Lumbar Disc Injuries

Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease study 2010. More than 80% of people will experience one or more episodes of low back pain in their life. The intervertebral disc (IVD) is responsible for up to 70% of lower back pain. Lower back pain can be debilitating and persistent, and some people suffer repeated episodes. It can also be a cause of leg pain or sciatica. It may start following a traumatic incident, such as bending awkwardly or lifting heavy objects with poor technique.

Disc anatomy

The disc is a fibrocartilaginous cushion that serves as the spine’s shock absorbing system, distributing and absorbing the load that is applied to the spine. It protects the vertebrae, nerves and other surrounding structures. The disc is made up of two primary structures the annulus fibrosus and nucleus pulposus. The annulus fibrous is the durable outer portion of the disc; it is a well-organized series of concentric laminated fibrous rings that serve to protect the inner portion of the nucleus pulposus. The nucleus pulposus is softer and less organised; it serves to absorb axial load. It is more dynamic than outer layer and moves forwards and backwards with flexion and extension movements of the back. Ultimately the disc functions to maintain mobility and stability of the spine in order to allow us to perform our routine daily activities.

Injuries

Disc injuries can occur in a numerous amount of different ways.  However they usually occur in one of two ways; through repetitive microtrauma and unexpected loading of the disc. A disc injury is suspected when your back pain is aggravated by:

  • sitting
  • forward bending
  • coughing or sneezing
  • lifting

Repetitive microtrauma: This type of injury usually occurs over long period of time, and often involves repetitive activities such as sitting with poor posture or performing bending forward movements combines with rotation loading that irritate and stress the disc. Eventually the disc cannot take any more load and tearing of the posterior fibres of the annulus fibrosus occurs, which results in the release of  chemicals being released that are responsible for inflammation and pain.

Unexpected Loading: occurs when the disc tissue is placed under a significant amount of stress or strain in a short period of time. A good example of this is when people go to pick up a heavy box or when they try to do heavy squats with poor form.

Annular fissure (tear)

An annular fissure occurs in the outer portion of the disc in the annulus fibrosus.  This can occur through a traumatic event, although more often it occurs over a longer period of time, through wear and tear.  Fissures are classified by their orientation there are three types of fissures

  • Concentric fissure is a separation of the annular fibres parallel to the peripheral contour of the disc.
  • Radial fissure is a vertically horizontally or obliquely oriented separation.
  • Transverse fissure is a horizontally orientated radial fissure

Bulge

A disc bulge is present when there is disc tissue extending beyond the edges of the ring apophyses (the outer margin of the disc), throughout the circumference of the disc. The inner fluid presses against the outer disc wall and the disc bulges beyond its normal perimeter.

Herniation

A disc herniation is refers to a localised or general displacement of the nucleus, cartilage, fragments apophyseal bone or fragmented annular tissue beyond the intervertebral disc space. A herniation is only thought to be symptomatic when the herniation or the inflammatory proteins (swelling) come into contact with the spinal cord or nerves of the lower back. Disc herniations are classified on the shape of the displaced material into either protrusion or extrusion.

  • Protrusion occurs essentially when the material that is outside the normal disc space is wider than it is long, (in terms of protruding away from the disc).
  • Extrusion occurs when the base of the herniation that connects it to the disc, is narrower than the width of the herniation at its widest point.

Sequestration is a form of extrusion. It occurs when herniation separates itself from the disc. If the portion of the disc that has become dislodged (the sequestration) comes into contact with the surrounding structures such as the spinal nerves, the sequestration can become symptomatic. Potentially causing numerous different symptoms including pain, tingling, numbness or weakness. The sequestration can be broken down and resorbed back into the blood stream. A recent study showed that the larger the sequestration the more chance there is that it will be broken down and resorbed into the blood stream.

Do I need any Imaging ?

  • If our highly skilled chiropractors suspect a spinal disc injury based on the history of your injury and your symptom behavior, they will perform the appropriate clinical neurological and orthopaedic tests to confirm a disc injury and to detect if you have any signs of nerve compression. The most accurate diagnostic tests to confirm the extent of your spinal disc injury are MRI and CT scans. However, It is important to remember that over time everyone experiences wear and tear on their bodies and many of these injuries or the changes to the disc anatomy are a normal part of aging. A study performed in 2015 validated this as they concluded that disc herniation’s and bulges are now thought to be a normal part of aging as up to 30% of 20 year olds and 60% of 50 year olds having a disc bulge with no symptoms of low back pain (1).

How do I know if I have a disc injury?

The above changes to the disc tissue can present to the clinical on wide spectrum, from mild discomfort to crippling back pain. Discogenic pain typically presents as centralized low back pain that can radiate or referral into one or both legs and into your calf or foot, symptoms include pain, tingling/numbness and weakness.  The pain is often worse in the morning and with flexion-based movements such as sitting, and a deep ache and tightness in the gluteal muscle area and hamstrings is often reported.

Treatment

The treatment for a disc injury is dependent upon the severity and the type of injury that the patient is presenting with, which is why the correct diagnosis is so important. The initial goal of treatment is get you out of pain, and then work on the underlying cause of the injury to prevent it coming back.

The types of treatments provided at In Good Hands Chiropractic include

  • Mobilisation/manipulation
  • Dry Needling
  • Rehabilitation exercises
  • Soft tissue therapy – specific soft tissue release
  • Shock Wave therapy
  • Taping Techniques

If you have any questions about disc injuries, low back pain or any other type of pain, come in and see us or book an appointment online today on (02) 8095 0393 or visit our clinic at 78 Enmore Road Newtown, 2042 for more information.

 

 

 

 

 

 

References:

  1.  Brinjikji W, Diehn FE. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. 2015;35(12):2394-9
  2. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, et al. (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2197–2223
  3.  Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, et al. (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2095–2128
  4. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, et al. (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2163–2196