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What is Lumbar Disc Injury?
Lumbar disc injuries either occur as a result of a bending/twisting/lifting event or, more commonly, due to poor habits that become compounded over time. Many patients are unable to identify a specific movement or event that triggered disc pain.
Lumbar disc pain is usually felt in the lower back and can radiate down one (or occasionally both) legs. An injured disc can commonly have an impact on its adjacent nerve root, which can cause nerve-related symptoms in the leg(s). These include pins and needles, tingling and weakness of particular muscle groups.
A disc is shaped like a jam doughnut, with a shock-absorbing fluid centre, and a strong, doughnut shaped ligament wall that contains it. This ligament wall attaches very firmly to the vertebrae above and below and because of this, the notion of a “slipped disc” is not particularly accurate; perhaps a “disc sprain” is a more accurate term.
A disc usually becomes injured when forces on the disc cause the disc wall to fail, pushing the disc fluid closer to the outside of the disc. There is a large spectrum of severity with disc injuries, from small sprains, to complete disc wall ruptures, meaning parts of the disc have broken out and are left out of place and irreparable. The majority of disc injuries, although painful, recover with conservative treatment and without the need for surgery.
Most of the time, disc injuries happen towards the back of the disc as a result of repeated or forceful bending, or prolonged poor sitting postures characterised by flexion (or forward bend) in the spine. Aggravating activities often include sitting, driving and bending, while standing, lying down and walking tend make the pain decrease. There is typically a loss of range of movement of the lumbar spine, be it obvious or subtle, in one or more directions.
Interestingly, there is poor correlation between low back pain and accompanying scans or X-rays, so referral for scanning is not usually required unless there are special reasons to do so.
Treatment:
As physiotherapists, we offer treatment techniques and strategies to decrease symptoms by improving movement of the spine. This often includes gentle, pain-relieving exercises and manual therapy. Your physio will place a big emphasis on identifying clear cause-and-effect relationships between movement and activity, which makes the problem manageable while a clear roadmap for recovery is identified.
In addition to abolishing pain and recovering full range of movement, there should always be a focus on establishing good strength and stability of the spine so it can handle future rigours and prevent recurrence.
Tips:
1. Sit well. You should always maintain the slight backwards curve of your low back when sitting. Most office chairs offer some form of lumbar support for this reason, however a lumbar roll makes a good alternative if your chair isn’t helping.
2. Reverse your curve. If you are spending a lot of time in sitting or bending positions, spend some time arching your back backwards every hour or two.
3. Stay strong and check your technique. Exercise such as Pilates or weight training can be a great way to stay strong. Remember that when you’re lifting things, either in the gym or in real life, neutral spine is the key. If in doubt, ask your physio.
4. If you suffer an episode of low back pain, get to your physio sooner rather than later. Many people suffer with symptoms for far too long simply because they did not seek help at the beginning.
Interesting facts
- Degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is deemed to be a normal finding, not the exception.
- Pain is a product of inflammation of the disc as a result of uncontrolled micro-motion (movements) over time
- Not all disc injuries will lead to herniation/ ‘slipped disc’.
- Tight hamstring muscles have been shown to increase the internal disc pressure during forward bending.
- Disc injuries cause a reflex inhibition of the stabilising muscles around the spine (multifidus). These muscles become weakened and fat infiltrated over time, this can lead to increased shear forces in the disc and cause further disc injury, thus creating the beginnings and a vicious cycle.
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