Help! I’ve got a slipped disc in my back!
Nothing annoys Physiotherapists more than when a patient explains that they have a ‘slipped disc’ in their back or neck. This is by no means the fault of the patient. Incorrect diagnoses by medical professionals and a general lack of community awareness is to blame. Unfortunately, this catastrophic belief of severe structural damage can lead to persistent/chronic pain patterns and a reliance on passive intervention… not to mention the millions of dollars of taxpayer’s money spent on back pain treatment each year.
What is a disc?
An intervertebral disc is essentially a shock absorber. They are fused between each of the vertebrae or building blocks in your spine. The discs in your neck are smaller than the ones in your lower back, due to the size of the vertebrae and also the different forces they are subjected to. Discs have a tough outer portion (annulus fibrosus) and a soft inner portion (nucleus pulposus), a little like a jam donut. As your spine moves in one direction, your disc will compress or bulge a little on that side and stretch a little on the opposite side. The discs and the vertebrae are completely surrounded by strong ligaments, tendons, fascia and muscle and contrary to common belief, they simply CAN NOT slip out of place.
So what’s wrong with my disc?
The discs in our back and neck are not immune to aging, they are subject to wear and tear just like the rest of us. NORMAL degenerative changes are often seen on imaging studies in people as young as teenagers and do not always correlate with back pain. Repetitive movements like bending, sustained postures like slouch sitting and heavy lifting can potentially cause disc injuries, especially in those of us who are deconditioned. Common injuries include disc bulges, disc protrusions and disc extrusions. These occur when part of the tough outer portion of the disc becomes weak or soft and bulges outside it’s normal margin.
How long will my disc injury take to recover?
90% of disc injuries will recover on their own without the need for surgical intervention. Compare a disc injury to an ankle sprain… If you injure your ankle, you will likely rest it for a couple of days, maybe strap it up, gradually load it again with a little bit of walking and progress back to jogging and running after a few weeks when it feels better. Unfortunately that concept of relative rest and progressive loading seems to be forgotten or ignored with low back injures. If your back injury has occurred due to repetitive bending, logic suggests that if you return to repetitive bending too quickly, you will likely interrupt the normal healing process. In saying that, bed rest can be disastrous so make sure you consult your Physiotherapist to ensure your disc injury is managed correctly. Most minor disc bulges recover within 3-6 weeks and more moderate disc injuries can take up to 3 months. If your back pain hasn’t resolved within 3 months, I would recommend you see you seek Physiotherapy advice as you may be managing your back injury incorrectly.
I have disc bulges on my MRI so I’m condemned to a life with back pain!
WRONG! “There is a high prevalence of ‘abnormal’ findings on MRI in pain-free populations: disc degeneration (91%), disc bulges (56%), disc protrusion (32%), annular tears (38%).” Those stats are according to Professor Peter O’Sullivan who is internationally renowned as a leading researcher and clinician specializing in back pain. That’s right, nearly all of us have abnormalities in our spine but it absolutely does not mean that we will be subjected to back pain. Pain is very complex phenomenon – stay tuned for a future blog on pain.
Do I need surgery for my back pain?
We have already established that disc abnormalities are highly prevalent in pain free populations and are not strongly predictive of future low back pain and correlate poorly with levels of pain and disability” (Deyo 2002, Jarvik JG 2005).
So you may find it surprising that according to a recent study performed by Franz EW, et al in the Journal of Neurosurgery, more than 50% of patients indicated that they would undergo spinal surgery based on MRI findings alone, regardless of whether they had symptoms or not.
WHAT!!! These findings confirm the common misconceptions around low back pain, especially disc injuries and highlight the necessity for improved communication between the patient and health professional.
Speak to your Physiotherapist at My Physio Perth today to learn more about disc injuries or click here to read about treatment options.