The intervertebral discs are found between the vertebral bones of the spine.  The disc consists of two distinct components.  On the outer portion of the disc are a series of tough fibrous rings (the annulus fibrosus) that fully enclosed the jelly like core (nucleus pulposus).  The structure is analogous to a donut, the annulus pulposus being the dough and the nucleus pulposus analogous to the jelly filling.  The function of the disc is to allow movement and act as a shock absorber to absorb axial forces.

There are 3 different types or grades of injury to the disc

• Grade 1 is the least serious type of injury and is called an annular strain.  This involves tearing of some of the fibres of the outer annulus fibrosus.
• Grade 2 is a disc bulge. Due to trauma and ageing cracks begin to form in the annulus fibrosus.  This permits the central nuclues pulposus to be pushed out towards the outer edge of the disc causing the disc to bulge outwards.  The bulge causes pain by compressing adjacent structures.  If a nerve is compressed this can cause shooting pain into the buttock and leg along with sensations of pins and needles and possibly weakness in the legs.
• Grade 3 is a prolapsed disc, otherwise know as a slipped disc.  In this type of injury the jelly like core of the disc is forced outwards and breaks through the outer annulus (unlike a grade 2 bulge in which the nucleus is still contained within the boundary of the disc).  This can cause pain either by compression as described in a grade 2 injury or stimulate a strong inflammatory response in the surrounding tissues causing considerable pain and discomfort.  Around 95% of disc prolapses occur at the base of the back in the lowest two joints i.e. at L4/5 or L5/S1.

Disc injury causes

• Disc injuries are most frequently experience by people in the 25-45 age group.  As we age the nucleus pulposus tends to dehydrate and contract making bulges and herniations less common over the age of 45.
• Individuals with a history of strenuous manual work are more likely to suffer from disc injures.
• A sudden traumatic incident, especially lifting with the back in a bent over and rotated may precipitate an episode of pain.  Sometimes an innocuous movement can trigger an injury when the disc has been subject to long term repetitive strain.

Slipped Disc Symptoms

Pain maybe caused by disc bulges and herniations compressing adjacent structures.  The surround musculature can react and go into a protective spasm.  A bulge or herniation can compress a spinal nerve triggering symptoms in the distribution of the nerve.  Symptoms include

• Pain in the back, buttock and legs
• Tingling, numbness and weakness in the back, buttock and legs
• Symptoms are usually worse first thing in the morning from around 15 minutes to an hour and towards the end of the day.
• Pain aggravated by
  • Sitting
  • Lifting
  • Bending forwards
  • Coughing or straining on the toilet
• Pain relieved by
  • Getting up and moving around carefully
  • Lying down

Less commonly the following symptoms can be caused.  If this is the case seek medical attention immediately

• Loss of control of bladder and bowel
• Inability to feel the passage of urine on urination
• Inability to feel the passage of faeces on defecation
• Numbness, tingling or reduced sensation in the area between the legs around the anus and genitals (saddle anaesthesia).

Duration of symptoms typically 3 to 6 months.

Self Help

• Rest with avoidance of activities that exacerbate pain, especially lifting and bending.
• Ice therapy
• Employing good posture and correct body use to reduce the strain on the back
• Anti inflammatory medication – speak to your pharmacist or doctor before taking any medication.

Treatment of Slipped Disc

• Osteopathic traction of lower back to enhance circulation to discs
• Osteopathic articulation to improve movement of spinal joints around damaged discs to improve circulation to discs
• Massage to reduce reactive spasm in surrounding musculature
• Prescription of exercises to reduce spinal disc herniation
• Taking mechanical load off injured area by
  • Improving alignment of pelvis and spine
  • Spinal manipulation to improve movement above and below injured area
  • Stretching of hamstrings to alleviate flexion forces on the spine
  • Exercise prescription to strengthen core muscles

Tags: back pain