What is a disc? What is a disc bulge? Is my disc "slipped"?
These are questions I hear all the time. Most of the time when people ask these things they are worried, scared and in pain. But I'm here to hopefully explain these questions fairly simply and to show you that disc bulges are not as scary as they sound and are quite common.
What is a disc and what is their purpose?
- An inter-vertebral disc (or IVD) in simple terms is a small oval shaped "cushion" made up of fibrocartilage that lies in between each vertebra in the spine. Each person has on average 23 - IVD's in their spines and they are found from the low back all the way into the neck.
- IVD's main function is to provide shock absorption for the spine during everyday tasks and to allow bending and twisting of the spine.
- The IVD's are held firmly in place by fibres that attach them to the vertebrae below and above so there is no chance that a disc will "slip" or "come out".
What is a disc bulge then?
A disc bulge occurs when part of this "cushion" pushes out in a particular direction further than its typical radius. This may damage some of the fibres that lie on the outer portion of the disc and can cause inflammation in the area which may be perceived as pain or sensitivity. This can be also accompanied by strong muscle spasms which adds to the discomfort and restrict your movement substantially.
If a disc bulge occurs in a particular position, such as near enough to some of the nerves that exit the spine, it may place some pressure on that nerve. This may elicit some referred pain due to the nerve responding to this pressure. Common symptoms may include shooting pain or a constant ache down the leg or arm, electric shocks, tingling or a pins and needles sensation. Very rarely this may also produce weakness in the extremities and even changes to bowel or bladder function. In this last scenario urgent care is required as prolonged changes to bowel or bladder function can result in long term issues.
All that may sound a bit scary right?
Well it shouldn't be. The likelihood that you will have a disc bulge over your lifetime is almost guaranteed. Does that mean you will experience excruciating back pain or disabling side effects? Nope! Plain and simple.
Let's have a look at the prevalence of disc bulges in pain free individuals.
A systematic review looking at spinal MRI findings of over 3000 people found some really interesting results. Now I want to make it clear that these people were all pain free when they had these MRI's taken and did not have any ongoing back pain.
What the review found was that 60% of the 50 year old people had at least 1 disc bulge. This figure continues to rise as we age and by the time people reach 80 years of age, you can expect 84% of them to have disc bulges (1). But interestingly levels of back pain do not increase as we get older!
What about younger people? Well it may surprise many to find out that 40% of people aged 30 will have at least one disc bulge (1). So almost half of all 30 year old people are walking around with a disc bulge but have no pain! Very interesting.
So it may not be the dreaded injury that many people fear and it doesn't condemn you to a life of pain?
Imagine you put a few extra kilos on at Christmas time from over indulging. The extra weight might go straight to your stomach which is then going to put more pressure on your pants and belt and become rather uncomfortable.
Think of your belly as a disc bulge. Bellies can shrink, just as disc bulges can, but it does take some time and effort. In the vast majority of cases if you keep active and follow good advice from a knowledgeable health professional, you can expect to make a full recovery.
So why is there such a negative stigma around disc bulges? Previously when someone had bad back pain they would most likely be sent for an MRI to investigate if their pain may be associated with any structural damage or changes in the spine. From the evidence I've just provided you it's easy to see that more often than not the scan would show something, a disc bulge for example. Then the doctor or therapist would simply put 2 and 2 together and conclude that the reason for their patients pain was the disc bulge. The patient may then have been told to "protect" their back, or that they shouldn't do "X and Y" anymore.
Not only is this simply wrong, it also causes people to form unnecessary fears and beliefs about their backs and injuries. Backs are strong and resilient!
Thankfully over the last several years the healthcare world is starting to realise the error of their ways and the tide is slowly turning. We now know that pain is far more multi-factorial than originally thought and in most cases we are unable to "see" what is causing our patients pain. Scans are rarely needed and usually give us no reliable information.
"Backs are strong. If you have had an injury, healing occurs within 3 months, so if pain persists past this time, it usually means there are other contributing factors. A lot of back pain starts with no injury or simple, everyday movement. These occasions may relate to stress, tension, fatigue, inactivity, or unaccustomed activity which make the back sensitive to movement and loading" (2).
Does that mean disc bulges mean nothing? No, of course not. They can cause a lot of pain and do take time to heal. It simply means that they are not the end of the world and that recovery from conservative management is achievable for most people. In fact, the natural healing time from a disc bulge is anywhere from 6-12 weeks. The important thing is to stay as active as possible and remember that the amount of pain you are in does not correlate with the amount of tissue damage present.
"The pain you feel during movement and activities reflects how sensitive your structures are - not how damaged you are. So it's safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are of of the most effective ways to help treat back pain" (2).
If you are experiencing back pain it is normal to be concerned or worried about what to do next. If you want to know how and when you will get better it's always a good idea to see a qualified health professional that is capable of guiding you through the rehabilitation process and to address any concerns you may have.
If you would like any more information or are experiencing pain and would like some advice, you can book an appointment at Forward Osteo online or call the clinic on 03 5215 1788.
Follow us on Facebook and Instagram @forwardosteo for more content!
Aidan Mill is the owner and principal osteopath at Forward Osteo
Osteopath Geelong West
Pain management and injury rehabilitation
References:
1. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015, April). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/#SD1
2. O'Sullivan, P. B., O'Sullivan, K., Lin, I., Bunzli, S., Wernli, K., & O'Keeffe, M. (2019, December 31). Back to basics: 10 facts every person should know about back pain. Retrieved from https://bjsm.bmj.com/content/early/2019/12/31/bjsports-2019-101611
Comments