Lumbar disc injury is very common and is a consequence of walking on two legs, i.e. expecting our spines to move while bearing the weight of our upper body. Discs are the rubbery pads in between the vertebrae and their role is to allow flexibility and absorb shock. They are firmly glued to the bone and CANNOT ‘slip’ out of place or be ‘put back in’.
Disc injuries can be put into 3 rough categories.
1. Annular strain.
This is the mildest form and happens when there is minor damage to the outer fibrous part of the disc but no displacement of the inner jelly-like part of the disc. In practice I see it most in young people and it results in backache which is worse on sitting or after high-impact exercise e.g.running. It usually resolves within 3-4 weeks but can be a sign of future problems.
2. Disc herniation.
This is when increased pressure on the disc causes weakening of the annulus allowing the jelly-like centre(nucleus) to bulge outwards, usually towards the back and side of the disc. This causes more severe back pain, restriction of movement and sometimes sciatica (pain down the leg on the affected side.)
3. Disc prolapse.
This is when the annulus tears and allows the nucleus to ooze outwards usually pressing on the adjacent nerve root where it branches off the spinal cord. This usually causes severe leg pain and can also result in numbness and/or weakness of part of the leg or foot depending which nerve is affected. In most cases this will get better in 6-8 weeks but can take much longer in some unfortunates.
Patients often want to know why they have a disc injury. Latest research indicates that there is a strong genetic influence so you may find your parents have had similar problems. After 40 the disc dries out and becomes tougher so it is less likely to be injured so disc problems tend to happen to the young and middle aged. Episodes can be precipitated by heavy manual work such as bending and lifting but even a sneeze can cause a disc prolapse and some seem to happen for no reason at all. In the early stages disc damage can be completely painless so you may be unaware that there is a problem until it is too late. Diagnosis is usually made by careful history-taking and examination and can be confirmed by MRI scan. X-rays are not helpful as discs are invisible on them.
Pain relief will probably be necessary unless you have a very high pain threshold. This can be in the form of strong painkillers like co-proxamol or anti-inflammatories like Voltarol or Diclofenac. Some patients find these unhelpful but may get some relief from a TENS machine. Osteopathic treatment is not a quick fix (there isn’t one!) but aims to help healing by boosting circulation to the area, relaxing tense muscles, tractioning the affected area to reduce the pressure and giving general advice on what a patient can do to help themselves at every stage of their recovery.
© Justine Knowles 2018
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