In our previous two series, we looked at sciatica and facet pain. The purpose of this series is to educate the patient so that they are more confident of representing themselves properly when seeking care from a professional. This installment of our low back series will focus on the intervertebral discs.
These discs are sandwiched between each vertebrae throughout your spine. One of their functions is to act as shock absorbers.
Every time you jump, run or carry something heavy, each disc in the spine compresses a little bit. Just like your car’s shock absorbers. Discs are not made of bone but of a water-filled special material that makes it a cross between play-do and a gel pack.
If you were to look at the disc, you would see it was made of two distinct parts: the anulus fibrosis and the nucleus pulposus. And no, those aren’t Roman emperors… The anulus fibrosis is the series of outer rings in the disc and are made of fibrocartilage filaments. Further, the fibrocartilage has a special molecules called a proteoglycan which attracts water. This ensures that your discs are plump and ready to absorb physical stress. The center of the disc is the nucleus pulposus and it is essentially a gooey jelly donut center. It serves as a pivot point that allows the spine to move in all directions.
You now know more about spinal anatomy than anyone at your work! Let’s put that knowledge to use.
I was supposed to teach you how to make an educated guess as to whether or not you had a disc bulge. I must admit, this was slightly misleading.
This blog entry is actually to teach you how to detect disc pain. Bulges may or may not accompany disc injuries. An estimated 20% of the population has a disc bulge. Of those, only about 50% have any low back pain.
So whether if your disc is causing you pain does not mean you have a disc bulge. You can have disc pain without disc deformation.
The bulging disc is the first step in a spectrum of deformations that may or may not lead to herniation (i.e. extrusion/sequestration). However, you can have a pre-bulge disc injury and therefore your MRI results will come back normal but all the while you are still suffering from disc-based pain and need a disc-focused solution.
So it is still paramount that you understand how to differentiate your back pain from sciatica and facet pain.
SYMPTOMS OF DISC PAIN IN THE LOW BACK
Patients who have disc pain typically display the following:
1. Pain in the center of the low back along the center of the spine (near or above the belt line)
2. Pain made worse when bending forward at the waist (i.e.: lumbar flexion).
3. Pain relieved by bending backward (i.e.: lumbar extension).
4. Pain that seems to prevent twisting the low back or bending sideways
Again, this entry is not to replace examination by a health care professional, but to help you know if you are getting appropriate care once you see a clinician.
Disc pain is almost always the result of too much forward flexion (i.e.: bending forward at the waist). What many of my patients don`t realize is that sitting in an office chair is equivalent to forward flexion.
In both instances, the lumbar spine is bent forward like a fishing pole. As a result, the vertebrae pinch down on the front of the disc. And just like stepping on the front of a water balloon would cause it to bulge backwards, the pinched disc is bulged towards the back.
This bulging is temporary and disappears when we stand up straight. However, for those who sit in office chairs most of the day, the cumulative strain can cause fiber damage in the anulus fibrosus. Eventually the disc can stay bulged even when the individual stands straight. But even if the disc isn’t bulging, the constant flexion position strains the disc and can cause pain. As time goes on, bulging can begin and eventually pinch nerves or even wear out the fibers in the anulus fibrosis, causing herniations. Most disc pain however, is pre-bulge. And it is simply a matter of cumulative micro-damage to the back of the disc due to constant strain caused by forward flexion. Even if you are diagnosed with a bulge, this does not mean it’s too late for you. Bulges can be reversed. Forward flexion caused the bulging, therefore eliminating the flexion and undergoing extension-based exercises can eliminate the bulge.
If your work requires constant bending at the waist or prolonged sitting in a chair, unless you have proper lifting and sitting education, you are most likely placing your lumbar spine in flexion much of the work day.
If you suspect that your low back pain is disc pain, please contact us for an over the phone consultation to see if we agree that it is disc pain and if it is at a stage we can help. Typically, our disc patients are placed on an exercise rehabilitation program that is right for them. Ultimately, this is the primary tool for recovering from a disc injury. Strong core, hip, leg and upper body muscles as well as appropriate flexibility allow the discs to breath a little easier. Further, knowing how to lift and how to sit will remove the negative strain back patients tend to place on their discs.
There is freedom from disc pain!