The Back Talk Podcast

Herniated Disc Red Flags And When Should You Worry

• Dr. Peter Peduzzi • Episode 9

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A lot of people live in the gray zone of back pain: it hurts, it lingers, and you keep wondering if it’s just a strain or something deeper like a herniated disc. Julie Schwenzer sits down with Dr. Peter Peduzzi of American Back Centers to make the signs clearer, so you know what patterns matter and what steps actually lead to answers.

We talk through how clinicians separate disc pain from muscle pain, including the symptoms that raise the biggest flags: sharp pain, numbness, tingling, and weakness that can travel into the legs, feet, arms, or hands. We also explain why an X-ray can’t “see” a disc and why an MRI for back pain is often necessary to confirm a bulging disc, herniated disc, or nerve compression. Dr. Peduzzi breaks down the terminology people see on reports including bulge, herniation, extrusion, and sequestered disc and how spinal canal narrowing can show up as stenosis. 

Then we get practical. Sitting can create more spinal compression than standing, and common moves like toe-touch stretching or twisting can aggravate sciatica-like symptoms. We share simple posture and movement cues, plus why changing positions throughout the day matters if you work at a desk or drive for a living. We also cover how insurance rules can slow down MRI access and what conservative, non-surgical options may help, including vertebral axial decompression, cold laser therapy, bracing, and the right timing for physical therapy. 

If back pain is slowing you down, listen now, share this with someone who needs clarity, and subscribe so you don’t miss the next one. After you listen, leave a review and tell us what symptom or myth you want us to tackle next.

To learn more about American Back Centers visit:
https://www.AmericanBackCenters.com
American Back Centers 
103 Bradford Rd, Wexford, PA 15090  
724-935-3300 

Welcome And Natural Back Pain Care

SPEAKER_00

Welcome to the Back Talk Podcast, where we talk about your facts with Doctor Talk Back to you. Hosted by Dr. Peter Petusi, Clinic Director of American Backstarter. Each episode explores real solutions for back pain using non-invasive, non-surgical care, designed to help you avoid spinal surgery. Helping people throughout the greater Pittsburgh area feel better naturally without the hardware or the drama.

SPEAKER_02

Back pain can come from many places, but certain patterns can reveal what's really going on. Welcome

How To Spot A Disc Issue

SPEAKER_02

back. I'm Julie Schwenzer, co-host and producer, back with the awesome Dr. Peter Padozzi, the clinic director at American Back Centers. Dr. Padozzi, it's always good to sit down with you and learn more about all of this. If we could jump in, when someone's dealing with stubborn back pain, they might wonder, how do I know if my back pain is coming from a herniated disc? What do you say to that, to that, and how do you diagnose this?

SPEAKER_01

Well, typically when a patient comes in, we do ask them if they have any imaging to bring it in, X-ray or an MRI, typically with a disc problem, which is a soft tissue-related issue. You have to have an MRI to really accurately diagnose it to actually see the disc that's actually her needed or bulged. With an X-ray, you can see the space where the disc resides, but you can't see the actual disc, the soft tissue. So we do need the MRI in most cases. If they don't have a one or if they don't have a current MRI, we can send them across the street, uh, you know, write them out of prescription and schedule an appointment for the MRI and have that done.

Sharp Pain Numbness And Weakness

SPEAKER_02

And what symptoms tend to point like more strongly toward a disc issue rather than a muscle strain? How do we know the difference?

SPEAKER_01

Typically, but not always, the patient's gonna have more of a sharp uh pain. They may have some numbness, uh, whether it's in the back or the legs or even the feet. Uh, same thing in the neck. They could have numbness uh into the arm and the fingers and hand as well. Sometimes they'll have weakness in the extremities as well. Um typically with a disc problem, um, we're gonna see more pain that's uh outside the back. So maybe, as I mentioned, traveling down the leg, down the arm, weakness, numbness tangling, those type of things. And then we do an orthopedic evaluation where we're gonna do specific tests that are geared toward uh disc and that type of problem.

Bulge Herniation Extrusion Sequestration Explained

SPEAKER_02

And then, you know, you were just explaining to me before we were recording the difference in the disc issues, like ballging, herniated, sequestered. Could you please explain all of those?

SPEAKER_01

Yeah, so typically uh the the cause of the problem is compression on the spine. So the disc resides between two bones, two vertebrae. And over time, all the things we do, sitting, standing, all the things we do throughout life doesn't happen one day, doesn't happen one week, and it happens over a period of months, if not years, the spine compresses. So it's kind of like sitting on a jelly donut. The jelly of the disc starts to ooze out, and that's the beginning of a bulging disc. The disc also degenerates too, the height degenerates, and then the disc is being compressed, so it's not getting proper nutrients, it starts to dry up. But the fluid starts to bulge out, and a bulging disc is still contained by the rings of the disc, so that's considered a bulging disc. Now the next step would be a herniation where it's no longer confined by those rings of the disc and pushed out or herniated out through those rings. And then the third step, as I mentioned, would be a sequester or an extruded disc, I'm sorry, where the disc material is herniated, now it goes up or down the spinal canal. So it's either going up or down, extruding up or down the spinal canal. So that's a more severe case. We'll call that like a stage three. And then if a piece of disc breaks off, that's become that's called a free fragment or sequestered disc. And that becomes more of an issue now because you have that free that piece of disc floating around in the spinal canal, and that's a more severe case, or maybe a stage four, we'll call it.

SPEAKER_02

Wow. Yeah, that sounds uh pretty bad. Um, and then can you see anything like on the skin or anything? Is there any bruising? Like wow.

SPEAKER_01

I mean, typically, I mean, you'll see you may see swelling inflammation, but I mean you can't really see inside the body. So that's why you do the MRI. With the X-ray, you can see uh spacing between the vertebrae being diminished, but you can't see what's happening in that space. And then with the MRI, you can see if the soft tissue, the uh donut, the jelly donut, is actually oozing out into the spinal canal and how far it's pushed out and what it what it's contributing to. So if it's narrowing the spinal canal, that's spinal canal stenosis. And then you can also see the disc bulging, perniated out, or even extruded up or down the spinal canal.

Why MRI Findings Can Mislead

SPEAKER_02

So you must see all types of patients at different stages of severity because some people have a high pain tolerance or they just don't want to go in and get treated.

SPEAKER_01

So that's a good comment because many people have really, really bad MRIs with, you know, herniations, extrusions, and have very limited symptoms. And really, I tell patients you're it's pretty much a ticking time bomb because the MRI doesn't lie. The MRI is telling us exactly what's going on, and symptoms aren't everything. And there's some studies out there showing that upwards of 95% of the nerve has to be impinged upon before some patients will even notice any symptoms at all. That's a scary thing. And then on the flip side, you have patients with the very minimal findings on the MRI with severe pain. So, you know, symptoms aren't everything.

SPEAKER_02

Yeah. Do issues with the disc affect, like if they are more severe, does it affect other body parts like your brain, heart, anything, circulation, or not really?

SPEAKER_01

I mean, it can. I mean, there are complicating factors that can contribute to these problems too. People that are smokers, if they're overweight, diabetic, they're gonna have decreased healing capacity. So they're gonna be more prone to these uh type of problems and their prognosis, their success um is gonna be slightly less because of that as well. But I mean, yeah, there's compensation, if you're asking, there's compensation in the areas above and below, too. So those areas are affected as well. So we so in many cases have to uh treat those areas as well.

SPEAKER_02

Yeah, thank you for answering that.

Sitting Bending Twisting What To Avoid

SPEAKER_02

And are are there specific movements or positions that make disc-related pain more noticeable? Have you noticed that in patients?

SPEAKER_01

Yeah, believe it or not, sitting actually creates more compression than standing. Of course, bending over. A lot of people think that they want to bend over and touch your toes to stretch their their legs. That actually can make things worse. The sitting posture, the bending over, we always advocate patients squat lunge to pick things up, right? And turn the whole body as one unit, trying not to twist and twerk the spine because that can cause problems. Of course, crossing your legs can actually irritate the sodic nerve as well. So a number of these things add up over time. You know, we advocate patients using a standing desk so they're not sitting all day at work or driving in a truck, you know, taking breaks, those type of things. Changing positions throughout the day is key. Staying in one position is where a lot of these issues come about, whether it's a forward head posture, rotted shoulders, or compression of spine. All that is due to just staying in one position for too long.

SPEAKER_02

Well, I'm glad we both have dogs because we have to do dog walks no matter what the day what the day presents. Um That's right. Yeah.

When Insurance Delays An MRI

SPEAKER_02

And then, you know, this might be an obvious question for many people and maybe not so obvious, but when should someone consider imaging to confirm what's happening if they can't tell where this pain is coming from?

SPEAKER_01

Well, unfortunately, a lot of times we're dictated by our insurance companies, and typically the insurance companies want to do the x-ray first because it's cheaper. Um, so we do the x-ray first. If you already have an x-ray, then there's a certain course of action that some insurance companies require us to do. Maybe you have to do a couple weeks of treatment before they'll approve an MRI in some cases, and then with the MRI, we can actually conclusively see the soft tissue. Uh what's it if it's a soft tissue-related issue, like a disc. Or if you have a tear in your shoulder, or tear in your knee, you're gonna have to do an MRI to see that. You can't see that on an X-ray. So sometimes we have to jump through through some hoops to get there, but ultimately we can get there.

SPEAKER_02

And

Non-Invasive Options Decompression And Cold Laser

SPEAKER_02

then the conserve more conservative treatments like cold laser therapy that you just covered in the last episode. What what can we do that's non-invasive to help?

SPEAKER_01

Well Yeah, of course, the the back steed, the vertebral axo decompression that we do here for the disc is non-invasive, non-surgical. You know, the cold laser is part of that program as well. You know, we get into the physical therapy portion as well later on, once things settle down, because in many cases, the physical therapy will help strengthen your core structure and the muscles surrounding it. But initially, if you have a hot disc or a hot nerve, it's just going to make it worse. So that's why we take a step back from that and into the near future once things settle down with the conservative treatments I just mentioned, the backsteen and the cold laser, and maybe sometimes bracing, uh, then we get into the physical therapy later that that helps support uh and supplement what we're doing with the BAC and the cold laser.

SPEAKER_02

Okay. Well, thank you for explaining everything, Dr. Padozzi, very clearly. We always appreciate you.

SPEAKER_01

Well, thank you so much for having me.

Consultation Details And Wrap-Up

SPEAKER_00

Thanks for listening to the Back Talk Podcast. If back pain is slowing you down or bossing you around, it may be time for a natural approach that works. Call 724-935-3300 to schedule a consultation with one of the doctors at American Back Center. Or AmericanVaccenters.com