In between each of the five lumbar vertebrae or bones is a disc, which functions as a shock-absorb when doing everyday activities. The disc is made of a gel-like centre called the nucleus pulposus and a tough outer layer called the annulus fibrosus. The annulus fibrosis provides good strength to the spine so movements can be completed without the nucleus substance coming away. Many ligaments of the spine provide stability as well as muscles which provide stability and allow movements of the spine.
The vertebra also contains the spinal cord with many nerves from the spinal cord passing through small passageways between the vertebrae and discs. Pain and other symptoms can develop when a disc pushes onto the nerves or spinal canal which may result in uncomfortable neurological symptoms into the legs.
You are more than likely to have heard the term “slipped disc”, however this is not really true. Discs don’t slip as such, as this term would mean the disc has moved out of position, rather they held in place by surrounding ligaments, muscles and vertebrae. These disc injuries occur due to either a to build-up of pressure causing the annulus (outer tough layer) to tear or it can be due to a pre-existing weakness of the annulus. Terms more appropriate to use instead include “bulging”, “herniated”, “ruptured” or “prolapsed”.
Disc injuries follow a continuum of increasing severity. They are often categorised into the following.
- degeneration – outer wall is weak and the disc bulges
- prolapse – the nucleus of the disc pushes out to the annulus
- extrusion – a tear to the annulus allows the nucleus to protrude
- sequestration – the nucleus protrudes completely through the annulus, with fragments of disc material being separated
The symptoms of a lumbar disc injury often include:
- low back pain
- pain radiating down one or both legs which may be associated with pins and needles, tingling or numbness if a nerve is involved
- increased pain associated with bending/flexion
- increased pain coughing or sneezing
- muscle spasm
Causes of a lumbar prolapsed disc:
- Age – more likely to occur as get older
- Trauma – car accidents, sports injuries
- Repetitive bending forwards – picking up children, bending over to do laundry
- Lifting heavy objects – stacking heavy boxes, picking up children
- Incorrect lifting techniques
- Long periods of sitting
- Obesity (extra weight increases stress on the lumbar spine)
- Sedentary lifestyle and poor posture
- Lack of regular exercise
What can you do about a prolapsed disc?
Lumbar disc pathologies can usually be treated conservatively using physiotherapy modalities. A study by Chiu et al, 2015 concluded that spontaneous healing of discs can occur and they can completely resolve after conservative treatment. Healing of discs improves with a higher “severity”, healing rates are mentioned below:
- Disc Bulging: 13% regression
- Disc Protrusion: 41% regression
- Disc Extrusion: 70% regression
- Disc Sequestration: 96% regression
Surgery should only be considered if conservative management fails – usually after six months unless there are any “red flag” symptoms. Often disc injuries can be diagnosed based on symptoms, history of injury and a thorough assessment. The best diagnostic approach is the use of an MRI or CT scan. However, it must be stressed that many people who show evidence on imaging of damaged discs but often have no symptoms, therefore changes on scans don’t necessarily correlate with symptoms.
Some of the ways physiotherapy can help include relieving pain, strengthening and stability exercises to protect the area, motor control exercises, taping, manual therapy, Mackenzie treatment approaches and prevention strategies.
Is this something which is affecting you?
It might be due to one of your lumbar discs.
Please get in contact with us to today!
Written by William Lewis (Physiotherapist) & Anouska Symons (CEO)