Injuries to the lumbar intervertebral discs account for 40% of lower back pain. These injuries are most common between the ages of 20 and 60 years old. Disc injuries are not a one-off event, they are a process that happen over time.
The intervertebral discs are made up of gel-type substance with a high water content, surrounded by rings of cartilage. The beginning of trouble in a disc is a loss of water content. Once the disc is dehydrated small tears can happen, usually closer to the centre of the disc. These initial tears are pain free, as nerve endings only reach the outside third of the disc. So even though an injury process has begun in the disc, we don't feel a thing.
Further tears can now happen, and move towards the outside of the disc. Once this process reaches the outside of the disc, it can result in the sensation of pain. Initial painful episodes might last for a few days or up to one week, and then the pain resolves, sometimes with treatment, or sometimes on its own. The pain in this case may be a relatively mild, aching type pain. It is common for people to suffer multiple episodes like this, that may happen months or years apart.
More serious cases involve part of the disc bulging or herniating out past its normal border. This can happen due to a serious trauma, but can also happen after a simple movement, such as bending over to tie up your shoes, or pick something up off the ground. It can even happen after sneezing. This herniation can result in severe pain and muscle spasm in the low back region due to local inflammation. In some cases the herniation will press against a nerve, and can cause sciatica, or pain traveling down the leg into the foot.
There are many factors that may lead to this type of injury, including genetic tendencies, work or sporting activities that place loads through the spine, prolonged time spent sitting, poor posture, and poor muscle control through our spine and core. Treatment needs to be specific to your individual case and involves chiropractic manual therapy, advice on posture, work and sporting activities, ergonomics, core stabilisation and postural control exercises, stretching and strengthening exercises.
While mild cases can settle without treatment, it is a good idea to be evaluated so a correct diagnosis can be made. In some cases no treatment will be recommended, while in others manual therapy and home exercises will be combined to both reduce the pain levels more quickly, and improve the muscle control of the low back to prevent further episodes. In the worst cases of severe leg pain and muscle weakness, referral to a spinal surgeon may be necessary. It is preferable to prevent these injuries by beginning exercises after mild episodes, rather than waiting for more severe episodes to begin. Click here to book an appointment.