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What does my disc injury mean?

So you have been suffering with back pain and you go to see your Physiotherapist, Chiropractor, Osteopath or GP. You are told an all to familiar diagnosis of a ‘disc herniation’, ‘slipped disc’, ‘bulging disc’ or perhaps ‘your disc has gone’.

While I can assure you your disc has not gone anywhere, this is a very common and overused diagnosis that comes in many forms, including ‘disc protrusion’, ‘disc extrusion’ and ‘disc sequestration’. These are the medical terms to classify the changes in your back.

  • Disc protrusion – this is where there has been a bulge in the cartilage of the disc and it appears to be poking out more than it should.
  • Disc extrusion – the fluid inside the disc has escaped through the cartilage wall of the disc, but is still attached to the disc.
  • Disc sequestration – the fluid inside the disc has escaped through the cartilage wall of the disc and has separated from the rest of the disc.

These phrases are all different terms for the same injury – a very common injury I might add!

A ‘degenerated disc’ is another common diagnosis that simply refers to a natural age related change to the disc, just like our hair turns grey and our skin wrinkles as we get older our joints age.

So, what do we know about disc injuries?

It is very likely that the changes revealed on scans have been there long before your symptoms. This means that we are unable to say with certainty these changes are causing your pain.

We do know that these changes are very common, so there is no need to panic or worry if you are told you may have them.

We also know that most cases of low back pain (disc-related or not) get better within 6 weeks and those that do not will benefit from a targeted physiotherapy treatment involving exercise.

If you were to MRI scan most of the population here is what you would likely find:

Age-specifc prevalence estimates of degenerative spine imaging findings in asymptomatic patients.

 
Imaging Finding Age (Years)
20 30 40 50 60 70 80
Disc Degeneration 37% 52% 68% 80% 88% 93% 96%
Disc signal loss 17% 33% 54% 73% 86% 94% 97%
Disc height loss  24% 34% 45% 56% 67% 76% 84%
Disc bulge 30%  40%  50%  60%  69%  77%   84%
Disc protrusion 29%  31%  33%  36%  38%  40%  43% 
Annual fissure 19% 20% 22%  23% 25% 27% 29%
Facet degeneration 4% 9% 18% 32% 50% 69% 83%
Spondylolithesis 3% 5% 8% 14% 23% 35% 50%

What symptoms are common?

Symptoms vary significantly; here are some of the common symptoms we see in clinic:

  • Nearby nerves can be irritated and this may lead to pins and needles, tingling, odd sensations and/or the pain jumping around
  • The sciatic nerve may be irritated leading to pain in the buttock or down the backs of the leg, often referred to as sciatica
  • Your may find it difficult to get going and/or feel stiff following periods of sitting, standing and lying
  • Pain when bending and twisting
  • Difficulty staying in one position moderate periods of time
  • Constant underlying aching

These are symptoms for general back pain and that includes disc related injuries. Symptoms usually improve with treatment and getting moving again.

In some cases your back pain may need further investigation. When back pain is accompanied with the following specific symptoms you should go to your GP. For instance if you:

  • Have difficulty passing urine *
  • Lose control of your bowels *
  • Develop numbness around your back passage or your genital area *
  • Develop erectile dysfunction *
  • Have weakness in your legs or you are unsteady on your feet *
  • Have severe pain going down both legs into your heels *
  • Have had a direct trauma to your back *
  • Have a history of cancer
  • Have very severe pain through the night
  • Have rapid onset of weight loss

* if you develop these symptoms you should attend your local A+E department for urgent investigation.

What should I do to help a disc injury?

Look for up-to-date and evidence based help from a physiotherapist. We can help you improve pain, improve mobility and get back to your hobbies with targeted exercises, education on your symptoms and hands on treatment, as appropriate.

What should I avoid with a disc injury?

When seeking help please understand there is NO QUICK FIX and please do not listen to bad advice that is unfortunately still given. This includes:

  • Your disc needs to be pushed back into place
  • You need to bed rest/rest for long periods days
  • Your back HAS to be adjusted
  • Your pelvis is out of line and needs adjusting
  • You have one leg longer than the other – so you are always going to have back pain
  • Avoid lifting heavy objects
  • Avoid bending over

Article by Dominic Richmond, Chartered Physiotherapist at Capital Physio

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