Disc Related Low Back Pain

Asking for a friend….



Have you ever had to lift something that had this symbol on it, but you didn’t have a team with you so you figured you could probably handle it by yourself? You thought it went ok until the next day when you woke up and you couldn’t really move, or stand up straight and one of your legs was on fire and you couldn't really walk.


Well, you are not alone.


Many of us have experienced this issue. This is just one example of what a lumbar disc issue might look like. There are so many things that can cause pain in your low back and knowing how to differentiate between them can really help speed up your recovery. All issues are not the same and need to be treated differently. You can’t fix everything with a hammer.


So, today we are going to dive into one common low back issue: disc related low back pain.


I want to break down what a disc is, the symptoms that are associated with disc issues, how you can test yourself out to see if a disc is what’s causing your pain, and what you can do about it.


What is a disc

The intervertebral discs are like cushions that lay between the bones in your spine. They are made up of a cartilaginous structure that has a thick outer portion and a gel-like center.


Their job is to help the spine absorb and transmit shock, maintain flexibility, and under higher loads, help to stabilize the spine. The greater the height of the disc, the greater the mobility of the lumbar spine and the greater the space for adequate passage for the spinal nerve root.


Just like skin starts to lose some of its collagen as you age, creating wrinkles in the skin, the cartilage in the disc undergoes a natural aging process as well. There is substantial evidence that shows as one ages, the incidence of disc degeneration and disc herniation increases.


In fact, it was found that individuals over the age of 50 had an 88% likelihood of having a degenerated disc in their lumbar spine. That study also showed that by the time an individual is in their 30s, they are more likely to have a degenerated disc than not.


'Another study found that 30% of individuals in their 20s have a herniated disc and 84% of people in their 80s have a herniated disc. I bring this up not to let everyone know that they will have a disc issue as they get older, I bring it up to let you know that disc changes are normal. The good news is that this degeneration DOES NOT correlate with the presence of pain.


You can have these changes, and probably already do, but don’t even know it because it’s not causing pain. Or maybe you do have back pain and these changes are present, how do you know if your back pain is related to your disc?


How to recognize if your disc is the issue:

There are 3 things to think about when trying to decide if your back pain is related to your disc. They are: mechanism of injury, symptom presentation and testing.


Mechanism of Injury

If the disc is the issue there is typically a mechanism that leads to the pain. With a disc it’s normally a lifting, bending or twisting episode that causes some inflammation to occur, resulting in pain. There can also be microtrauma that happens over time to create an issue, but if you experience a sudden onset of pain it’s more likely that it was the former scenario.


Symptom presentation

Disc related pain is typically felt in the back and can radiate into the leg. It can be described as throbbing, aching, shooting, sharp or burning. Pain may increase with things like coughing, sneezing, reaching, bending or sitting. You can also experience an inability to bend, stand up straight or rotate the back. Pain is usually worse first thing in the morning, but will also increase with prolonged positions.


Does this sound like you so far?


Testing

There are a couple tests that can be helpful to rule in disc pain. The one with the most research to back it up is called centralization. The basis of this test is that lumbar extension reduces disc symptoms.


To perform this test you simply bend backwards 10-20 times and monitor what your symptoms do. A positive test occurs if your pain decreases when you bend backwards repeatedly. The test is also positive if you are experiencing pain into your leg and the pain moves up your leg.


For example, say you have pain down your leg into your right foot. You bend backwards 10-20 times and now the pain is going down your leg to your knee. This is a positive test.


Does this still sound like you? If so, let's look into what to expect and how to fix it!


Timeline

On average, symptoms from a herniated disc resolve within 2-12 weeks with most clearing up by 6 weeks. It’s also encouraging to know that a lot of herniated discs are able to reabsorb naturally.


Spontaneous resorption was shown to happen up to 96% of the time in severe disc bulges. With most happening within the first year. This study showed that as the severity of the disc bulge increased the likelihood of spontaneous resorption also increased.


Awesome, now we know that our herniated disc should feel better soon and it isn’t something we need to go seek out a surgery for, but are there things that you can do during your 2-12 weeks to speed up the process and get you back to your “team lift” again? ABSOLUTELY!


Treatment

Although it may feel like you don’t want to move, you need to. I promise that you will feel better if you move appropriately.


Research supports the use of extension based exercises as a good starting point. Positions that place your back into extension should feel relieving. Pushing into too much extension too early may not feel good and won’t be super beneficial.


So, do what you can.


Just touch the pain and come out, don’t blow through your pain with this one, start with little motions. You should notice that you are able to go further and further into extension as you repeat these motions. Some examples of things to try are laying on your stomach, laying on your forearms, pushing up into a “cobra position”, doing a bridge and performing lumbar extension in a standing position.



A few other treatments that have been shown to be effective are strengthening of the trunk muscles and endurance training. Strengthening your lower abdominal muscles is important in helping you to feel better and in prevention of recurrence later on.


Strengthening your butt muscles will help decrease the tightness associated with a herniated disc. Endurance training, such as walking or performing an elliptical can help increase the blood flow to your back which will decrease your pain and allow for increased freedom of movement.


If you have back pain and your symptoms, mechanism of injury and testing fall in line for disc involvement give these exercises a try. If that doesn’t work give us a call and let one of our experts help guide you forward.

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