Spinal Discs 

Spinal discs are the cushions or shock absorbers between the vertebrae of your spine. They have tough, fibrous outer layers and the middle bit, the nucleus, is soft like toothpaste.

Pass out

The spinal nerves branch off the spinal cord and pass out of the spinal column on either side, behind the disc and in front of the facet joints.

Above and below

Each vertebrae contacts the 1 above it and the 1 below it with the disc at the front and the facet joints at the back. They are bound together by ligaments and muscles.

Damage

The classic bad disc injury is a prolapse, where the tough outer fibres crack or tear and some of the softer nucleus is squeezed out.

Back side

Because of the way we are designed the most likely place this will happen is the back of the disc, off to each side.

Unfortunate

Unfortunately this is where the spinal nerves pass out of the spinal canal and if they get compressed by the prolapsed material it will cause pain and maybe also numbness, tingling and muscle weakness.

One is bad, both is worse

This occurs in the spine and often effects an arm or a leg. It may even effect both arms or both legs. if this is the case you really need to get it diagnosed and treated properly. Immediately. Get to a hospital.

Prolapse

Pain from disc prolapse that goes down a limb runs in a line, following the path of the nerve.

Sciatica

For lower back prolapses this causes sciatica, a line of pain running down the back of the leg. Anywhere from the middle of the buttock to the foot.

Sciatica is only ever down the back of the leg.

Not Sciatica

If you have pain in the front of your thigh it is associated with problems in the upper lumbar spine, L1, L2 and maybe L3 or the groin.

Ilio-tibial band

If you have pain or tenderness down the outside of your leg it is probably coming from your sacro-iliac joint, the bottom joint of the spine between your tail bone (sacrum), and your pelvis (ilia). The sacro-iliac joints play a pivotal role in low back, pelvic, hip and leg biomechanics.

Absolutely essential 

The sacro-iliac joint is absolutely essential in our ability to move freely.  Strain of the sacro-iliac joints is responsible for a large proportion of back pain. This is a different problem to spinal disc damage.

L5

The disc most often damaged is the bottom one, between L5 (the bottom lumbar vertebrae), and the sacrum. The sacrum is the big triangular shaped bone at the base of your spine that sits between the 2 pelvic bones.

The further you go up the lumbar spine the less likely you are to get disc damage because there is less load and mechanical stress.

Vulnerable

If you have significant arthritis in your low back, more pressure is put through the discs and they are more vulnerable to damage. Arthritis affects the facet joints (zygopheseal or z joints), at the back of the spine. When they get stiff, the discs at the front of the spine have to work harder.

Lifting Badly

The easiest way to damage a lumbar disc is by lifting badly.

Really bad habit

Most people, unfortunately, are in the habit of picking things up by bending at the waist. This is the quickest way to really stuff up your spine, so if this is how you usually pick things up, don’t.

1 bad lift

You may have been doing it for years and gotten away with it every time so far, and your thinking, nar, that doesn’t apply to me. Please, count your blessings and move on to lifting well because 1 bad lift can ruin your life.

Lifting Really Badly

There are 3 ways to compound the disaster in waiting of bending from the waist to pick something up. They are

        • turning to the side during the lift, while your feet are still 

           pointing forward.

      • reaching out to pick something up.

        • picking up something that is too heavy for you.

Turning

Turning your trunk during a lift puts much greater strain on your spine, especially the discs, which make a prolapse for more likely than keeping whatever you're holding right in front of you.

When you're lifting always keep your feet, hips and shoulders pointing in the same direction.

Leaning

The further an object is from your centre of gravity, the more force it puts through your spine when you pick it up. Because of leverage, the force multiplies massively.

Whenever you pick up anything, even if it's fairly light, get it as close to you or you as close to it as you can before you lift.

Too Heavy

The most obvious and easily overlooked element of them all, don’t pick you things that are too heavy for you.

It doesn’t matter how strong you are, or were, the moment you put more force through your disc that is able to bear, it breaks. That's bad.

Rupture happens fast and there's no going back

When the outer layer of your disc ruptures and the inner material prolapses, or squirts, most often into the canal on either side of the back of the disc. Once the damage is done there is no return to the 'good old days'.

Big problem

The big problem with that is this is the canal that the spinal nerve runs through and these nerves are pain sensitive. Squeezing or squashing them with the stuff that's come out of the disc can be very, very painful.  

Twinkling of an eye

At it's worst a prolapsed spinal disc will cause severe pain, tingling, numbness, weakness and debility to the point of paralysis, loss of bladder or bowel control and disrupt other organ function.

And it all happens in the twinkling of an eye. One moment you're fine then wham! the next moment you’ve got a bad back that may haunt you for the rest of you're life.  

Mid back

The discs of the thoracic spine or mid back, are far less likely to be damaged because of the supporting and stabilizing effect of the ribcage.

A far more common cause of mid back pain in older people, especially those with osteoporosis, is crush fracture of the vertebrae from picking up something too heavy.

Neck

The neck is a different story. It is the most unstable part of our spine.

There are 7 vertebrae stacked on top of each other with the great weight of a human head on top with virtually only muscles and ligaments for support. And we keep moving it around all day.

Car Crash

The commonest way to damage your neck is in a car crash especially if you have old fashioned low backed seats. The best way to minimize that damage is to be wearing a seat belt. So always, always wear a seatbelt.

You can also easily hurt your neck with a bad lift, falling over or by banging your head on something.

Always

The point is you always need to look after your neck. Some things you can anticipate and some you can't.

Rupture

When a disc ruptures or prolapses the soft inner part of the disc squishes out thru cracks or tears in the fibrous outer layers of the disc and it may press on a spinal nerve as it passes out of the vertebral column.

A classic disc prolapse, or slipped disc, is usually accompanied by severe spinal pain, usually with a line of pain running down an arm or a leg, often accompanied by numbness tingling or weakness.

It is caused by chronic strain, degeneration of the disc or facet joints or traumatic compression of the disc.

Half a million hours

Remember that your discs are weight bearing for about 6,ooo hours every year, that's nearly ½ a million hours in a lifetime!

Common causes

Prolapse is often triggered by lifting badly, whiplash or a fall where you land on your head or backside. However it maybe caused by something as insignificant as sneezing while your head is turned to the side

Diagnosis

It needs a CT or MRI scan to confirm a diagnosis. Plain x-rays do not show up disc prolapses. Clinical signs like severe or radiating pain, numbness or weakness give us clues but they are not dependably diagnostic.

Management

If you do prolapse a disc you should always get professional help for opinion, treatment and advice.

Get help and help yourself

See an osteopath, doctor, masseur or other suitably qualified professional.

As well as the treatment that is given to you, always ask what they can suggest that you can do to help yourself. The better you know to manage your problem, the better off you will be.

Indirect

If it's mild to moderate, pain killers, antinflammatories, manipulative treatment, massage, time and exercise are usually enough to get over or manage it. This type of treatment doesn’t treat the prolapse itself, it works on the nearby tissues that are effected, directly or indirectly, by it.

Local irritation

When a disc is damaged or prolapsed, the pain and inflammation cause local muscle spasm, strain and imbalance in the immediate area and further afield. This in turn can aggravate the disc problem.

Brace it

A flexible back brace can be a big help in reducing the pressure on the disc facet joints and muscles in the low back. This reduces the pain. Start by using it for short periods and work up to 30 or 60 minutes at a time.

Sitting

When you have a prolapse sitting properly is extremely important.

You will most likely have already figured this out if your back is bad.

When you sit keep your torso upright and the top of your pelvis tilting forward somewhat. This gives it a neutral alignment much the same as when you're standing up.

Slouching is bad

If you slouch, it puts extra pressure on the discs at the front of the spine, and extra strain on the joint capsules, muscles and ligaments at the back of the spine. When you sit, always keep your pelvis and spine properly aligned.

Surgery

If it's a bad prolapse surgery may be required. Surgical technology and technique have come a long way.

Keyhole

There's a lot of keyhole surgery done these days, removing disc fragments shaving away bone to take the pressure off the nerve. This is minimally invasive surgery and turns out some great results.

Fusion

If there is more damage to the disc, the joints or the bone, a spinal fusion, joining bones together with screws, may be what's needed.

This used to be the back operation 'of choice' in years gone by. Current preference tends toward less invasive procedures. Sometimes it is still what is required.

Disc replacement

If it's just the disc that is damaged or destroyed disc replacement may be appropriate. I have one patient that had a disc replacement 2 years ago. In his late 30's, he worked for the Water Board, so there was lots of digging and lifting.

Some days he would come in, obviously in a lot of pain, having trouble just walking, let alone doing his job. He had damage, caused by the nature of the work he had to do. Treatment would help, but it could never actually fix his problem.

Successful surgery

Cortisone helped for a week. It was time for drastic measures. He had disc replacement surgery and it was very successful. He's got his life back. He can do most of the things that he used to. I hardly ever see him.   

Scary

Spinal surgery is a very scary thought but these days, they do as little as they have to and I have seen great success from all of these procedures.

Emergency

If you lose even partial control of your bladder or bowels, or your arm or leg, consider it a medical emergency and you need to get to a hospital fast. Any delay could cause permanent damage.

Disc bulges rarely need surgery and usually don’t actually cause pain. That comes from strain in the nearby soft tissues – muscle tendons ligaments fascia nerves and or joint surfaces. These type of problems usually respond well to manipulation, massage, stretching and exercising.