“I Threw Out My Back, Where Did It Go?” By Philemon Ayele | Element Physio

The spine, a series of small bones that create one of the most important anchors and barriers in our body for muscles, nerves and organs. It is tasked with many different jobs – housing our spinal cord, providing structural support to maintain posture, and allowing mobility so we can bend over. What is the spine? It is composed of a bunch of bones stacked on top of each other  – like building blocks that form a tower from your skull to your tailbone. These building blocks provide structural support, maintain posture, and allow mobility. Within the spine, you will find the spinal cord – a highway of nerves that runs down the spine that branches out between each vertebra to connect our brain to all our muscles and organs. It allows transmission of information between our body and our brain. It literally bears a heavy weight of responsibility in keeping us upright and healthy.

 

Image retrieved from: http://journals.cambridge.org/fulltext_content/ERM/ERM3_11/S1462399401002885sup002.htm

 

With all of these important functions, it is almost ironic that our spine is also one of the most common sites of injury in the body. Up to 80% of adults experience back pain at some point in their life and it is the most common cause of missed workdays in the workplace1. The disc is a common area of injury in the back that can be extremely debilitating and we see it quite often in the clinic. We hear all sorts of descriptions – herniated disc, bulging disc, slipped disc, broken disc – an injury of many titles. The disc in particular has a lot of myths and misnomers and there seems to be much confusion around what it does, why it hurts so much, treatment options, and how to manage the pain at home.  This article will address a few of these topics and provide you with (and hopefully give you) a better understanding of disc injuries.

What is important to know first is that not all injuries to the disc are created equal. We can simply irritate our disc, we can have a small tear in the membrane of the disc, or we can have a large amount of disc material extruding and applying pressure to a nerve root. Disc injuries can happen anywhere in the spine but are most commonly seen in the low back near our pelvis2. Our vertebral discs consist of a gel-like structure called the nucleus pulposus (consistency of toothpaste up until the age of approximately 40) surrounded by fibrous tissue called the annulus that keeps the nucleus intact. They are found between each vertebrae and their job is to absorb shock and impact, and disperse forces through the spine3.  Age, trauma, repetitive stress, poor body weight and/or diet can all increase the chances of a disc injury occurring3. As you can see below in the photo below, there are different severities of disc injuries and symptoms can range greatly for each person. Some may experience mild irritation and others may be in excruciating pain with numbness/tingling/weakness down a leg. Disc injuries are grossly classified into 4 categories based on the extent of injury4:

 

Image retrieved from: http://stenosisspinal.org/blog/herniated-disc-spinal-stenosis/

– Disc degeneration is the thinning of the disc that occurs naturally from aging and wear and tear on the disc

– Disc prolapse/protrusion is when the disc presses in to the spinal space but stays intact (bulging disc)

– Disc extrusion is when there is a rupture of the fibrous tissue and part of the nucleus enters the spinal space but remains in contact with the rest of the inner disc

– Disc sequestration is a rupture of the disc with the part of the nucleus that enters the space being separated from the rest of the disc

Imaging such as MRI or CT scan can reveal bulging of the disc into the spinal canal. However, while these imaging tests will reveal any abnormalities in the disc, it is important to note that it may not necessarily be the cause of your back pain. Disc injuries can be asymptomatic if it doesn’t contact the spinal cord or adjacent nerve roots. Many people who do not suffer from any back pain may reveal a bulging disc on imaging without suffering any symptoms.  They can occur without the individual being aware, so don’t assume that it is the cause of your pain just because it showed up on your imaging tests. These should be useful tests to confirm a disc injury on top of a proper subjective and objective assessment, as opposed to your only information source.

Unless recommended otherwise by your doctor, conservative treatment is first line of defense in treating disc injuries. Disc injuries have a negative connotation, but the pain usually does not last long-term. In most cases of disc injuries, pain usually resolves over 6 to 8 weeks. Physiotherapy can help treat injuries through the use of stretching, strengthening/stability exercises, tissue massage, and modalities. These help (a) relieve pressure on the spinal cord to reduce pain and (b) strengthen the surrounding muscles to prevent future issues. Pain with movement is common with disc injuries, so it is common to think that not moving is the best thing to do to help heal, but that is completely false! While some time may be needed to rest after a disc injury, prolong inactivity can actually make recovery longer and may not respond to treatment as well – so don’t be afraid to start moving once pain has improved. It is important to know that a bulging/herniated disc is not something that should ruin your life, as there are a lot of accepted myths and horror stories about them. Having a negative outlook on your condition and/or treatment can actually make things worse. Our psychological mindset plays a role in our recovery, and can affect our ability to recover from the pain. It is common for someone’s pain to get worse once they are diagnosed with a disc injury due to their own perception of the injury and their outlook. Thinking that the pain will get worse even when it shouldn’t could potentially make recover more challenging than if they attempt to be more positive. It’s always better to be a positive Polly over a negative Nancy!

So no, not all herniations are pinching nerves and cause pain, and no, not all herniations require surgery.  Disc bulging is something that happens naturally as we age and our fibers lose their elasticity.  Our physiotherapists can help minimize your symptoms with stretching, manual therapy, strengthening exercises, and modalities among other things. They are excited to offer their services to the public and help get you pain free and moving freely. We got your back!!

Sources:
  1. National Institute Of Neurological Disorders and Stroke
  2. Dawson, E.G. (2018). Herniated Discs: Definition, Progression, and Diagnosis. Retrieved from: https://www.spineuniverse.com/conditions/herniated-disc/herniated-discs-definition-progression-diagnosis
  3. Stenosisspinal.org (2018). Herniated Disc Spinal Stenosis. Retrieved from: http://stenosisspinal.org/blog/herniated-disc-spinal-stenosis/
  4. Course notes from Joanne Carswell: Conditions of the Lumbar Spine and Pelvis