Updated: Jun 20, 2019
A straightforward guide to the disc and what it may or may not mean for you.
First up, Don't Panic
The purpose of this blog is to clear up what discs are and to hopefully put your mind at rest. The significance of disc bulges and other findings on your scan results needs to be taken in context with your signs and symptoms of low back or neck pain.
Consistently we hear from clients who present with back pain that they have a bulging disc or collapsed disc and this seems to be accompanied with a sense of finality and despondancy.
It does not have to be this way.
Yes the disc can be a source of pain in low back and neck issues, but so can other structures. In some individuals it may be that surgical intervention is required.
These types of back issues are often accompanied by neurological signs such as weakness and loss of feeling. However they may also resolve without surgical intervention and can get back to normal function again.
However more often than not back and neck pain is often wrongly attributed to a disc and if it is, it rarely needs surgical intervention.
What the research shows.
The disc is capable of getting stronger over time with exercise.
A disc bulge is capable of "healing".
Effective treatment with exercise and advice is very successful in the short and long term with these issues.
Most important is most of us have disc bulges and NO associated pain , thats right NO PAIN.
But my scan says i have a bulging disc and i have back pain so that must be the cause.
This old chestnut again. The thing with scans is they always need to be taken in context with your symptoms and signs.
If your signs and symptoms can be related to the scan results then we can probably assume we have found a "player" in your pain or maybe even the culprit.
If the symptoms and scan don't match up then maybe they are not anything to worry about, but we can keep an eye on it. Even if they do match up with a disc related issue it just helps us get you on the right path and back to full health.
The funny thing is that there are many individuals wandering around living full lives , playing sport etc with no pain but on a scan they have evidence of disc bulges !
According to the research presented above i have a 50-60% chance of a disc bulge in my spine, yet i'm still doing "fatnastics",( thats what i call my exercise) 5-6 days a week.
What are intevertebral discs ?
There are 25 discs in the human spine;
7 cervical or neck
12 thoracic or region of the ribcage
5 Lumbar or low back
1 Sacral , between low back and pelvis
They are quite ingenious feats of engineering and have multiple functions.
They help allow the spine to be flexible without compromising its strength.
They are also important shock absorbers.
Provide a smoother surface for the adjacent vertebrae to move on relative to each other.
Anatomy of a disc
Discs are made up of three different regions, The major 2 areas that are most discussed are the inner NUCLEUS PULOPSA, which is a thick viscous gel,(spine snot if you like). The nucleus is actually a substance that proves to be a real irritant if it comes in contact with nerve tissue and is possibly a likely candidate in generating the pain response attributed to disc isues. Actual pressure on a nerve seems not to be the main issue its contact with the nucleus.
The outer ANNULUS FIBROSIS, which are concentric rings of fibrous like material arranged in layers or lamellae to give it strength. Much like how plywood or structural beams are made making them strong and light for engineering and building projects.
Often the analogy of a jam donut is made to explain how the disc looks but its really less tasty and more complex than that. However it does help with visualising the nucleus, represented by the jam in relation to the outer cartilage, the donut.
On the top and bottom of the disc is the cartilage endplate which is responsible with binding the disc to the vertebrae and also with nutrition to it as well. Yup even discs need to be fed.
In the outer third of the annulus of the disc is where we find a nerve supply and where there are nerves there is the potential for them to become sensititised. As we get older or if we " injure the disc" there is potential for these nerves to grow and become more sensitized. However DON'T PANIC these nerves can always be calmed down or may not even cause an issue.
The other potential trouble spot is when the spine snot, sorry nucleus pulposa, comes in contact with the nerves at the back of the disc or the large nerve root that exits the spine. If the nucleus comes in contact with these nerves it sets off a complex neuro-immune pain response...ouch. This is what generates the symptoms of pain.
This can happen with a combination of small cracks in the inner part of the disc and delamination of the annulus creating a pathway for the nucleus to reach the nerve tissue in the disc. In some scenarios it may even find its way out of the disc and press on the nerve root. This can create symptoms running down the leg andif severe enough weakness and numbness requiring a scan or specialist opinion.
The mechanisim behind this tends to be one of repetitive flexion stress with rotation or compressive stress under some sort of load. Manual labour, repetive lifting or long periods of sitting over long periods of time seem to be popular culprits.
Do i have a Disc problem in my back?
I'm going to make a few generalisations here but by and they hold true if your back pain has a discogenic cause;
Tends to be more prevelant in under 55 age group.
Mechanisism of injury tends to be related to bending and twisting.
They usually are worse with flexion based movements e.g sitting and bending.
Pain can refer down the leg in a specific pattern.
Positions that make them feel better tend to be extension, so standing, walking or lying down may make the pain better.
What should i do next
The key is always don't panic and get assessed so you know what is really happening.
After that treatment is focused on the following key areas;
Stay positive, its not the end of the road, just a bumpy bit of track.
Postions of ease, especially in the acute phase to help reduce the pain.
Walking has been shown to be of great value.
Mckenzie regime and exercise plan, a much under rated protocol that is especially useful in the acute phase, can be very useful and encourages movement and self treatment.
Get your spine more flexion or compression tolerant. Exercises to improve the fitness, strength and movemnt quality are key. This is a great start (https://www.aranahillsphysiotherapy.com/blog/top-5-exercises-to-strengthen-your-core)
Get active again and address the underlying causes of why you have back pain. Not what structure may be aggravated and irritated.
Discs can be a source of pain but they can also be very responsive to treatment in both the short and long term.
Don't panic and love the disc, its a pretty cool wee thing.