BACK PAIN +/- Sciatica
Many people have heard the term ‘slipped disc’ and typically associate it with back pain and sciatica.
The first misconception to tackle is the fact that discs do not slip out of place and are very firmly attached to the vertebra above and below them.
The back is very strong and back pain does not always mean there is damage or harm.
To understand better, it’s probably best to go through some of the basic anatomy of the disc and what they do.
The disc sits between two bones called the vertebra. It acts as a shock absorber, reduces the pressure on the spinal joints and increases the amount of movement that the 2 vertebra can perform. They are found between every vertebra in the spine except the very top 2 levels in the neck.
We have 7 vertebra in the neck (cervical), 5 at the bottom (lumbar) and 12 in the middle (thoracic) meaning we have 23 discs.
The disc is soft and can change shape as we move due to the way they are made. They are basically made up of 2 parts; a jelly like material in the middle called the nucleus surrounded by thousands of layers called the Annulus
As we spend a lot of time with our back and necks bent forwards, the nucleus spends more time being pushed to the back of the disc than the front. Over time it is thought that this will cause small cracks in the annulus layers which the nucleus can move through. Occasionally, the nucleus can leak from the back of the disc (Extrusion), but this is actually quite rare and more commonly the disc bulges backwards or to one side (Prolapse)
It is important to remember that discs can bulge, degenerate and become thinner without causing any back pain at all. These findings are often reported on images such as MRI scans but does not explain if you have pain or not
Behind the disc are a pair of nerves that send and receive messages to and from the brain. In the neck the nerves on the left go into the left arm and the right go into the right arm. The lower nerves go into the left or right legs.
These nerves are very sensitive to pressure and chemical irritation from disc bulges. If the nerve is irritated a little it will produce pain. If it is affected a bit more then you will get sensation changes and finally the messages they send to your muscles are affected which makes the muscle feel weak. Different nerves supply different areas and so produce symptoms in those same areas.
The disc does not slip out of place.
Disc bulges are very common and do not always produce pain. If they do this often settles within 6 weeks.
The position of your back and neck will affect how much pressure is on the disc so posture and changes of positions are very important. Try to improve the way you sit and use some way to remind you.
Although the nerve can be ‘trapped’ or ‘irritated’ by a disc bulge, this is not always the case. Move regularly and if necessary use over the counter pain killers or speak to your GP.
If your symptoms do not improve, worsen or you feel weakness in your arms or legs then please seek medical advice.
At the Performance Lab we have expert Physiotherapists who can diagnose a disc problem and provide effective treatment to help speed up your recovery. Treatment such as manipulation of joints and muscles, exercises to reduce the bulge and nerve sliding treatment can reduce the symptoms.
DISC BULGES ARE NORMAL
37% of pain free patients under 25 years old have disc bulges with no functional limitations
EXERCISE AND WEIGHTS ARE GOOD
Back pain doesn't have to stop you enjoying exercise. In fact, keeping your back moving and exercising has been shown to help your back pain get better sooner. This can even include weight training and running.
PAIN DOES NOT MEAN DAMAGE
Our brain controls our pain. Sensors all over the body constantly tell the brain if there is a threat in the area it looks after. The amount of pain does not always link with the amount of harm and the sensors can be influenced by stress and emotion.
MOTION IS LOTION
People with back pain often fear twisting and bending but it's essential to keep moving. It used to be thought that bed rest would help you recover from a bad back, but it's now known that people who remain active are likely to recover more quickly. You should gradually increase the amount you move following an episode of back pain.