Ouch!! Low Back Pain and the Bulging Disc

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New Year's Resolution? How about relief for those niggling aches which held you back in 2013?
2014: Year of the Horse: let Rory Holliday Physiotherapy help you get galloping back into action!
Call 07854870865 to book your appointment.

FACT:                             
BENDING FORWARD 30 DEGREES WITH A 4KG WEIGHT IN EACH HAND INCREASES THE INTRADISCAL PRESSURE AT L3/4 BY OVER 6 TIMES*...THINK OF THIS NEXT TIME YOU ARE GETTING YOUR SHOPPING OUT OF THE BOOT

 

Quiz:                               
How many bones make up the human spinal column? (not including those of the pelvis)
Answer at the bottom of the page**

Low Back Pain and the Bulging Disc

As I expected when deciding to cover the world of Low Back Pain I am now drawn in to several pieces on the subject if I am to do it justice. If you didn't read my previous article then do it now. I thought I'd keep things in the tangible world of anatomical dysfunctions, that is, the more objective but not necessarily primary feature, of how a patient with low back pain might present to me. I'm moving onto the disc in a bit more detail today. More precisely, the inter-vertebral disc is a sophisticated shock absorber of sorts allowing modest movement at each level and with the valuable function of being a mini shock absorber between each vertebrae. As I stated in my last article and you can see in the picture, the nerve roots which exit at each vertebral level sit right behind the disc as does the spinal cord from which the roots emerge.
 
The disc can be thought of a bit like an onion. It has many fibrous layers tissue surrounding a central nucleus. These fibrous rings attach strongly to the vertebral body above and below it.
See how downward pressure through the vertebrae can cause damage to the disc starting with a bulge progressing to a prolapse.
(NB: BLUE = disc; YELLOW = spinal cord and nerve roots; BROWN = vertebral bones)
In the healthy spine, the disc is a hydrated and encapsulated structure. With disc injury or general ageing the disc can change somewhat. A common finding on MRI is the bulging or even herniated disc which can cause compression and/or irritation of the nearby nerve tissue. Even a small bulge with no herniation or nerve irritation can cause pain due to the disruption and sensitisation of nerve receptors within the disc and surrounding soft tissues. Material from within the disc is known to be highly toxic to nerve tissue and can irritate it leaving inflammation and sensitivity. This can happen without actual compression of the nerve and as such is not always observed on scans.
Clearly, understanding the signs and symptoms of this kind of problem is key in diagnosing the anatomical cause. A common area of confusion is whether the disc is irritating the nerve or the bony edge of the facet joint is responsible. In a classic disc bulge or herniation we might, in fact, see forward bending motion increase the disc bulge causing pressure on the nerve. This of course is the reverse of what we might see in the case where a facet joint is responsible. In both cases the contrary can be argued so it is never a black or white issue.
Manual therapy and exercise therapy approaches can be varied due to the range of severity and how easily irritated these disc injuries can be. If standing up, walking around and bending backwards seems to alleviate the pain then those positions and movements are best used as first-line rehab. 
Do you think that you or someone you know might be suffering with a disc injury? The right diagnosis and management can really make a diffrence in getting through these problems. Please feel free to call or email to discuss what can be done. Pass this newsletter on to those you think might benefit from this information or my help
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* Hamill, J, Knutzen, M (2003). Biomechanical Basis of Human Movement (2nd Ed).

** 24 not including sacrum & coccyx (7 x cervical, 12 x thoracic, 5 x lumbar)
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