Back pain is certainly one of the most common symptoms we see in the Physiotherapy clinic. There are many different sources of back pain, however a bulged disc is something we hear about frequently. So what is it?
What is a Spinal Disc?
As we spoke about in the previous blog post. A spinal disc is a shock-absorbing ring of fibrocartilage and glycoprotein, that is located in the spine, in-between each of the bony vertebral bodies. These spinal discs allow for movement at each spinal level and give room for the major spinal nerves to exit from the spinal canal to supply the rest of the body. The annulus is the outer, fibrocartilaginous, section of the spinal disc which creates a wall around the centre of the spinal disc. Inside the disc is a fluid component called the disc nucleus, which moves within the annulus adjusting to pressures placed on the spine.
What Happens when a Disc Bulges?
If the annulus is injured, the wall around the disc weakens and the nucleus can press outwards on the weakened disc wall. This then causes the disc to bulge outwards. A disc bulge may also be commonly referred to as a 'slipped disc.' This bulge can then potentially press against or irritate the nerve as it exits that level of the spine. This irritation or pinch of the nerve can cause back pain, spasms, cramping, pins and needles, or pain in the legs (depending on the location). A bulged disc can happen to any area of the spine, including the lumbar spine (lower back), thoracic spine (upper and mid-back), and the cervical spine (neck). The degree of severity can also vary from mild disc strains to complete rupture and herniation of the nucleus through the annular wall.
What Causes a Disc Bulge?
When a disc bulges, herniates, or ruptures, it typically is due to one of two reasons. One; due to a pre-existing weakness in the annulus. Or two; due to a sudden increase in the pressure through the disc, resulting in fibres of the annulus tearing.
General causes of disc injury can be summarised into three categories. Accumulated microtrauma is one of these causes. This is when the discs are stressed repeatedly over an extended period of time, leading to disc injury. The most common and best example of this is poor posture.
The next cause is a sudden unexpected load to the disc which may occur in traumatic situations, for example a motor vehicle accident. This sudden unexpected load on a disc can result in tearing of the annulus fibres and hence result in injury to the disc.
Whilst it is a known cause of disc injury, genetic factors are a very minor contributing factor to disc injury. If a disc injury is sustained, it can almost never be put purely down to genetic factors.
How Can Disc Injuries be Treated?
Most minor and moderate disc bulges are treated conservatively. There are several phases of treatment and management for disc injuries. The first stage will be to manage and reduce pain, inflammation, and help protect the disc from further injury. Techniques for this could include ice, dry needling, unloading taping techniques, soft tissue massage, and the temporary use of a back brace. As pain and inflammation reduce, treatment will then become focused on encouraging normal joint alignment, range of motion, and improving surrounding muscle length and strength. Core activation exercises are very important for this process. The third stage is to restore to full function, bringing attention to normal pelvic and spine alignment, and restoring range of motions in more complex body positions and postures. The final stage is focused on preventing recurrence. Exercise and posture are two of the main factors that will influence this.
Disc injuries aren’t exactly a quick fix and they usually take several weeks to settle down. The disc may also remain vulnerable and weak to a recurrence for at least six weeks, however it should not be painful during this period.
We strongly recommend that if you suffer from any neck pain, discomfort, or stiffness, that you arrange an appointment with your Physiotherapist for a thorough assessment.