When it comes to lower back pain that comes from disc injury, we can hear lots of different terms like bulge, herniation, sciatica, degeneration, slipped and lots of other terms. When you have never had acute lower back pain/injury, these terms can be very frightening to hear! Unfortunately all of these common names do nothing in the way of how we visualise these injuries, and language doesn’t help with how we think about these injuries which can harm our recovery. There are some things that Dr. Google is good for, but for this, if you did a search it’s overwhelming how much bad information is out there for you to read!
So let’s look at all the different disc injury types that we have!
Disc strains and sprains
This occurs like any other soft tissue sprain/strain in the body. It happens when a sustained load or an excessive load is placed through the disc and creates pain. The pain comes from irritation of the outer part of the disc (annulus fibrosis) and causes inflammation. These injury types don’t show up on scanning, and good news just like a muscle strain resolve very quickly!
These are also called “herniated, slipped, prolapsed, extruded”. What has happened in this situation is that the middle portion of the disc (nucleus pulposus) protrudes out of a small section of the tough outer part of the disc (annulus fibrosis) and creates a bulging section of the disc. Now what is important here is that the whole disc “HAS NOT MOVED”, I repeat, “HAS NOT MOVED”. The term slipped disc is highly inaccurate! If you have ever seen a disc within the spine, these suckers can’t move!! They are really stuck in place by ligaments, muscles, bones and the endplates of the discs that anchor them to the bones. They aren’t going anywhere!
Sometimes discs that have protruded can create referred pain down the leg, and can alter nerve function (numbness, pins and needles), and this is either by inflammation from the disc irritating the nerve, or the bulge is touching the nerve causing altered nerve function. Again, this shouldn’t cause panic as disc protrusions actually recede on their own with time, and usually we don’t need any invasive procedures or surgery to recover from these injuries. Remain active and get help from a health professional and you will be ok!
(trust me, they aren’t going anywhere! Look at all the ligaments and muscles that surround the area, the discs really can’t move!)
“Sciatica” is nerve pain caused by irritation of the sciatic nerve, and the most common cause is from a disc protrusion. In normal movement of the spinal column the spinal nerves have room to glide and slide up and down inside the spinal column, however a disc bulge can inhibit this normal movement and create referred pain into the legs along with numbness, tingling, pins and needles.
Sciatica is where the pain radiates from the spine, into the buttock, back of the thigh, back of the leg and into the sole of the foot. If you don’t have these symptoms, it isn’t sciatica. Because this is a side effect of a disc bulge normally, it will recover with time as the bulge heals and pressure and irritation is taken off the nerve. In 6 years of practice I have probably only seen this 2-3 times.
Degenerative Disc Disease
As we age we have normal changes to our connective tissue, and discs are connective tissue. When we are young children our discs are plump, fluid filled and well hydrated. As we age we have normal load placed through the discs, along with friction from the bones of the spine which makes them become thin and hard in comparison by the time we reach our 60’s. This change is not a reason for pain, so when it comes to scanning someone with back pain even in their 30’s changes can be found on scanning, at 34 I probably have these changes but I exhibit no pain! That is because it is normal!
This is probably one of the most common causes of back pain in the elderly, often from periods of prolonged bending and sitting. Again regular movement and exercise is the best thing for this!
So what does this all mean?
You will be ok!! I promise.
There have been numerous studies into all of these injuries and the best management of such injuries is us a health professionals educating you about your injury and likely recovery, encouraging you to remain as active as you can, and getting you to exercise for long term risk reduction of these injuries.
What is very interesting is a study that put 100 people with low back into an MRI machine, and a very low percentage of people had changes on their MRI that might explain why they had pain. After this finding they put 100 people in the MRI who had no back pain, and found that nearly all of them had some sort of normal connective tissue change (degenerative change, disc bulges, disc thinning, joint arthritis, etc). These findings are making us change our way of thinking and managing people when it comes to pain. Just remember if you are in pain, it normally doesn’t equal tissue damage! You are safe to continue being active and moving around.
Hopefully this has been helpful to expand your knowledge about the common terms and what they actually mean regarding disc injuries!