Last week we looked at the symptoms, causes and risk factors of some of the back pain that stems from disc related injuries. This week we’ll be taking a peek at some of the most common disc related injuries and how sports physiotherapists accurately diagnose and treat them.
When it comes to back pain, it can be related to any number of different types of feelings that come from muscles, bones, vertebral joints and intervertebral disc or other structures in the spine. Some studies have shown that up to 28 to 40% all patients suffering low back pain were caused by a discogenic affliction. Before you start bopping away to Saturday Night Fever, a Discogenic affliction isn’t anywhere near as funky as it sounds.
What are the most common discogenic injuries?
If you are suffering from chronic lower back or neck pain without the presence of a herniated disc, you may have discogenic pain stemming from degenerative disc disease, ruptured (or ‘slipped’) disc or sciatica.
Your sciatic nerve is the longest nerve in your body, so it should be no surprise that sciatica is one of the most common issues seen to by sports physiotherapists. Sciatica is the Latin word for “Pain down the back of the leg” but could really be described as more of a pain in the butt, hip, hamstring or lower back. Sciatica pain can cause a range of pain types from short and sharp, to infrequent and dull to debilitating. The most common cause of Sciatica is compression of the sciatic nerve due to a ruptured disc. Luckily, uncomplicated sciatica is very treatable and with a hands-on approach and some exercises with your physio, you should be all good to go shortly.
A ruptured disc injury is a common injury and can occur in your lumbar spine (lower back), thoracic spine (upper and mid-back) or your cervical spine (neck). The term ‘slipped disc’ is used interchangeably with ruptured disc, but this doesn’t paint an accurate description. You see, your discs are held in place by ligaments, muscles and the vertebrae structure and if they are slipping around the place, you’ve got bigger problems to fix I’m afraid. When the disc bulge is large enough for the disc nucleus to come out of the annulus, this is known as a herniated disc, about as close to a ‘slipped disc’ as medically possible.
How do physiotherapists treat disc injuries?
Physio has been shown to be an effective treatment for acute back pain associated with a discogenic injury in the lumbar spine. Due to the myriad of causes of discogenic pain, there are many different treatment protocols and possibilities. Firstly, your physio will take you through a thorough subjective and objective examination. Snapshots such as an MRI or CT scan may be required to confirm the diagnosis and extent of a lumbar disc bulge. Because physiotherapists are experts in human movement and musculoskeletal disorders, we understand the complexity of spinal structures and how these work together and how injuries occur. Your sports physio will be able to assess the problem associated with a disc bulge and provide an outline of the safe and effective treatment.
Physiotherapy treatment is designed to reduce the amount of inflammation and pain in the area by using a variety of mobilisation and soft tissue releases along with lower back strengthening exercises.
Our SMART Physiotherapy treatments are safe, effective and based on the most up to date research, guidelines and first-hand experience from sports physiotherapists.
Your treatment program could include:
- Massage therapy along with spinal mobilisation
- Specific exercises designed to improve mobility and decrease pain
- Biomechanical assessment, correction and ergonomic advice
- Activity modification – being active leads to faster recovery time – avoiding bed rest, prolonged sitting and poor lifting technique improves recovery
Functional training program
- Information on correct bracing or taping
Using Clinical Pilates to increase Core strength and reduce back pain
Spine stabilisation and maintaining a correct posture is the key to keeping back injuries at bay. Without strengthening your core this is just a pipe dream. FIXIO’s Clinical Pilates classes focus on targeting those muscles that are most important, while bringing your attention to the control and feel of how the exercises affect your muscles; increasing your own awareness of your body. Core strength plays a large part in a number of everyday activities like sitting for long periods of time, lifting weight, playing sports and even standing. The more you work on and are aware of your core the less pain will suffer.
For more information on Pilates for core strength and treating back pain, give us a call on (02) 8964 4086 or book an appointment.
 Fukui S et al. Intradiscal Pulsed Radiofrequency for Chronic Lumbar Discogenic Low Back Pain: A One Year Prospective Outcome Study Using Discoblock for Diagnosis. Pain Physician 2013. Level : 3A
 Lis, A. M., Black, K. M., Korn, H., & Nordin, M. (2006). Association between sitting and occupational LBP. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 16(2), 283-98.
 Hsu, S. L., Oda, H., Shirahata, S., Watanabe, M., & Sasaki, M. (2018). Effects of core strength training on core stability. Journal of physical therapy science, 30(8), 1014-1018.
Back pain doesn’t discriminate; it can affect people of all ages, sizes and backgrounds and getting to the bottom of the root cause of back pain can sometimes make a sports physio feel like Sherlock Holmes. With so many structures making up the back and spine, when a patient comes in and lays the blame of back pain on ‘a slipped disc’ or ‘pain in one of the discs’ I have to put my detective’s cap on rather than taking the pain at face value.
What is a disc?
Well it’s not a floppy disc (or so we hope!), it’s actually more like a jam donut. The term ‘disc’ is actually short for the term – ‘intervertebral discs’. Your spine is made up of 24 hard vertebrae that are placed on top of each other like building blocks. Between each of these hard building blocks are the spongy cushions (discs) that separate them. The hard outer shell of the disc is known as the annulus fibrosis and the soft, jam donut inner core is the nucleus pulposus. These intervertebral discs can take quite a lot of pressure before they become damaged, but particular movements and injury pathologies can damage the discs if in the wrong spot.
What are the symptoms of disc problems?
Damaged discs can cause a variety of symptoms and feelings in the area depending on the vertebrae in question and the severity of the injury. It’s actually quite common for disc injuries to fly totally under the radar and only become known from a scan or x-ray. Unless of course the disc has slipped far enough to catch the nerve roots extending from the spinal cord, then it’s a new world of pain. Common symptoms include:
- Pain localised to the back/spine
- Radiating pain in the butt, thighs, lower legs or even the feet
- Pain that gets worse when bending over or sitting down
- Pain exacerbated by sneezing or coughing
- Pins and needles or numbness in an arm, fingers or leg
- Muscular weakness in the back, core or legs
What are the common causes of disc related injuries?
Sports physiotherapists on the Northern Beaches are seeing an increase in disc related injuries that come as a result of inactivity rather than activity. This is because of the increasing amount of time people sit on their butts with poor posture, weak abdominal strength and a lack of stability in the lower back. Disc related injuries are more likely to occur when performing repetitive flexion & rotation movements like lifting heavy loads. The most common causes of disc issues we see normally come as a result of:
- Prolonged sitting (especially with poor posture)
- Bending over without engaging the core
- Lifting (especially with poor form or without safety equipment)
- Pulling or dragging (again with poor back stability or core technique)
Who is at higher risk of developing disc related problems?
Often, there is no recognisable risk factor present that sets patients apart who have disc problems. However, some people are more susceptible to disc problems if they engage in a number of risk activities or suffer from other health problems such as:
- Poor muscle tone
- Lack of regular exercise
- Cigarette smoking
- Advancing age
- Poor posture
- Incorrect lifting techniques.
Do I need surgery for a disc injury?
Luckily for most, surgery is not usually required in order to alleviate the pain caused by disc problems and get patients back to normal programming. With early intervention with a physiotherapist and a bespoke plan in place to treat and combat disc pain symptoms and causes, most flare ups only last a few weeks.
Surgery should only be considered after non-surgical options have been explored and a thorough course of action has been explored by doctors, surgeons and physiotherapists.