Disc Bulge Physio in Newcastle
What are lower back discs ?
The inter vertebral discs separate the vertebrae of the spine.
Discs in theory have a role in absorption and stabilisation as well as allowing movement in the back joints.
Discs are comprised of two parts; annulus fibrosis (outer fibrous layer) and the nucleus pulposis (inner layer)
Causes of disc injury
Specific types of pressure and repeated strain can cause a disc to become irritated.
Terms used to describe disc injury include
- disc bulge
- ruptured disc
- herniated disc
- prolapsed disc
Normal pain free people can have all disc changes on their spinal scans including MRI and CT's.
Here is a great graph that shows the percentage of normal people with so called disc budges, herniations, joint degeneration etc etc. Yes pain free, normal people with abnormal findings on scans.
Pain is not simply related to the level of disc changes on a scan but also has to do with all psychosocial factors.
Symptoms of disc injury
Some people with disc bulges can complain of
Radiated pain into the leg
Numbness or pins and needles into the leg
Weakness in the leg and foot
Pain worse with coughing and sneezing
Pain worse with bending or sitting for extended periods.
What physical things affect disc injuries
- Incorrect lifting techniques- This theory has been debunked. As a matter of fact, our spines naturally moves with a little bend and in fact with conditioning can become very strong. Watch this video of the heaviest weight any man has lifted. Click here . " Back not straight"
Poor posture has been widely publicised as a caused of disc injury but there isn't real research to back up this theory. However, Curitn University are currently researching this at the moment and hopefully the results will clarify this for us.
Obesity- This is still a risk factor in having back pain generally and not necessarily a risk for developing disc budges
Lack of regular exercise and strength
Self-Care for Disc Bulges
Some things that have been used include
- Relative rest in the correct alignment, resting in provocative positions such as sitting can worsen the condition
- Over-the-counter pain-relieving medication
- Ice packs or warm packs
- Upright posture
- Resting the back by not bending, twisting or lifting heavy weights
- Warm baths
- Sleeping on a mattress that is not too soft or too hard
- Ergonomic furniture, such as chairs with lumbar support
- Gentle exercises to strengthen and support the lower back
- Gentle walking program as pain permits
However, there aren't any real direct link that these interventions have a direct affect on the disc budge in the current research but some do have an effect on reducing pain perception.
Treatment for Disc Bulges
- Medication including pain relief and anti-inflammatories
- Epidural steroid injections into the disc region
- Manipulative therapies
- Alternate therapies such as Trigger point therapy, Chiro and Osteo
Surgery for Disc Bulges
Unless you have a severe nerve compression causing leg numbness, muscle strength loss, loss of reflexes than surgery should not be performed.
There has been over 200% increase in spinal fusions an all in the private sector. Back surgery for back and leg pain only is no more effective than good, high value physiotherapy care.
Here is a link to a great article by a neurosurgeon. click here
Types of treatments offered by physios
- massage - Muscle tension is usually a symptom of the underlying problem and can assist to unwind a tense area.
- spinal manipulation and joint mobilisations have no clear conclusive evidence that it has any sustained benefit.
- Dry needling or acupuncture has no clear research to back up its effects for disc budge related pain.
- Ultrasound, interferential, shockwave, any most machines haven't been shown to speed up recovery.
What do we do
Our clinic uses a cognitive functional approach to back care management of spinal related pain.
We do a full assessment to get a clear understanding of your situation, covering all aspects of what we know causes pain and injury
We will work with you to develop a management program addressing all aspects that are limiting your recovery.
Click here to listen to a report on this type of approach.