DISCS
Sarah Cowgill (Physiotherapist – Burnie/Somerset)
70% of people are likely to experience back pain at some point in their lives with 1 in 6 of us currently experiencing back pain. One of the most common structures that can cause back pain is are the discs, which are more formally known as intervertebral discs.
It is well known that discs are located in the spine, however fewer people are aware about the finer details of the structure, function, and pathophysiology of the intervertebral disc. For example, you may have heard of ‘bulging discs’, ‘popped discs’, and ‘herniated discs’ but what do these terms all mean and should you be worried?
Anatomy and Physioloigy of the Intervertebral Disc
Intervertrbal discs are situated between each of the vertebrae in the spine. Spinal vertebrae are our bony building blocks and the discs provide the cushioning in between them. Discs act as a shock absorber between our bones and they help to provide the spine with a lot of its flexibility and strength.
A disc is made of two layers of collagen called annulus fibrosis which encloses the gel like centre known as the nucleus pulposus.
Our discs are strong by themselves, but we also have other structures that provide our spine with extra support and stability. Around our vertebrae and discs runs a complex series of ligaments that help to provide stability to our spine. Over the top of these ligaments, we have layers and layers of muscles, from small stability muscles, that sit between each vertebrae, to larger force-producing muscles that extend over large segments of our spine.
Disc Injury
There are two main injuries that can occur to discs.
A disc protrusion (bulging disc) occurs when there is slight weakening of the annulus fibrosis (capsule) that allows for a change in the disc shape. This can cause the disc to push out slightly in an area. Repetitive strain, acute injury or degenerative changes can cause this.
A disc extrusion (herniated disc) occurs when there is a tear in the annulus fibrosis allowing for some of the nucleus pulposus to leak out.
While these may sound concerning, they are very common conditions we see as Physiotherapists and Exercise Physiologists, and we can help you to manage the issue.
Myth Busting
There are a lot of myths surrounding discs that can lead to fear and anxiety, which can further lead to heightened pain levels. Some of these common myths include:
- ‘You have slipped your disc’ – Discs are very strong structures and while you can have injuries to the disc, they will not move out of place.
- ‘Rest is the best medicine’ – Rest can lead to muscle weakening which can in turn put more pressure on the spine. Decreased movement can also lead to stiffening of other structures in the spine and further impact your movement. Overall, light, regular movement is the best way to manage a disc injury with periods of rest in between.
- ‘Your disc will never be the same’ – Discs can heal like any other injury, and, with optimal rehabilitation, most people can often return to their previous levels of activity. This does however take commitment, patience, and self-motivation.
Imaging
For most people with back pain, imaging (XRAYs, MRIs, CTs) is not necessary. A recent study has shown that at 50 years of age, 60% of people without lower back pain can have disc injuries show up on a scan. Therefore, scans do not tell us whether that disc is causing pain. Scans are normally only necessary to rule out red flags (‘nasty causes’) if assessment deems it necessary. Red flags can include signs and symptoms such as unremitting numbness or specific weakness. Most of the time scan results will not provide you with an accurate diagnosis or prognosis of your pain. They will often not change your treatment either.
Below is a chart from the study showing the percentage of people who had changes in their spinal anatomy on a scan but had no history of pain.
(Brinjikji et.al., 2014)
Managing Lower Back Pain
After any type of injury, our structures will undergo a natural healing process. Everyone’s timeline for healing is different. It is important to get an individualised treatment plan that provides education and treatment that is specific to your needs.
Recovery from a disc injury can go through stages:
- Acute phase
- Gentle movement encouraged
- Minimise further stiffness/tightness
- Modify aggravating factors
- Maintain muscle function
- Sub-acute phase
- Begin to return to normal movement patterns
- Build strength
- Slowly incorporate movements that were previously painful
- Post-acute phase
- Preparing the body to be more resilient to back injuries in the future
- Encouraging lifestyle changes that can help to prevent future injury
Treatment often involves a series of graduated steps: manage pain > increase movement > build strength > return to functional activities.
Pain After a Disc Injury
Chronic or persistent pain can occur after a disc injury has healed. There can be many changes within the body that occur following a disc injury that cause pain to persist. For instance, if you repeat an activity that caused the initial injury to the back (i.e. bending), the brain and nervous system may recognise this movement as potentially harmful which in turn produces a ‘pain’ output as a warning signal for the body; so you may experience pain despite the disc itself having already healed to its pre-injury capacity. Therefore, chronic back or neck pain that relates to a previous disc injury is dependent on context.
There are several strategies that can help to manage chronic pain after a back or neck injury; these involve:
- Having an understanding and educating yourself on why the pain is occurring – a Physiotherapist or Exercise Physiologist can help you.
- Having an understanding that the pain is likely not due to further injury.
- Controlling negative thoughts, with positive reinforcement, mindfulness and breathing techniques.
- Maintaining movement and exercise.
- Using symptom relief strategies such as heat, massage, physio, and hydrotherapy, as required. Often movement-based strategies are more effective than static management.
https://upwellhealth.com.au/app/uploads/2021/02/Disc-Injury-Directory_Final_Web.pdf
Surgery
For a majority of people with a disc injury surgery is not required. Evidence has shown that the outcome is the same at two years post operation as it is at two years post conservative management (i.e. Physiotherapy) (Kim et.al, 2021).
Preventing Re-injury/Flare-ups
- Remain active
- Maintain a healthy weight
- Use correct manual handling techniques
- Change postures/positions often
- Otimise nutrition
- Optimise sleep
- Maintain a healthy lifestyle
This blog provides very generalised information and advice. It is always best to consult a Health-care Professional if you experience pain that relates to spinal structures. For appointment with a Physiotherapist or Exercise Physiologist at Coastal Physiotherapy, please contact our Burnie clinic on 64314586.
DISCS
Sarah Cowgill (Physiotherapist – Burnie/Somerset)
70% of people are likely to experience back pain at some point in their lives with 1 in 6 of us currently experiencing back pain. One of the most common structures that can cause back pain is are the discs, which are more formally known as intervertebral discs.
It is well known that discs are located in the spine, however fewer people are aware about the finer details of the structure, function, and pathophysiology of the intervertebral disc. For example, you may have heard of ‘bulging discs’, ‘popped discs’, and ‘herniated discs’ but what do these terms all mean and should you be worried?
Anatomy and Physioloigy of the Intervertebral Disc
Intervertrbal discs are situated between each of the vertebrae in the spine. Spinal vertebrae are our bony building blocks and the discs provide the cushioning in between them. Discs act as a shock absorber between our bones and they help to provide the spine with a lot of its flexibility and strength.
A disc is made of two layers of collagen called annulus fibrosis which encloses the gel like centre known as the nucleus pulposus.
Our discs are strong by themselves, but we also have other structures that provide our spine with extra support and stability. Around our vertebrae and discs runs a complex series of ligaments that help to provide stability to our spine. Over the top of these ligaments, we have layers and layers of muscles, from small stability muscles, that sit between each vertebrae, to larger force-producing muscles that extend over large segments of our spine.
Disc Injury
There are two main injuries that can occur to discs.
A disc protrusion (bulging disc) occurs when there is slight weakening of the annulus fibrosis (capsule) that allows for a change in the disc shape. This can cause the disc to push out slightly in an area. Repetitive strain, acute injury or degenerative changes can cause this.
A disc extrusion (herniated disc) occurs when there is a tear in the annulus fibrosis allowing for some of the nucleus pulposus to leak out.
While these may sound concerning, they are very common conditions we see as Physiotherapists and Exercise Physiologists, and we can help you to manage the issue.
Myth Busting
There are a lot of myths surrounding discs that can lead to fear and anxiety, which can further lead to heightened pain levels. Some of these common myths include:
- ‘You have slipped your disc’ – Discs are very strong structures and while you can have injuries to the disc, they will not move out of place.
- ‘Rest is the best medicine’ – Rest can lead to muscle weakening which can in turn put more pressure on the spine. Decreased movement can also lead to stiffening of other structures in the spine and further impact your movement. Overall, light, regular movement is the best way to manage a disc injury with periods of rest in between.
- ‘Your disc will never be the same’ – Discs can heal like any other injury, and, with optimal rehabilitation, most people can often return to their previous levels of activity. This does however take commitment, patience, and self-motivation.
Imaging
For most people with back pain, imaging (XRAYs, MRIs, CTs) is not necessary. A recent study has shown that at 50 years of age, 60% of people without lower back pain can have disc injuries show up on a scan. Therefore, scans do not tell us whether that disc is causing pain. Scans are normally only necessary to rule out red flags (‘nasty causes’) if assessment deems it necessary. Red flags can include signs and symptoms such as unremitting numbness or specific weakness. Most of the time scan results will not provide you with an accurate diagnosis or prognosis of your pain. They will often not change your treatment either.
Below is a chart from the study showing the percentage of people who had changes in their spinal anatomy on a scan but had no history of pain.
(Brinjikji et.al., 2014)
Managing Lower Back Pain
After any type of injury, our structures will undergo a natural healing process. Everyone’s timeline for healing is different. It is important to get an individualised treatment plan that provides education and treatment that is specific to your needs.
Recovery from a disc injury can go through stages:
- Acute phase
- Gentle movement encouraged
- Minimise further stiffness/tightness
- Modify aggravating factors
- Maintain muscle function
- Sub-acute phase
- Begin to return to normal movement patterns
- Build strength
- Slowly incorporate movements that were previously painful
- Post-acute phase
- Preparing the body to be more resilient to back injuries in the future
- Encouraging lifestyle changes that can help to prevent future injury
Treatment often involves a series of graduated steps: manage pain > increase movement > build strength > return to functional activities.
Pain After a Disc Injury
Chronic or persistent pain can occur after a disc injury has healed. There can be many changes within the body that occur following a disc injury that cause pain to persist. For instance, if you repeat an activity that caused the initial injury to the back (i.e. bending), the brain and nervous system may recognise this movement as potentially harmful which in turn produces a ‘pain’ output as a warning signal for the body; so you may experience pain despite the disc itself having already healed to its pre-injury capacity. Therefore, chronic back or neck pain that relates to a previous disc injury is dependent on context.
There are several strategies that can help to manage chronic pain after a back or neck injury; these involve:
- Having an understanding and educating yourself on why the pain is occurring – a Physiotherapist or Exercise Physiologist can help you.
- Having an understanding that the pain is likely not due to further injury.
- Controlling negative thoughts, with positive reinforcement, mindfulness and breathing techniques.
- Maintaining movement and exercise.
- Using symptom relief strategies such as heat, massage, physio, and hydrotherapy, as required. Often movement-based strategies are more effective than static management.
https://upwellhealth.com.au/app/uploads/2021/02/Disc-Injury-Directory_Final_Web.pdf
Surgery
For a majority of people with a disc injury surgery is not required. Evidence has shown that the outcome is the same at two years post operation as it is at two years post conservative management (i.e. Physiotherapy) (Kim et.al, 2021).
Preventing Re-injury/Flare-ups
- Remain active
- Maintain a healthy weight
- Use correct manual handling techniques
- Change postures/positions often
- Otimise nutrition
- Optimise sleep
- Maintain a healthy lifestyle
This blog provides very generalised information and advice. It is always best to consult a Health-care Professional if you experience pain that relates to spinal structures. For appointment with a Physiotherapist or Exercise Physiologist at Coastal Physiotherapy, please contact our Burnie clinic on 64314586.