What is it and how does it happen?
Your intervertebral discs are the shock absorbing rings that sit between the bony vertebral bodies in your spine. They are made up of two main parts - the annulus and the nucleus. The nucleus refers to the inner, jelly-like section of the disc, which can change shape to adapt to different loads placed on the spine. This is important for shock absorption between spinal segments, as well as ensuring there is enough room between each vertebra for movement of the spine and for major nerves to pass in and out of the spinal canal.
Most discogenic back pain is mechanical in nature and may be caused by sustained maladaptive postures, bending/twisting, pulling or lifting to a level or load that is not able to be tolerated by the musculature supporting the spine. Often these mechanical injuries are due to accumulation of increased load on the lower back over a matter or weeks or months, but may become symptomatic with a particular (often innocuous) incident such as bending over to put your shoes on or twisting while lifting a weight.
When a disc becomes irritated or injured it can create low back pain as well as referred pain, numbness or tingling into your legs and/or feet. This can be caused by the pressure or inflammation around nerves as they exit the spinal cord in the vertebral column and travel down your legs and into your feet. This pain and/or referred pain can also be caused by muscle spasms that often occur in the area as a natural response to the altered biomechanics of the spine. This spasm can create the sensation of tightness in the lower back or hips and can restrict your ability to move comfortably.
Although back pain is a common, there are some factors that may increase your risk of developing discogenic back pain. These often relate to increased forces travelling through the spine, and include:
- Carrying excess body weight
- Activities or tasks that involve heavy manual labour or vibrations
- Sedentary lifestyle
- Conditions affecting the biomechanics of the spine, such as osteoarthritis and scoliosis.
- A previous history of back pain/injury.
Management and treatment of discogenic back pain
PHASE I – Pain Relief & Protection
- Try to avoid movements that increase the pressure on your discs such as ‐ sitting slouched or unsupported, bending forwards, heavy lifting, coughing & sneezing.
- Your physio will use an array of treatment tools to reduce your pain and inflammation. These can include soft tissue massage and joint mobilisations, gentle exercises such as stretching, heat packs dry-needling, de-loading taping techniques, education on activity modification and postural advice.
- A home exercise program will be implemented by your physio.
PHASE II – Restoring Normal ROM and Strength
- As your pain and inflammation settles, your physiotherapist will aim to restore your normal range of motion, muscle length and resting tension, muscle strength and endurance.
- You will gradually begin a supervised exercise program focussing on dynamic motor control and strength of the muscles supporting your lower back – increasing the stability of your spine. This can be in the form of clinical pilates and/or a gym based program.
- As the dynamic control of your lower back musculature improves, your physio will progress your home exercise and supervised exercise programs into more stressful body positions and postures.
- Depending on your chosen work, sport or activities of daily living, your physio will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their body that will determine what specific treatment goals you need to achieve.
PHASE IV – Preventing a Recurrence
- Back pain does have a tendency to return with the number one predictor of developing lower back pain being a past history of lower back pain. But the main reason for this recurrence is due to insufficient rehabilitation in the first instance. In particular, reduced compliance with the rehabilitation plan and home exercise program.
- Lower back and core strengthening exercises should be incorporated into your regular exercise routine. These should be performed in some capacity 2-3 times per week. Your physio will assist you in identifying the best exercises for you to continue indefinitely.
- General exercise is an important component to successfully preventing a recurrence. This may be in the form of pilates, yoga, swimming, walking, hydrotherapy, a gym program or whatever else you enjoy doing and can continue to do in the long-term.
- Fine-tuning and maintenance of your back stability and function is best achieved by addressing any deficits and learning self-management techniques with the guidance of a physiotherapist.
If you are experiencing lower back pain and would like to have a FREE assessment by a Physiotherapist or Exercise Physiologist, book in to Back in Motion Aspendale Gardens here.