Low back pain and related disabilities are a persistent problem for all industrialized nations. For persons under 45 years of age in the USA, low back pain is the most common work disability.
First let’s discuss what a NORMAL lumbar spine and disc look like and why it’s important.
The lumbar spine is made up for five vertebrae (L1-L5) separated by five discs. The discs are much like shock absorbers, in that they absorb the load coming down from all the weight above. They allow the bones to permit movement such as bending twisting, lifting and rotation because they act as a pivot point. When you jump off of something, it’s your discs and spinal curvatures that absorb the shock and disperse it so that you don’t get injured.
Another important thing to understand about a normal disc is that it is like a hydraulic system. Think of a car tire, the center is filled with air, whereas your discs are filled with fluid. If you slice a tire, air is going to leak out and deflate the tire. If you puncture the disc, fluid is going to leak out and press on nerves, causing pain. Imagine you punctured a tire but not all the way through and while driving along you hit a bump causing the tire to blow. A similar thing happens with your discs. The physical or chemical stress of everyday life can weaken the outer layer of the disc rendering it unstable. This is why when most people have their back “go out” they really weren’t doing much; typically bending forward to pick up a pen off the floor is enough to cause the disc to bulge in some cases.
You may have heard the term “slipped disc” used to describe a low back injury. Discs do not actually “slip”. Rather, they may herniate or bulge out from between the bones. A herniation is a displaced fragment of the center part or nucleus of the disc that is pushed through a tear in the outer layer or annulus of the disc. Pain results when irritating substances are released from this tear and also if the fragment touches or compresses a nearby nerve. Disc herniation has some similarities to degenerative disc disease and discs that herniate are often in an early stage of degeneration. When this happens and disc material protrudes it places pressure on delicate spinal nerves which can cause low back pain, neck pain, sharp stabbing pain and pain that travels down the leg; sciatica.
What causes discs to herniate?
More often than not people that injure a disc often ask themselves, “what did I do” or “I don’t know what I did”. It’s never something that can be attributed to one event. Discs most often go bad because of lack of proper structure or alignment of the spine. When you have a proper alignment, everything is balanced and the weight is distributed properly, and the curves in the spine absorb shock and keep the discs healthy.
After hours of sitting (puts 8 times the normal pressure on a disc) at a desk, driving or having poor posture for a long time, your spine eventually ends up looking like the one on the right if you aren’t seeing a good chiropractor. This spine is now at a disadvantage structurally and this causes the bones to not move correctly leading to premature disc degeneration.
Many factors decrease the strength and resiliency of the disc and increase the risk of disc herniation. The biggest reason for a lumbar disc herniation is a structural shift of the spine away from it’s normal alignment. When the spine is not aligned properly the abnormal pressure on the discs eventually wears them out. It’s important to note that you don’t always feel this happening and pain can start at any time. This is why it’s important to have your spine check by a structural chiropractor early on and constantly maintain the health of your spine over the course of your lifetime. Waiting until your back “goes out” to see a structural chiropractor is like waiting for a cavity before going to the dentist or brushing your teeth!
Lifestyle and Nutrition
Lifestyle choices such as smoking, lack of regular exercise, and inadequate nutrition, all contribute to poor disc health. Poor posture, daily wear and tear, injury or trauma, incorrect lifting, and twisting all put stress on discs. If the disc is already weakened, it may herniate with a single movement or strain such as coughing or bending to pick up a pencil.
The discs are primarily composed of proteoglycan (protein and carbohydrate), collagen (cartilage), and water. This is important to understand because many people are suffering from low back pain because of a degenerated or slipped discs. Today, many diets are very high in sugar and refined grains, when there is excess blood sugar such in diabetes or poor diet, it will bind to protein molecules like collagen in the disc. And in an avascular environment (without blood supply) such as your discs, these molecules are formed called Advanced Glycation End-products or AGEs for short. These molecules cause the disc to become more brittle and susceptible to a bulge, herniation or slip disc.
How do I know if I have a disc herniation?
Herniated discs are most likely to affect people between the ages of 30 and 40. Disc herniation’s may be present without causing pain. The most common symptom will be pain in the area of the herniation that may radiate across the hips or into the buttocks. You may also experience numbness or pain radiating down your leg to the ankle or foot. If the herniation is large enough, you may notice weakness with extension of your big toe and you may be unable to walk on your toes or heels. In severe cases of lumbar disc herniation, you may experience changes in your bowel or bladder function and may have difficulty with sexual function.
How is a lumbar disc herniation treated?
Because back pain is a widespread common problem, there are a myriad of treatment options for low back pain such as medication, exercises, PT, surgery, restricted activity, rest, physiotherapy, and manipulation. Lets go through each of them here:
Spinal Decompression Therapy using the DTS table:
Chiropractic adjustments (SMT) for Lumbar Disc Herniation:
Chiropractic adjustments or Spinal Manipulative Therapy (SMT), have demonstrated effective for decreasing low back pain. A few important research studies have identified that chiropractic adjustments to the lumbar spine and spinal decompression therapy provide substantially greater relief from chronic low back pain than exercise programs
Mild to moderate disc herniations can usually be treated conservatively with spinal decompression therapy, chiropractic care and stretching. More advanced cases will often require some form of spinal decompression, such as traction or mechanical decompression, in conjunction with chiropractic care.
How Can a Physical Therapist Help?
If you’ve injured your back and visited your local MD he or she may have mentioned getting PT. This is a form of Functional Rehabilitation. Allow me to explain the difference between Functional Rehabilitation VS what we structural chiropractors do, which is called Structural Rehabilitation.
A physical therapist’s overall purpose is to help you manage your pain and continue to participate in your daily activities. The therapist will design a treatment program based on both the findings of the evaluation and your personal goals.
Your therapist will design stretches and exercises
- Exercises that involve specific movements to relieve pain & disability, especially during the early stages of treatment
- Stretching and flexibility exercises to improve mobility in the joints and the muscles of your spine, arms, and legs—improving motion in a joint can be key to pain relief
- Strengthening exercises—strong trunk muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off those joints
- Aerobic exercise, which has been proven to be helpful in relieving pain, promoting a healthy body weight, and improving overall strength and mobility—all important factors in managing a herniated disk
Exercises for the low back can be bending forward, backward, postural, treadmill, McKensie streches, resistance training, stabilization exercises and the like. Exercises are by and large ineffective for acute lower back pain.
Medication for low back pain
In extreme cases of acute low back pain your MD or DO may give your pain medication and a powerful anti-inflammatory. These are only meant to reduce your discomfort during the healing process. These medications are in no way a replacement for spinal correction. Remember, medications are not cures, they help mask problems, they don’t cure anything. Many times people get addicted to prescription pain killers when introduced to them following an acute low back pain flare up.
Occasionally, a herniation may be severe enough to warrant surgical intervention. These cases are usually reserved as a last resort when other forms of therapy have failed to relieve pain, or if there is significant compression of the spinal cord or nerves.
This is an image of a NORMAL MRI:
Notice the nice curve that this person has in their lower back. This discs are white in the center which represents a healthy disc that is full of fluid and nutrients.