Have I done a disc in my back?
For this blog piece we are going to run down what a disc injury is, how common they are, how to correctly diagnose one and what you can do to manage it.
What Is A Disc?
A disc is what the body has between the vertebrae of the spine. It is useful to provide shock absorption as well as to hold the two vertebrae together.
Up until one is in their 50’s discs are a bit like a jam donut in that they have a soft inner part and a harder outer part.
But as we age they become harder and firmer, sort of like a 3 day old jam donut, the jam-part becomes less fluidy and more like the donut part.
If you think about how your mother/father or grandmother/grandfather has shrunk it is because their discs have less of the jam in the middle of it.
It is very rare to have a disc bulge once you’re in your 50’s. There ain’t much jam left in the middle.
How Can They Be Injured?
Like any part of the body if a disc has too much load placed on it it may fail, or buckle, or get injured.
Movement requires muscles contracting to move bones through space. When there is load the muscles will pull harder.
If we move in a way that isn’t ideal then more of that load will be placed on one particular spot rather than spread amongst various joints and muscles and bones.
If you think about someone that does their back lifting something the body should spread that load by bending the ankles, the knees, the hips and the back.
If someone lifting something instead doesn’t bend their knees, or bend their hips, this means that somewhere else will have to do more of the work.
So their low back muscles will contract harder, to make up for the lack of work the glutes and thighs are supposed to be doing, they will pull on the vertebrae but because bones are stronger than discs it can be that the load is placed on the disc.
The excess load causes the disc to have a tear, or sometimes a bit of a protrusion of the inner jam material, or sometimes a larger protrusion of the jam-like nucleus pulposus.
How Do You Know If You Have A Disc Injury?
Ideally it is because you have seen a competent practitioner that has gone through a thorough clinical history and movement examination.
What Would Indicate A Disc Injury?
A low back disc injury would usually present with back pain, pain shooting down the leg, pins and needles in the foot and sometimes muscle weakness.
A neck disc injury would be painful in the neck, shooting pains into the arm, pins and needles in the hand and sometimes muscle weakness.
Sometimes you can have mild discal irritation that just presents as low back pain.
How Would a Practitioner Go About Figuring Out If You Have A Disc Injury?
Practitioners, whether they be osteopaths, physiotherapists, chiropractors or doctors must perform a physical examination.
The physical examination is aimed at determining what structure is causing the pain you are suffering.
In the case of a disc injury they will be trying to replicate the pain you are feeling.
If your practitioner doesn’t perform a physical examination and they have told you you have a disc injury you should get a second opinion.
But What If They Looked At My X-Ray Or MRI?
X-rays do not show disc injuries
Perfect, Why Aren’t We All Getting MRI’s Then?
This is the challenging part. The temptation for medico’s and for people in pain is to assume that an MRI will show what the cause of your pain is.
But as the table below shows a great many people have disc and spine related issues on an MRI that cause absolutely no pain.
An MRI of your spine is almost certain to reveal a disc injury or some other injury and as you age the risk increases.
But what is shown as an injury on a scan does not necessarily indicate the cause of your pain.
What research has been indicating for a while now is that it is extremely common for people with absolutely no back pain at all, never had any, to have an MRI showing they have a disc injury.
You could have a facet joint sprain (something that heals by itself within one week) but get a scan that shows a disc injury, which you have had for years and is not causing pain.
Which means that to diagnose someone with a disc injury the doctor/osteo/physio/chiro/etc must perform the orthopaedic examination as well as use a scan.
If we just relied on MRI’s then everyone would be diagnosed with disc injuries!
And If You Do Have An Orthopaedically and Image Diagnosed Disc Injury?
Then don’t fret. See a good practitioner that provides you with a path forward to your recovery.
Discs do recover. Just like muscles and joints the body will send inflammation to the area which will heal the injury.
The inflammatory cells will work to heal the disc.
It will take time, but combine the natural healing process with manual therapy and corrective exercises that teach you not to load the disc so much and you will be fine within several months.
NB the featured table is from the study:
Brinjikji W. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.
Which can be found here: http://www.ncbi.nlm.nih.gov/pubmed/25430861