People are often very concerned when they believe that they have disc injuries or have injured another structure in the back, often after being informed by a medical professional. But is this concern warranted? The short answer is most often no.
The intervertebral discs are robust structures that sit between the vertebrae and in conjunction with the facet joints, allow movement of the spine. They are composed of two structures: the anulus fibrosis, a robust and thick ligament-like structure which runs in circles around the outer disc (similar to the rings of an onion that has been cut in half) and connects it to the vertebra above and below; and the nucleus pulposus, a jelly-like substance in the centre of the disc, with the consistency of toothpaste, which allows shock absorption and shifts within the disc when we move.
As the disc responds to the way we move (and also age), the shape of the disc will vary. It is not uncommon for the inner fibres of the anulus fibrosis to tear causing the outer fibres to swell or bulge towards the spinal cord or exiting nerve roots. Many people with back pain, upon having an x-ray or CT scan, will be informed that they have one or more disc injuries such as a bulge. However it is important to realise that research has shown that 30% of 20-year-olds with no history of back pain, have radiological findings of disc injuries (that’s right NO BACK PAIN!), and up to 84% of 80-year-olds also without back pain. This tells us that bulges in discs are a normal consequence of aging and may not be significant or even be a source of pain in most people.
So what if I do have back pain and my x-ray shows that I have disc bulges? It is quite likely the pain is coming from another source such as an overloaded muscle from poor posture or repetitive tasks (ie: the Psoas) or from an inflamed facet joint in the spine. Your back pain could be something quite benign and easily fixed by a skilled physiotherapist. It is important to note that just because you have one or more bulging discs you most often don’t need surgery to fix your back pain.
So can discs actually be injured and can they be a source of pain? In some cases yes! Just as it is possible to sprain an ankle or strain a muscle, it is possible to damage a disc. Likewise, just as an injured ligament in a sprained ankle WILL HEAL, so too will a herniated disc, annular tear, or other disc injury with treatment from a skilled physiotherapist.
In some cases a disc can herniate or rupture. In this situation all the fibres of the annulus fibrosis tear and the contents of the nucleus can ooze out and cause irritation of the spinal nerve root. This causes radiculopathy which is commonly known as Sciatica (pain in the leg). Sometimes these people will require surgery but most can be treated successfully using physiotherapy. Research has shown that 30% of the population have radiological findings of a herniated disc with nerve impingement and have no reported symptoms of pain, numbness, or paraesthesia (symptoms of sciatica). Nerves are very hardy structures and it is possible to impinge them so that they are flattened to only a few microns thick without any of the above symptoms occurring.
So what causes Sciatica? Researchers believe that it is irritation of the nerve that causes inflammation and that in turn causes the symptoms of Sciatica. Skilled physiotherapists are very effective at treating this problem and in most cases avoiding the need for surgery.
In summary, many findings on imaging (MRI, x-ray, CT etc.) regarding disc injuries and other structures in the low back can be found in normal people without back pain. They are a normal part of the aging process and rarely cause back pain or indicate damage. In a lot of cases, back pain is muscular in origin, which is easily treated by a skilled physiotherapist. Whatever is causing your back pain, it is important to be assessed by a skilled physiotherapist and not be alarmed or make rash decisions based on imaging findings. Alpha Physio is staffed by highly skilled physiotherapists who are able to accurately diagnose your back pain and provide effective treatment.
If you have any further questions, have lower back pain, disc injuries, or just want to make sure you have a healthy spine and posture, please feel free to contact Alpha Physiotherapy and book an appointment on (07) 3279 3871.
