‘Disc bulges’ or ‘disc herniations’ are common phrases and often scary terms to hear when you experience back pain. When clients come into our clinic and say “I bent down to pick up a pen and my back just went,” it is an all too common expression. So why did picking up such a small pen produce so much pain?
Well, let’s start with the structure of the spine.
Our spine is made up of 33 vertebrae. The lower back, or lumbar spine (which consists of 5 vertebrae) is the most common area for a disc injury to occur. Between each vertebra are structures called discs which act as shock absorbers and assist us to move well. There are also a number of muscles and ligaments that help stabilise the spine, many of which can be involved when you experience ‘acute low back pain’ (which just means low back pain that hasn’t been there for very long).
Think of a disc as a jam doughnut – you have the doughnut on the outside which contains the jam on the inside. As we age, the doughnut section (dark blue area in the picture) slowly hardens and becomes less ‘spongy.’ This is one reason why our movement becomes more stiff as we age. Normal disc function allows for one side of the disc to be compressed with movement, and for the ‘jam” to move inside the doughnut, without significantly changing the shape of the doughnut as a whole.
If, however, the outer layers of the disc have weakened, often through repetitive stresses, or prolonged positions, then when one side of the doughnut is compressed, the ‘jam’ is pushed out into the opposite side of the doughnut, causing that side of the doughnut to expand or bulge. The most common type of disc injury occurs with bending forward, and as the front of the disc is compressed disc contents are forced posteriorly, sometimes bulging into the spinal canal.
So when your back “goes,” it is likely not just the act of picking up that pencil that caused the injury, but the weekend of gardening after a week of sitting at your office desk that predisposed the disc to significant injury. As we often here ourselves repeating in the clinic:
“It’s the straw that broke the camel’s back”
Interestingly, many people actually have disc bulges without even realising it and remain asymptomatic. It is important to understand that it is normal for our discs to slowly degenerate as we age and that we can continue to function normally even when we have a disc that isn’t quite perfect. For this reason, it is very rare that an evidence-based health care provider will request x-rays or MRI’s in an episode of acute low back pain (if a great number of asymptomatic people will demonstrate a disc bulge on MRI, how can we be sure this is the cause of your pain?)
So where does pain come into it? You will usually experience pain with a disc injury because the disc is touching neural tissue within the spinal canal. Running along the back of the spine (within the spinal canal) is your spinal cord and each vertebral level has nerves that protrude either side. Sometimes a disc injury can compress these nerves and you may feel symptoms such as:
- Sharp, shooting pain into the buttocks or thigh
- Tingling, pins and needles or numbness down your leg
- Pain on one or both sides of your lower back
We should also be aware that:
“Pain is not a marker of tissue damage, it is a protective conscious experience trying to promote changes in behaviour.”
When you bent forward and felt immediate pain, you would have immediately tried to move into the opposite direction – this is the pain response. We’ll be delving into this in more detail in coming blogs:
“HURT (pain) does not always reflect HARM (tissue damage)”
The brain is an awesome organ, but can sometimes be the cause of our demise when it comes to pain. When we have a lower back injury, the brain thinks: ‘‘I felt a lot of pain in my back after bending over….let’s not ever do that movement again!” As a result some people continue to believe they will never again be able to bend forwards. This is NEVER the case.
If you never extended your knee again after knee pain, you would walk with a limp, your knee would not heal appropriately, and the pain wouldn’t go away. When the knee is moved through its full range, you facilitate optimal healing, and it starts feeling better. The same with your lower back…the more normally the back moves into all directions, the better it recovers, and the better its function is!
So what do you do if this happens to you? Let’s pretend: “As I lifted a heavy box, it accidentally slipped in my hands. I tried to catch it but I felt my back twinge and I fell to the floor in pain….What do I do?!?”
Do not panic! What has happened is a new experience for your brain and although it is painful, it will recover and you will not be like this forever. There is rarely any reason to go for any sort of x-ray or MRI, and these investigations will often show things that are unrelated to your current injury.
Place a heat pack on the lower back and call a physiotherapist. We will be able to provide assessment, treatment and advice on how to help you go about treating the injury. This will usually involve education, some gentle mobilisation and massage, and gentle exercises.
You will be instructed how best to manage your particular injury at home, and may also be taped for a short period of time to allow a period of time for your disc to repair. At Empower Physiotherapy, we are huge advocates of the benefits of hydrotherapy in the early stages of a disc injury, as the buoyancy of exercising in water allows injured people to move functionally without adversely stressing the injured tissues.
The earlier you see a physiotherapist, the quicker we can help get your pain under control and get you back to your normal activities!
Unfortunately, having injured your lower back once, you may be at a higher risk of re-injuring yourself if you don’t undertake an appropriate rehabilitation program. Although the injured tissues will heal, it is common for the stabilising system of the spine to need to be re-activated or retrained.
At Empower we have plenty of options for you, including hydrotherapy, Exercise Rehabilitation and Clinical Pilates sessions, or one of our physios can provide you with your own home program. All programs are individually tailored to fit with your lifestyle and to enable you to achieve your personal goals.
REMEMBER: The prognosis of an acute disc injury is usually very good. With appropriate early intervention and subsequent rehabilitation, you will be able to return to your normal activities.
If you have any queries or comments regarding this article, or would like some input on your own back injury, please drop me a line at firstname.lastname@example.org.
Until next time…keep moving!