Lumbar Disc Injury
1. Introduction
Lumbar disc injury is an umbrella term for a range of disc-related changes such as disc herniations, disc bulges and degeneration. Some of the words seen online or used by health professionals can be alarming and misleading. The phrase known as a ‘slipped disc’ is one we try and avoid as discs do not slip. They are very strong and robust structures that can tolerate huge amounts of force, therefore these changes in the lower back are generally normal and are of no serious concern (1, 2).
The discs consist of an inner core (nucleus pulposus) made of a gel-like structure, and a tough exterior made of fibrous collagen that surrounds the inner core. The spinal discs are very strong and robust structures and their function is to absorb shock, allow for effective movement of the spine in all directions and act as tough structures that allow the spine to tolerate load and compression (1, 2).
The problem arises when the inner gel structure herniates/protrudes through the tough exterior. This can irritate local structures which can lead to a variety of symptoms you may feel (1, 2).
Frequently Asked Questions
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A lumbar disc injury is where pain is felt in the lower back. This is sometimes referred into the legs and is due to disc inflammation or bulge onto surrounding structures, including nerves.
- Common.
- 60% – 80% of the population may experience back pain at some point (1).
- On a yearly basis, 1% – 3% of people will have a lumbar disc injury.
- 50% of 40-year-olds have a disc bulge on an MRI scan without any pain (2).
- No.
- Changes to the discs are generally normal, age-related changes.
- These changes can occur without any symptoms or pain.
- When pain is present, it is not an indicator of damage and could be due to a variety of reasons.
- People between the ages of 30 – 50 (2).
- Men are more likely to suffer than women.
- Increased likelihood with age.
- Sedentary populations.
- Low back pain.
- Referred pain into the back or front of the legs (tingling, pins and needles, burning sensation).
- Muscle weakness that is limited by pain.
- Spasms/cramp-like feeling in the back muscles.
- Seek advice from a physiotherapist or a healthcare professional who can perform a thorough assessment and provide appropriate advice specific to you.
- Try to keep moving regularly. Continue with normal activities as much as pain allows, as this will help more than rest.
- Depending on the severity of the pain and symptoms, approximately 8-12 weeks (3).
- You can recover fully, become pain-free, and return to all the activities you love doing.
- Over 85% of patients with symptoms associated with an acute herniated disc will resolve within 8 to 12 weeks without any specific treatments.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
The typical symptoms of lumbar disc injury include:
- Low back pain.
- Nerve pain – referred pain into the back or front of the legs (tingling, pins and needles, burning sensation).
- Weakness caused by pain.
Symptoms can vary from person to person and can be postural or activity dependent. You may experience pain or discomfort with movement, standing up after sitting for a long time, when waking up first thing in the morning, or with any increased activity.
You may experience sleep disturbances, waking up more often, and difficulty getting comfortable (1, 2).
3. Causes
Lumbar disc injury is often caused by normal age-related changes, combined with excessive stress/strain on your back. As people age, the water content within the discs reduces, they can become less flexible, begin to shrink or bulge/herniate; however, these changes are completely normal (1, 2).
Our bodies adapt to what we do on a daily basis, and so the more we move, the more our discs are exposed to this and can tolerate these movements. The problem comes when we lack movement in different directions, which can cause discs to lose their flexibility and ability to tolerate these movements. If we bend, twist, or lift something too heavy too quickly, this can lead to changes to the discs if we do not normally perform these activities (1,2).
Disc changes can also be caused by any traumatic events such as falls, car accidents, and sports injuries. As long as any serious injuries are ruled out by your doctor or physiotherapist, this again is not of any serious concern.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone sustaining a lumbar disc injury. It does not mean everyone with these risk factors will develop symptoms.
- Age.
- Gender – men are more prone than women.
- Sedentary lifestyle.
- Trauma.
All of these factors may pre-dispose someone to developing changes in their lumbar discs however, this may not always lead to pain or problems. A recent study with over 3000 participants ranging between ages 20 – 80 found positive signs on MRI scans (i.e. disc herniations, degeneration, bulges) that were asymptomatic (pain-free), and these changes increased with age (2).
5. Prevalence
Back pain is extremely common; 60% – 80% of the population may experience back pain at some point (1). On a yearly basis, 1% – 3% of people will have a lumbar disc injury. Lumbar disc problems are common; 50% of 40-year-olds have a disc bulge on MRI scan without any pain (2).
6. Assessment & Diagnosis
During an initial assessment, your physiotherapist will ask a series of questions and undertake a physical examination to understand your story. This may include the mechanism of injury, or how it happened. They will also ask about relevant medical history, previous injuries, surgeries and any medications you normally take to ensure they have a good understanding of what can be influencing your symptoms.
Your physiotherapist may ask you to perform some very simple movements and go through some simple movements on the treatment bed. This is to create a list of problems you may be experiencing which will allow your physio to create a tailored treatment plan that will be specific to you and your goals so they can help you return to doing all the activities you love.
Many patients visit with the hope that a magnetic resonance imaging (MRI) scan or X-ray will help to form an accurate diagnosis, however, in the majority of cases, they are not required. As mentioned above, we often find things on scans that are normal age-related changes and not linked to the cause of your pain, therefore this does not change how we deal with your problem (1,2).
7. Self-Management
The best place to start is to have a thorough assessment by an experienced physiotherapist who can advise you on the self-management techniques that may be best suited to you. Your physiotherapist can provide you with an effective explanation as to why you have your symptoms, and give you knowledge and confidence to effectively manage them to support your recovery (7).
In general, keeping moving is more important rather than resting and, in fact, in most cases, resting will have a negative effect. Try to keep up with your normal daily activities as best you can; working with some pain and discomfort is completely safe and you will not do any further damage. Just make sure to pace your activities and not do too much at once as this may aggravate your symptoms (7).
8. Rehabilitation
Various exercise types all have a positive impact on symptoms, therefore finding activities that you enjoy is a good place to start. Specific, individualised rehabilitation provided by your physiotherapist may include activities to increase your range of movement, strength and function to return to sports, playing with children or any other activities you love (4,5,7,9).
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing back pain. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Lumbar Disc Injury
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Initially, your physio may provide you with simple movement or stretching-based exercises, to ensure we can restore your movement before we move on to the next stage of rehabilitation. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
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- 3
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- 5
- 6
- 7
- 8
- 910
The next stage may involve strengthening exercises to ensure your muscles, bones, tendons and other structures can tolerate load to meet the demands of your daily activities (5,9). This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This stage involves further strengthening activities to allow your muscles to tolerate the load for you to return to activities with ease. This should not exceed any more than 3/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
Manual therapy – hands-on treatment (massage, manipulation, mobilisations) can be effective and should be part of a treatment package including exercise, and not used exclusively in the absence of regular exercise (7).
Epidural injections – can be used in cases of severe pain or sciatica symptoms (3,7).
Surgery – can be an option for advanced cases to treat compressed nerves in the lumbar spine that aims to improve persistent pain and/or numbness if various non-surgical treatments have been exhausted and your symptoms continue to impact your quality of life, however, there are various risks associated with surgical interventions (6).
12. Links for Further Reading
References
- Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar disc herniation. Current reviews in musculoskeletal medicine, 507-516.
- Brinjikji, W., Luetmer, P. H., Comstock, B., W, B. B., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neurology, 811-816.
- Bupa. (2020, July 17). Epidural injections for lower back and leg pain. Retrieved from Bupa: https://www.bupa.co.uk/health-information/back-care/epidural-lower-back-leg
- Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical activity on non-specific chronic low back pain. Healthcare.
- Lee, J.-S., & Kang, S.-J. (2016). The effects of strength exercise and walking on lumbar function, pain level, and body composition on chronic back pain patients. Journal of exercise and rehabilitation, 463-470.
- NHS. (2018, July 23). Lumbar decompression surgery. Retrieved from NHS : https://www.nhs.uk/conditions/lumbar-decompression-surgery/
- NICE. (2020, December 11). Low back pain and sciatica in over 16s: assessment and management. Retrieved from NICE Guidline NG59: https://www.nice.org.uk/guidance/ng59/chapter/Recommendations
- Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain. A randomized controlled trial. Medicine.
- Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., . . . Franklyn-Miller, A. (2015). The effects of a free-weight-based resistance training intervention on pain, squat biomechanics, and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. Sport and exercise medicine.
Other Conditions in
Lower Back, Hips & Pelvis, Upper Legs, Orthopaedics, Pain
Spondylolysis
An injury due to a stress fracture through part of a vertebra known as the pars interarticularis of the lumbar vertebrae (lower back).
Spondylolisthesis
A term to describe a slight change in position (usually further forward) of one vertebra relative to the vertebrae below.
Sacroiliac Joint Dysfunction
Pain originating from the sacroiliac joint at the base of your back where the spine joins the pelvis.
Mechanical Back Pain
Lower back pain caused by structures in the back, such as joints, bones and soft tissues.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Greater Trochanteric Pain Syndrome
A condition affecting the tendons that insert into outside of the hip. A common cause of pain felt around the hip and pelvis.
Femoroacetabular Impingement
A condition that results in pain in the groin, hip and down the front of the thigh.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Deep Gluteal/Piriformis Syndrome
A presentation where the sciatic nerve is irritated in the buttock and can cause sciatica symptoms in the leg.
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Ankylosing Spondylitis
A rare condition that can cause joint stiffness and pain, often worse at night and when resting.