"I blew a disc in my back....now what?"
Back pain can be one of the worst.
It can make sleep and rest difficult, nevermind anything physical.
Back pain can also be caused by numerous structures. But remember; we usually don’t need an X-Ray or MRI to determine the cause.
Most importantly - nothing in your back “blew up”, and your back likely didn’t “go out”.
You have a back that is painful due to irritation or injury to some of the structures.
Disc related back pain often stems from a “bulge” or “herniation” of the disc. Sometimes it can lead to a radiculopathy (“pinched nerve”) in which the disc puts some pressure on a nerve root as it comes out of the spinal cord, through the joints, and to where-ever in the body it needs to go. There’s also the times where the gel-like substance from inside the disc “leaks out” and components of that substance cause some inflammation to the surrounding structures, leading to the pain.
These types of injuries can be traumatic in nature (think about lifting heavy in the gym and going one rep to far, a motor vehicle accident, or lifting and twisting at work or home), but they can also seem to come out of nowhere with something small like reaching over to pull off a sock, or sneezing. These “small incidents” are usually just what pushes the disc past it’s limit…it’s been repeatedly irritated over the years, or the joints around the injured disc were stiff and immobile from disuse.
Regardless…we can usually figure out what’s going on in your first clinical visit.
No matter the practitioner, there’s a lot of similarity in the assessment.
- Taking a symptom and medical history, and asking specific questions to rule out other pathologies
- We look for specific patterns of pain referral, postures/positions/movements that recreate or relieve your pain.
- We check the sensation related to each nerve root
- We test the strength related to each nerve root
- We check to see if reflexes are symmetrical on each side
Putting these pieces together, we can determine if your pain is likely related to a particular nerve root and disc level, or something else.
Rehab is then pretty straight forward.
First, we treat the inflammation - perhaps with some manual therapies, acupuncture, or electrical modalities. We might alter how you do certain things to minimize stress on the area as well. Sometimes a chat with a physician for anti-inflammatories is also indicated.
Then, right away, we need to get into creating some movement in the area - there are specific protocols we can use depending on the exact cause, such as gliding the joints to facilitate reabsorption of the disc, or flossing the nerves.
Decompression techniques through diaphragmatic breathing and core exercises can also help relieve pressure off the discs, as we slowly but surely progress strengthening.
In the end, we need to make sure we’ve addressed the cause in the first place if this was non-traumatic in nature. This could mean making sure your hips aren’t stiff, your legs are strong, or that your spine moves well in all directions.
In the case of a true pathological disc herniation and radiculopathy, this can take upwards of 6 months to recover from.
Disclaimer: sometimes imaging is needed, and sometimes this type of back pain can be from something more serious in nature…like a tumor or myelopathy (pressure on spinal cord vs. a nerve root). Please always check with a practitioner before taking any advice off the internet!