Lumbar Disc Injury

Lumbar disc injury is an umbrella term for a range of disc-related changes such as disc herniations, disc bulges and degeneration. Some of the words seen online or used by health professionals can be alarming and misleading. The phrase is known as a ‘slipped disc’ is one we try and avoid as discs do not slip. They are very strong and robust structures that can tolerate huge amounts of force, therefore these changes in the lower back are generally normal and are of no serious concern ^{(1, 2)}.

The discs consist of an inner core (nucleus pulposus) made of a gel-like structure, and a tough exterior made of fibrous collagen that surrounds the inner core. The spinal discs are very strong and robust structures and their function is to absorb shock, allow for effective movement of the spine in all directions and act as tough structures that allow the spine to tolerate load and compression ^{(1, 2)}.

The problem arises when the inner gel structure herniates/protrudes through the tough exterior. This can irritate local structures which can lead to a variety of symptoms you may feel ^{(1, 2)}.

Lumbar disc injury is often caused by normal age-related changes, combined with excessive stress/strain on your back. As people age, the water content within the discs reduces, they can become less flexible, begin to shrink or bulge/herniate; however, these changes are completely normal ^{(1, 2)}.

Our bodies adapt to what we do on a daily basis, and so the more we move, the more our discs are exposed to this and can tolerate these movements. The problem comes when we lack movement in different directions which can cause discs to lose their flexibility and ability to tolerate these movements. If we bend, twist, or lift something too heavy too quickly, this can lead to changes to the discs if we do not normally perform these activities ^(1,2).

Disc changes can also be caused by any traumatic events such as falls, car accidents and sports injuries. As long as any serious injuries are ruled out by your doctor or physiotherapist, this again is not of any serious concern.

Back pain is extremely common; 60% – 80% of the population may experience back pain at some point ⁽¹⁾. On a yearly basis, 1% – 3% of people will have a lumbar disc injury. Lumbar disc problems are common; 50% of 40-year-olds have a disc bulge on MRI scan without any pain ⁽²⁾.

During an initial assessment, your physiotherapist will ask a series of questions and undertake a physical examination to understand your story. This may include the mechanism of injury, or how it happened. They will also ask about relevant medical history, previous injuries, surgeries and any medications you normally take to ensure they have a good understanding of what can be influencing your symptoms.

Your physiotherapist may ask you to perform some very simple movements and go through some simple movements on the treatment bed. This is to create a list of problems you may be experiencing which will allow your physio to create a tailored treatment plan that will be specific to you and your goals so they can help you return to doing all the activities you love.

Many patients visit with the hope that a magnetic resonance imaging (MRI) scan or X-ray will help to form an accurate diagnosis, however, in the majority of cases, they are not required. As mentioned above, we often find things on scans that are normal age-related changes and not linked to the cause of your pain, therefore this does not change how we deal with your problem ^(1,2).

The best place to start is to have a thorough assessment by an experienced physiotherapist who can advise you on the self-management techniques that may be best suited to you. Your physiotherapist can provide you with an effective explanation as to why you have your symptoms, and give you knowledge and confidence to effectively manage them to support your recovery ⁽⁷⁾.

In general, keeping moving is more important rather than resting and, in fact, in most cases, resting will have a negative effect. Try to keep up with your normal daily activities as best you can; working with some pain and discomfort is completely safe and you will not do any further damage. Just make sure to pace your activities and not do too much at once as this may aggravate your symptoms ⁽⁷⁾.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

Manual therapy – hands-on treatment (massage, manipulation, mobilisations) can be effective and should be part of a treatment package including exercise, and not used exclusively in the absence of regular exercise ⁽⁷⁾.

Epidural injections – can be used in cases of severe pain or sciatica symptoms ^(3,7).

Surgery – can be an option for advanced cases to treat compressed nerves in the lumbar spine that aims to improve persistent pain and/or numbness if various non-surgical treatments have been exhausted and your symptoms continue to impact your quality of life, however, there are various risks associated with surgical interventions ⁽⁶⁾.

Chartered Society of Physiotherapy – “Back Pain MythBusters”
https://www.csp.org.uk/system/files/myth_busters_leaflet_-_final.pdf