For many people, injury to one of the discs in the lumbar spine (lower back) evokes thoughts of costly MRIs, large needles for injections, and stories of friends who have had bad backs their whole life. An injury to the low back doesn’t have to be a career or recreation ending injury and can be safely treated with conservative measures, so before you start thinking surgery I want to do some educating on discs and disc injuries to ease any fears of the unknown.
Anatomy of your Disc
The discs of the low back are like other structures in the body (bones, skin, tendons, muscles, etc) that can heal. To give you a better understanding, let’s start with some basic anatomy
- A healthy, normal disc sits between 2 of the bones (vertebrae) in the spine to cushion shock forces, control movement of those 2 bones, and give us some extra height to tower over the competition. (well, for some)
- The disc consists of outer and inner fibrous layers oriented like the skin of an onion. These are attached to the vertebrae above and below, which helps control the motion of the bones from moving too much on one another. Due to this connection, you can’t technically “slip” your disc out. I’m telling you this so you sound smarter when talking to medical professionals. (on a related note , don’t tell your therapist you “twerked” your back. That is definitely not the term you think it is. You might have “tweaked” your back, which can happen, but I don’t want to know if you were trying a Miley Cyrus dance move)
- Inside of the fibrous layers of the disc is an inner nucleus that is more gelatinous. Think about a jelly donut (you know you want one now!). This nucleus gives you the cushion of the spine. Overall the nucleus and fibrous layers work together with your muscles and joints to provide the stability that allows you to do what you need to with your back.
A disc can become weakened due to the normal degenerative process of aging, prior injury from the glory days of high school sports, current or past overuse that is often due to lifting during work or sports, or a multitude of other injuries from falls or accidents. These past injuries often predispose the disc to future injury and limit its normal functions of support and cushion. The disc is most prone to injury with combined flexion and twisting motions. Throw on a weighted load such as during shoveling snow or yard work and you are setting yourself up back pain.
Injury can happen to inner or outer layers of the disc, the internal nucleus or a combination of those, which can cause a herniated (bulging) disc. In some cases a bulging disc can impinge on a spinal nerve and cause pain, numbness, and/or tingling down the leg. However, depending on the extent of the bulge and where the injury is, the back may or may not even hurt and there are not always symptoms down the leg. For this reason, we can’t say that all discs herniations benefit from traction (aka “decompression therapy”), injections or surgery. This is where detailed evaluation from a skilled physical therapist can help you. Put us on your list of things to try if you think you might have injured your back at some point.
This post has covered the basics of the anatomy and what happens during an injury. In our next post we will go into more details of the symptoms of a herniated disc and what treatment approaches physical therapists can use to eliminate your symptoms and get you back to a normal life without surgery. If you have any questions, please give us a call or comment on this post. If you know you do have, or suspect you have, a herniated disc, give us a call to set up an initial consultation. We can often have you feeling better in just a few treatments.
Make sure to look out for Part 2 of this post, “Herniated Discs: Treatment“.
– Kacie Rognlie, DPT
Synergy Manual Physical Therapy
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