Have you been diagnosed with a disc herniation or disc bulge? A disc herniation occurs when the fluid-like material in the centre of the discs exits the out wall of the disc. A common misconception is where people refer to this as a “slipped disc”. Discs do not “slip” but the fluid-like material within the disc can get redistributed resulting in the disc to protrude or herniate.
What are intervertebral discs?
Inter-vertebral discs lie between each vertebrae, linking them together. Their main role is to provide mechanical support for the spine transmitting load from the body and muscle activity from the spinal column. They are complex structures made up of different types of protein fibres. The outer ring is made up of fibrous cartilage termed the annulus fibrosis which surrounds a more gelatinous core known as the nucleus pulposis. Surrounding the disc are nerves and blood vessels that act as control centres providing sensation, circulation and nutrition.
What can happen to our discs?
Disc Degeneration
When we age, our outer appearance naturally starts to change. This predominantly happens over time and we notice changes in the appearance of our skin and hair. Similar types of transitions commence within our intervertebral discs and joints. With increasing age, discs change in morphology where the inner-core of the disc dehydrates becoming more fibrotic which slowly results in protein fibres breaking down. What typically happens as a result of these changes is a decrease in disc height between each vertebrae. This is a normal process of aging and often don’t give rise to any pain.
Disc Prolapse or Bulge
Disc prolapses/bulges are a relatively common injury most frequently seen in the lower back and neck. There are several different types of prolapses that can occur depending on the nature of the injury. The most frequent type of disc prolapse is when the inner fibres of the nucleus submerge through the annulus in a backward and outward direction (postero-lateral). Due to a large number of nerves in the area, this results in heightened inflammation, often leading to muscle spasm, pain and lack of mobility.
Common Symptoms
- Localised pain/discomfort
- Muscle weakness
- Mild swelling
- Lack of mobility especially when bending forwards
- Peripheral nerve pain (pain in your leg or arm)
Risk Factors
There are many different causes or risk factors for disc injuries which are frequently dependant on body positioning under load or resistance. Here are several common influences that may increase chances of discal injuries:
- poor biomechanics and spinal mobility
- manual occupation
- incorrect lifting posture
- poor technique/form when weight lifting
- trauma or road traffic collision
How are disc injuries diagnosed?
Disc pathologies are often diagnosed by primary health care professionals including GPs, osteopaths, physiotherapists and chiropractors. This is done through a selection of orthopaedic testing, neurological and physical examination. However, the gold standard for diagnosis is magnetic resonance imaging (MRI) which shows a detailed image of all spinal elements.
What is the treatment?
Treatment options can vary depending on the severity of symptoms as well as the severity of the prolapse. Recent empirical evidence has elaborated that patients with disc prolapses that do not have significant clinical findings that need urgent medical intervention are advised to seek conservative management for symptom relief prior to surgical intervention (1). Research has indicated that treatment including osteopathy and chiropractic in combination with physical therapy can significantly improve outcomes in patients with disc prolapses (2,3,4).
Can discs heal without surgery?
Several studies have evaluated that prolapsed discs in the lumbar spine can dramatically decrease in size and resolve with conservative management including manual therapy and exercise (5,6).
Does this apply to all discs?
Although selected disc prolapses have been shown to improve without surgery, this does not apply to every disc prolapse. Depending on the severity of the prolapse, some can get worse and lead to permanent problems. If you have been diagnosed with a disc prolapse or even just have back pain, there are several important things to look out for.
- Loss of feeling between the legs, numbness in or around your back passage or genitals (saddle anaesthesia)
- Bladder disturbance such as inability to urinate, difficulty initiating urination, loss of sensation when passing urine or inability to control urination
- Bowel disturbance
- Sexual disturbance
- Worsening pain into both legs accompanied by weakness.
All of these signs are relatively rare. The vast majority of people are unlikely to have all of the above symptoms. However, in cases where these clinical signs are seen, immediate medical management is recommended which often involves surgical interventions.
Do you have back pain and unsure what to do?
Spinal pain is very common and does not always mean you have a disc problem. However, pain is frequently a sign from the body telling you that something is not right. Our team of osteopaths, physiotherapists and exercise therapists and specialised in diagnosing and treating a wide variety of spinal conditions. So, don’t ignore your symptoms. Book an appointment, see what’s going on and what we can do to help.
References
- Ming Zhong, M. D., & Liu, J. T. (2017). Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain physician, 20, E45-E52.
- Mo, Z., Zhang, R., Chen, J., Shu, X., & Shujie, T. (2018). Comparison Between Oblique Pulling Spinal Manipulation and Other Treatments for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Journal of manipulative and physiological therapeutics, 41(9), 771-779.
- Yamin, F., Musharraf, H., Rehman, A. U., & Aziz, S. (2016). Efficacy of Sciatic Nerve Mobilization in Lumbar Radiculopathy due to Prolapsed Intervertebral Disc. Indian Journal of Physiotherapy and Occupational Therapy-An International Journal, 10(1), 37-41.
- Yu, P. F., Jiang, F. D., Liu, J. T., & Jiang, H. (2013). Outcomes of conservative treatment for ruptured lumbar disc herniation. Acta Orthop Belg, 79(6), 726-730.
- Raj, P. P. (2008). Intervertebral disc: anatomy‐physiology‐pathophysiology‐treatment. Pain Practice, 8(1), 18-44.
- Cribb, G. L., Jaffray, D. C., & Cassar-Pullicino, V. N. (2007). Observations on the natural history of massive lumbar disc herniation. The Journal of bone and joint surgery. British volume, 89(6), 782-784.