Having a disc injury doesn’t mean you will have problems for life and you shouldn’t need regular treatment forever. But it does depend on the individual and the help you receive, along with other considerations.
“Find out what is possible by understanding why your discs are struggling, we can then work on strategies to improve symptoms so that you can use your body confidently again”
Addressing predisposing factors (such as restricted movement patterns) and improving how well your body functions can have a profound impact, improve symptoms and give you confidence in your body. There is almost always good scope for improvement, and much of that you can often do yourself with the right help and direction initially. Having pain and dysfunction is not an inevitable part of getting old or having a disc prolapse.
Typical Symptoms of a Lumbar (low back) Disc Prolapse
Although it’s possible to injure discs in the neck and upper back, it most commonly happens in the low back and you may experience one or a combination of symptoms:
- Low back pain
- Buttock pain
- Sciatica: pain that travels down the back of the leg to the knee or into the foot, with or without back pain
- Numbness and/or pin and needles (for example, on the outer side of the lower leg)
- Weakness: this may feel like heaviness in the leg, like you are dragging a foot or have difficulty in lifting your foot/toes when you walk known as foot-drop for which it’s necessary to seek prompt advice to avoid long term damage
If your symptoms are accompanied by bowel or bladder dysfunction, numbness or pins and needles in the saddle area, seek medical help immediately to rule out serious underlying causes, especially if symptoms progress rapidly over 24 hours.
How are discs injured?
An intervertebral disc can bulge/prolapse/herniate when a lot of pressure is placed on part of the spine in movement, for example if you lift a heavy weight you’re not used to, you have an accident involving extreme force or as a result of highly repetitive movements.
Sometimes disc injuries happen during what would normally be considered a relatively innocuous movement, such as a twisting or bending motion. This doesn’t mean you shouldn’t twist or bend in the long term. It is likely that your body has become deconditioned in some way (eg. parts of its function are restricted) and is no longer able to deal with what should be relatively normal tasks. Disks are the mobile shock-absorbing part of the spine so if there is restriction in the upper (thoracic) spine or in other parts of your body’s biomechanical chain such as the feet or hips, these intervertebral discs can be forced to deal with pressure above and beyond what they’re happy with.
And the good news is that this kind of function can be regained with specific movement strategies and the process aided further with hands-on treatment for symptom relief and improved body function to avoid recurrence.
Tips on dealing with a disc injury
- Be respectful of pain rather than fearful of it; this is easier if you understand why you have pain. Knowledge power. If you are anxious it can affect your response to pain so seek help and advice.
- KEEPING MOVING. GENTLY… whenever there is tissue trauma/injury, the body creates an inflammatory response, which is packed with essential ingredients to fight infection, clear damaged cells and heal the area. We need inflammation. But as well as doing an effective job, it does cause pain and stiffness. Gentle movement is important to help drain inflammation. Often the worst thing you can do is to be immobile. Try gentle walking or stretching.
- KEEP MOVING. CONSISTANTLY… the less you move the more deconditioned you become, especially over time. This can lead to chronic issues as your body becomes less strong and agile even in simple tasks such as walking. Even if you have a long-term issue, there will be ways of improving and finding pain free movement.
- Don’t assume that the amount of pain is equal to the level of actual damage, or that a disc is involved. Back problems can be acutely painful with very minor or no actual damage. For example a muscle spasm isn’t dangerous but can be extremely painful. It can indicate underlying dysfunction so it’s more a message to get things checked out.
How can I help with a Disc Injury
In most cases symptoms ease off within weeks, however seeking help can resolve things quicker and help you understand how to avoid on-going issues.
Treatment depends on the individual. It is often a mixture of hands-on techniques and active movement strategies to help joint and soft tissue function. It is informed by assessing the whole body and analysing biomechanics (how the body moves) to target problem areas that may have led to a disc issue, are maintaining it or have led to recurrence.
The aim is to understand why the area (in this case the low back) has had to deal with excessive pressure and load and change that pattern in ways that you understand and can carry on doing independently in the future.
The process and solutions are always unique to the individual. Some people respond very quickly, for others it takes a little more time and this depends on a combination of finding the most effective approach, and on an individual’s history, conditioning, behaviour and activity.
The goal is always to find ways to help you get better quicker and help you understand why injury has occurred. It is also to create a plan that makes sense to you and that provides tangible progress that you can feel and sustain for yourself in the long term.
Surgery for disc injury
Surgery for chronic back pain really should be a last resort and considered only after high quality rehabilitation that includes hands-on treatment, specific movement exercises and evaluation of activity levels, and a second opinion. In article Spinal Surgeon Mr Damien Fahy talks about the importance of movement in addressing back issues. He also discusses the potential merits and disadvantages of spinal procedures. For example, a laminectomy (surgery to decompress nerves in the low back) or discectomy (to remove part of a disc pressing on a nerve) can be effective in treating nerve pain, but not for treating back pain, and may actually make it worse.
Epidural injections can be useful to help with sciatica symptoms due to a disc prolapse but relief may be temporary and this procedure doesn’t address causative factors.
In summary, be informed about the goal of any treatment or procedure you are advised to undertake. If surgery or a less invasive procedure such as epidural injections are necessary, ensure you have good prehab and rehab to address underlying predisposing and maintaining factors – discs are very effective at their job as part of a big musculo-skeletal system and become dysfunctional because of inappropriate forces – often the result of altered bio-mechanic chains, which can be improved with the right help.
Relevant resource: NHS information on spinal surgery for disc problems.
More on Intervertebral Discs
Discs are part of the spine, the spine is part of the rest of the head-to-toe musculo-skeletal system where nothing acts in isolation.
Humans have 23 intervertebral discs in the spine. They are the connective-tissue cartilage between each of your vertebrae (bones in the spine), and allow movement and shock absorption. Discs act a bit like ligaments do in other joints: holding the bones together. They’re tightly connected to their neighbouring vertebral bones rather than being totally separate structures.
A healthy disc is a bit like a jelly-doughnut, with a tougher outer part (annulus fibrosus), and soft middle (nucleus pulposus), and forms an effective shock-absorbing- system that evenly distributes pressure and forces imposed on the spine and whole body. At birth, 80% of each disc is water. As we age the discs naturally dehydrate and get stiffer. This may or may not lead to symptoms, depending on how well the rest of the body’s movement/function is helping out.
The vertebral bones and discs together (the spinal column) bear a lot of weight and resolve forces created by gravity and movement from the rest of the body/head/legs/arms. You could think of it as the body’s central pillar, which needs stability and mobility throughout the musculoskeletal system it is part of to be happy.
This column houses and protects the spinal cord and allows nerve roots to exit the spine. Lots of muscles attach to your vertebral bones and create movement; the discs allow that movement to happen, without discs the spine would be rigid and unable to absorb shock – we’d be more like rigid robots!
How do discs cause pain?
Having a ‘Slipped’ disc is a rather a misnomer. Discs don’t really slip even though that is how it is often described. The disc doesn’t go anywhere but its contents can bulge, protrude, herniate or prolapse. Terms like ruptured, torn, or collapsed, may also be used to describe what has happened to a disc. Sometimes is can be confusing especially if different medical practitioners have different opinions about what’s going on!
One thing that probably all disc problems have in common is bio-mechanical compromise. Simply put, how your whole body works, and moves and what you chose to do with your body, has an impact on how well the discs can absorb shock.
Nerve root impingement from disc issues can cause pain, even if you don’t feel back pain. Nerves exit the spine through gaps/holes between the vertebrae. A nerve root can be physically impinged by a disc prolapse, or it can be irritated by inflammation around an injured disc. This may – or may not – cause pain, numbness, tingling or weakness that travels into the arms or legs, depending on where the injured disc is.
Discs in the low back (lumbar spine) are injured more often than other areas, and may impact the sciatic nerve causing symptoms into the leg or buttock.
Disc injuries in the neck (cervical spine) causing nerve impingement may result in symptoms travelling into the arms.
A thoracic disc injury may cause pain radiating into the chest or belly – these symptoms especially need to be properly assessed to rule out non-spinal causes such as from the heart and lungs.
Note that it is possible to have a disc prolapse show up on a scan but experience no symptoms. Equally, it is possible to have severe symptoms yet minimal findings on a scan – symptoms can be out of proportion to the actual level of tissue injury.
Degenerative disc disease is a term used to describe what are actually natural changes in the spine. This wearing of tissues is very normal as you age, but for some it’s more extensive than others. People who are inactive and sedentary are likely more susceptible to developing problems but genetics can also play a part.
Remember that back pain is not an inevitable part of getting old. Disc problems are always multifactorial, meaning that a variety of things contribute to disc health or degeneration.
Usual suspects causing disc problems
Doing too much… Intense or extreme exercise or repetitive movements with heavy weights can compromise the back and its disc. For example rowing, kettle bell workouts, manual labour. This does not mean you shouldn’t do them, just ensure you have good technique and good conditioning so the whole body function supports the movement.
Doing too little… Causes de-conditioning. The less you use your body, the less it is used to doing. The saying USE IT OR LOSE IT is true. If you sit a lot or are very sedentary, your musculo-skeletal system becomes less practiced at movement so it becomes weaker and less agile even in normal things like walking, and you be more prone to any kind of injury (not just discs). Have you ever heard someone say, “My back just went while I was reaching for a cup”? This is a big indicator that underlying issues that have been ‘brewing’- a healthy body can deal with reaching for a cup of tea but the good news is you can improve conditioning at any stage of life – it’s never too late.
High impact trauma… such as car accidents or significant falls can also injure discs. You are more likely to recover quicker if you are in better shape to begin with. With any injury, ensure the whole body is working to help heal rather than hinder.
X-rays and MRIs
If you don’t respond to conservative treatment or your symptoms are getting worse then further investigations, such as scans, are sensible. It is common for anyone over the age of 20 to have ‘abnormal’ findings so don’t be alarmed if things do show up – it’s actually pretty normal. Ask questions so that you understand which findings, if any, are significant and require intervention, and what the goals of that intervention are.
Speak to an Osteopath
If you have a disc injury and would like to talk to me about how I can help, don’t hesitate to contact me using the form below: