GThe Leg, Ankle & FootENERAL INFORMATION, SIGNS & SYMPTOMS, OSTEOPATHIC AND SELF MANAGEMENT OF
  Low Back Disc Injury
Annular Tear, Disc Bulge, Disc Herniation, Disc Prolapse
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Our spine is designed for stability and for flexibility. Our bodies are always aiming for harmony between these two elements to allow for pain free motion. Our discs that lie between the bones (vertebrae) of our spine are an integral part of most human movements and therefore are designed to withstand significant pressures and forces in different directions. When abnormal movement (e.g. repetitive or excessive strain), trauma or when long term strain occurs the disc can become damaged.
 
Causes of low back disc injury/degeneration
  • Sudden impact or trauma from (e.g.from a fall or motor vehicle accident or through heavy lifting).
  • Continual degeneration over time through postural/bio-mechanical stresses
  • Aging (but can occur at any age).
  • There are some reports that there is a genetic link.
  • There is also an increased incidence in disc injury in smokers.
 
Signs & Symptoms
  • Moderate to severe low back pain which may also be felt into the buttocks and legs.
  • In mild disc injuries the pain may be mild, felt intermittently and may only occur with certain movements (commonly bending forward or sit to stand)
  • Pain can come on immediately or can come on hours/days after the injury and can gradually worsen.
  • Pain can be aggravated by certain back movements (commonly bending forward)
  • Pain can be aggravated by coughing, sneezing, straining.
  • Pain with sitting for long periods
  • Pain may disturb sleep (generally when changing positions).
  • In some cases there may be pain or pins and needles down the leg all the way to the toes.

Note: In non-traumatic injuries (e.g. repetitive strain) pain from a disc injury often comes on well after the damage has been done as the inner part of the disc has poor nerve supply.

 
Types of Disc Injuries
Discs are oval shaped " doughnut like" structures with a thick ring and a middle filled with mainly water.
  • Annular Tear: In minor injuries the outer surface of the disc is torn a little with no bulge
  • Partial Herniation: in moderate cases it may bulge out a little
  • Postero-lateral Rupture/Large Central Rupture: in major cases the bulge can be large
  • Complete herniation: large rupture with fragments coming out of the disc.
A disc can bulge out in different directions mostly commonly it bulges between backwards and sideways. In some moderate to severe cases a bulging or prolapsed disc can compress on a surrounding structure such as a nerve or spinal cord causing changes to nerve function.
 
Diagnosis & Treatment
Your osteopath will take a full past medical history and physical examination which may assist in forming a provisional diagnosis. Confirmation of a disc injury is through MRI or CT Scan (X-ray may provide some clues but not to the same degree as a CT Scan or MRI).
 
Generally treatment is very gentle for an acute disc injury (aimed at reducing pain and augmenting the healing processes). Your osteopath will educate you on self management strategies such as gentle stretching techniques and lifestyle management. As the pain levels reduce and function returns your osteopath will educate you on rehabilitation and strengthening of the related areas.

Self Management
  • Ice is beneficial in the first 24-48 hours (3 sets of 10 minutes on 10 minutes off - 2 or 3 times per day). Stop using ice with any discomfort or if there is no relief.
  • Heat after the first 24-48 hours (20 minutes on 20 minutes off 2 or 3 times per day). Heat will assist in relaxing the muscles in spasm around the injury. Stop using heat with any discomfort or if there is no relief.
  • A short course of analgesics/pain relieving or anti-inflammatory medication as directed by your doctor or pharmacist.
  • Once pain has subsided: Stretching & Strengthening exercises for your back, lower limbs and general body will be prescribed according to what is required (as instructed by your osteopath).
  • Postural Retraining: involves supervised (with the osteopath) posture training in front of a mirror and taking these tools home and practicing with the goal of maintaining neutral spine and correct posture.
  • Lifestyle changes: reducing the amount of stress of on your back is very important. Ensuring good posture in both sitting and standing is a great start (your osteopath can help with this).
  • Low back injuries can be as a result of weaknesses in muscles (e.g. core muscles) and can also result in weaknesses in muscles. It is recommended that a consistent strengthening program commence once indicated. This is best done under supervision in a pilates class, gym, yoga or personal training program (you can discuss these options with your osteopath).
  • Swimming: Swimming is a great way to increase the mobility of your low back without too much stress. It is suggested to initially start with a paddle board to minimize rotational stress through your low back and progress to using your upper torso.
  • Click Here for stretches for The Low Back and Pelvis
  • Click Here for Strengthening for The Low Back and Pelvis