Lets talk about Discs Baby

by Daniel Heazlewood-Ross

One of the most common things we hear as physio’s is that people have a “disc bulge”. Unfortunately, this can lead to immense amount of worry regarding future pain and disability. Nearly everyone knows of someone who have “slipped a disc” and have ongoing back pain as a result.
 
The gap between what is known by the general public vs health professionals on this matter is huge.
 
Let’s discuss a few of the most important points:

1. What is a disc: A structure that sits between the vertebral bodies of a spine. We have 23 discs in total and they are made up of 2 distinct parts

1. The annululus fibrosis – The outer portion of the disc which is a tough fibrous part made up of concentric sheets of collagen fibres
2. The nucleus pulposus – This includes loose collagen fibres in a thick mucoprotein gel.

 
2. What do discs do: They have 3 main roles

1. Shock absorber between spinal levels
2. Ligaments that hold the spinal levels together
3. Cartilaginous joint that allows a degree of spinal flexibility

 
3. Can they get injured and cause pain: They can get injured and be the cause of pain. There are many factors that alter the likelihood of this happening but the main one is your genetics. We often see disc bulges in people who have both manual labour and sedentary jobs. Exercise and physical activity is likely to have a protective aspect and make discs more resilient. Whilst inactivity can have a detrimental effect. Occasionally discs may cause some irritation to the surrounding nerves. This can result in what’s caused referred pain and altered symptoms (i.e. pins and needles and numbness). If you have these symptoms its worth being checked out by a physio. 
 
4. Can they heal: Yes! Natural healing processes can see disc injuries heal and the vast majority of disc injuries do not require surgery.
 
5. But I’ve had a scan (MRI/CT) which shows a disc bulge. Modern medicine means that more people are getting scans earlier as the technology has gotten both better and cheaper. Whilst this sounds like a good thing it can have the opposite effect. Studies have found many evidence of disc injuries on pain free people.
 
Please see the below graph developed by the The Sports Physio – Adam Meakins which depicts the results of findings from over 3000 pain free individuals and what is seen on their lumbar spinal MRI’s.

As you can see even in a young population it is quite common for changes to be seen on imaging. The incidence of these changes increases with age which suggests that findings on imaging could be attributed to normal age-related changes.

All of this being said discs can be the driver of pain and people with findings can be more susceptible to back pain. Fortunately, in most cases they can be managed conservatively (Physio, back pain advice, simple pain management, exercise).
 
Ok but I have back pain. What do I do?
 
Our bodies are incredibly strong and resilient, capable of amazing things. From time-to-time people will experience spinal pain.  As physio’s we are here to work with you. Firstly, to assess what’s going. We will be able to identify the unlikely event that there is something serious that needs urgent medical care. Secondly, we will work with you to get the pain under control and restore normal movements. Finally, we want to get you back to life armed with the knowledge of your amazingly strong back and the tools to keep it that way.
 
One final word – disc’s won’t slip!!
 
As mentioned above they are securely held in place by multiple structures. The term slip implies that discs can slide around in the spine which just isn’t the case.

Have you been told you had a slipped disc or bulge and need a good physiotherapist? Our Tarragindi Physiotherapy team are on top of all the latest research and would love to help! Book an appointment at our Brisbane Southside Physiotherapy Clinic online here or give us a call on 07 3706 3407. We would love to help!

References:  Study: Systematic literature review of imaging features of spinal degeneration in asymptomatic populations