What is a thoracic disc herniation?
A herniated disc is also known as a prolapsed disc but you will probably have heard most people use the term “slipped disc”. This is slightly misleading as your discs physically can’t slip out of place. What has actually happened is that the tough fibers called the “annulus fibrosus” around the outside of the disc have split causing a weakness and allowing the soft material called the “nucleus pulposus” from inside the disc to start bulging out. Imagine that your discs are shock absorbers and act like your spines suspension system very much like a car. When you lift a weight the disc compresses, absorbs the weight and disperses it evenly down your spine. Now think of a strong car tyre that’s what the outside fibers of the disc act like and the soft substance inside is similar to the consistency of toothpaste. Any wear, tear or splits in the tyre surface would allow the soft toothpaste to start bulging out. Once the soft substance starts to protrude your body reacts by gathering Inflammation around the bulge. This creates quite severe pain around the disc itself and causes the sudden intense neck pain that sufferer’s first experience.
What does a thoracic disc herniation feel like?
Your thoracic spine surrounds the spinal cord to protect it from damage. Your nerves branch of from the spinal cord and pass out at the level of each disc and then continue to travel around to the side of the chest in-between the ribs. The nerve passes very close to the edge of the disc and can be adversely affected by a disc herniation in two ways. Firstly, if the disc bulge is significant enough it will touch and compress the nerve causing pain from the mid back to travel around into the chest and can occasionally be perceived to radiate to the stomach. Secondly, the side, chest and stomach pain can be caused by the high levels of inflammation around the disc bulge, irritating the near-by nerve. In many cases the mid back pain experienced is overshadowed by severe side, chest and stomach symptoms; as the nerve irritation and pressure can also cause additional symptoms like pins & needles and numbness along the course of the nerve.
It is quite possible to have a disc herniation with purely mid back pain or no mid back pain and only side, chest or stomach symptoms. Rarely, the disc herniation may occur in a slightly different position and put pressure on the spinal cord, this causes weakness and sensation problems to occur in the legs as well. There have been cases where only minor symptoms or in-fact no symptoms at all have been reported.
The pain is characterised as being an intense ache whilst resting to a sharp, shooting and stabbing pain on movement. The extent of the side, chest and stomach pain and symptoms can be misleading when coming to a diagnosis. Any sudden coughing, sneezing and bending to the side will be extremely painful and are the main aggravating factors for a thoracic disc herniation.
Why & when does a thoracic disc herniation happen?
There is not one specific reason for the onset of a disc herniation but there are many risk factors that may make you more susceptible. The main factor to consider is disc degeneration. As you get older, the soft nucleus pulposus in the center of the disc starts to dehydrate, retaining less and less water. This decreases the discs ability to act as a shock absorber. The deterioration of the disc in this manner can increase the likelihood of the outer annulus fibrosus layer tearing. Poor posture, previous trauma and a lack of exercise leading to poor core body strength can also leave the spine weakened. These risk factors can lead to early degeneration of the discs especially when combined with obesity and increasing age. Activities which increase the pressure within the disc such as carrying uneven weights, bending in an incorrect manner (back bent and knees straight), holding a prolonged poor seated posture (desk work, driving), direct contact sports and even sneezing can cause the already weakened structure of the disc to give.
A thoracic disc herniation is rare and accounts for less than 4% of all spinal disc herniation cases. Due to its location a thoracic disc herniation is the most stable type of disc herniation. Men are twice as likely to be affected as women and it usually develops within the 25-50 year old age range with the highest incidence between 35-45 years.
How long does a thoracic disc herniation take to heal?
The pain levels are normally most severe to begin with, particularly when the nerve is initially compressed or irritated. Over the first six weeks the herniated bulge should naturally start to shrink and reabsorb back into the disc. Due to this, most cases see a 50% improvement in symptoms with pain levels being dramatically reduced and the additional symptoms like pins and needles, weakness and numbness taking slightly longer to resolve.
What treatments are there for a thoracic disc herniation?
Your GP will be able to diagnose you by both listening to your history and examining you. Due to the presence of chest and stomach pain your GP will want to complete a full assessment of the heart, lung, kidney and gastrointestinal tract to rule out other possible diagnosis or complications. If symptoms persist longer than six weeks an x-ray or an MRI scan may be advised to confirm diagnosis and assess the size and state of the herniated disc. In these more severe cases surgery may be necessary however this only represents a minority group as only 1 in 10 cases are considered for surgery.
Most cases of thoracic disc herniation will improve without surgical intervention. Others find alternative therapies speed up the recovery process and alleviate the high pain levels. Your GP may advise a short period of rest after the initial onset when pain levels are high, however it is very important that after two or three days you begin moving again to prevent your mid back joints from stiffening and your back muscles from weakening. Your GP may prescribe you with anti-inflammatory medications to reduce the swelling around the bulge and analgesic medication for pain relief. You can help yourself by using ice packs on your mid back to control the inflammation levels. Make sure the ice pack is covered to prevent ice burn and restrict the time you apply it to 10-15 minutes with at least 30 minutes intervals. Once you start to recover it is very important that you get rehabilitation exercises to strengthen your back and maintain your flexibility. This can be done through the relative therapist or trainer. In most cases the back is left weak after a herniated disc, strengthening your back will ensure you make a full recovery and dramatically decrease future occurrences. It is advisable to seek medical advice from your GP before commencing your rehabilitation exercises.