When it comes to lower back pain that comes from disc injury, we hear lots of different terms like bulge, herniation, sciatica, degeneration, slipped and lots of other terms. When you have never had acute lower back pain/injury, these terms can be frightening to hear! Unfortunately all of these common names do nothing in the way of how we visualise these injuries, and language doesn’t help with how we think about these injuries which can harm our recovery. So let’s look at all the different disc injury types that we have!
Disc strains and sprains This occurs like any other soft tissue sprain/strain in the body. It happens when a sustained load or an excessive load is placed through the disc and creates pain. The pain comes from irritation of the outer part of the disc (annulus fibrosis) and causes inflammation. These injury types don’t show up on scanning, and good news just like a muscle strain resolve very quickly.
Protruded discs These are also called “herniated, slipped, prolapsed, extruded”. What has happened in this situation is that the middle portion of the disc (nucleus pulposus) protrudes out of a small section of the tough outer part of the disc (annulus fibrosis) createing a bulging section of the disc. Now what is important here is that the whole disc “HAS NOT MOVED.” The term slipped disc is quite misleading as in fact, it can’t move. Discs are tightly held in place by ligaments, muscles, bones and the endplates of the discs that anchor them to the bones. They ain’t going anywhere! Sometimes discs that have protruded can create referred pain down the leg, and can alter nerve function (numbness, pins and needles), and this is either by inflammation from the disc irritating the nerve, or the bulge is touching the nerve causing altered nerve function. Again, this shouldn’t cause panic as disc protrusions actually recede on their own with time, and usually we don’t need any invasive procedures or surgery to recover from these injuries. Remain active and get help from a health professional and you will be ok!
Sciatica “Sciatica” is nerve pain caused by irritation of the sciatic nerve, and a common cause is from disc protrusion. In normal movement the spinal nerves have room to glide and slide up and down inside the spinal column, however a disc bulge can inhibit this movement and create referred pain into the legs along with numbness, tingling and pins and needles.
Sciatica is where the pain radiates from the spine, into the buttock, back of the thigh, back of the leg and into the sole of the foot. If you don’t have these symptoms, it isn’t sciatica. Because this is a side effect of a disc bulge normally, it will recover with time as the bulge heals and pressure and irritation is taken off the nerve.
Degenerative Disc Disease As we age we have normal changes to our connective tissue, and discs are connective tissue. When we are children our discs are plump, fluid filled and well hydrated. As we age we have normal load placed through the discs, along with friction from the bones of the spine which makes them become thin and hard in comparison by the time we reach our 60’s. This is probably one of the most common causes of back pain in the elderly, often from periods of prolonged bending and sitting. Again regular movement and exercise is the best remedy for this.
So what does this all mean? You will be ok!! I promise.There have been numerous studies into all of these injuries and the findings for best management is keeping as active as you can, and getting plenty of exercise for long term risk reduction. Adding physical therapy to your recovery regime will be beneficial, and I can offer much help with pain relief using remedial massage, manipulation, joint mobilisation, spinal decompresssion and soft tissue massage.
Just remember if you are in pain, you are safe to continue being active and moving around.