healing. These complementary approaches ensure that patients have access to comprehensive, conservative management, even if an adjustment is contraindicated.