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Conditions 2018-07-03T10:41:58+00:00

The Importance of Self Treatment

It is essential that we understand back and neck pian are a normal part of life and that they recur.

  • Being actively involved in the treatment and long term management of your problem means you gain control over it.
  • Understanding the unique characteristics of the problem and how to deal with it minimises recovery time.
  • Reduced recovery time maximises your ability to remain active in work and leisure or sporting activities.
  • The more independent you become in treating the problem means less need for lots of expensive treatment, and you don’t become reliant on those providing the treatment.
  • Having control over the problem reduces your fear of it, even if it should return.
  • Reducing fear of the problem and improved recovery time means we have gone a long way to minimising the effect it has on us and our lifestyle.
  • An ability to control and treat the problem independently means also gaining an understanding of how to minimise the risk of recurrence.

The principles of creating an appropriate personalised self treatment program that reflects each individual clients needs has been the primary focus for Spine Care since its foundation in 1991. This is Spine Care’s speciality.

What Is Involved In Self Treatment

How effective the individual becomes in managing their back or neck pain depends on the level of understanding of their problems unique characteristics. Each problem has an array of causative or contributing factors, everything from the physical demands of lifestyle and postural stresses, to sleep deprivation or the stresses life brings etc. These factors all impact on the symptoms that are experienced. Likewise factors that improve the problem can also be identified. It is necessary to look at the person as a whole to identify the all factors that are important to the management of each problem. This is achieved by gaining a detailed understanding of the pattern of symptoms in each instance.

It is usually relatively simple to gain control of the problem and doesn’t necessarily require elaborate time consuming or demanding exercise programs. Basic self treatment reflects which movements and positions are found to relieve and provoke symptoms, advocating the regular performance of reductive exercises and minimisation of provocative loads. Once the problem is controlled a graduated reintroduction of full function can be achieved.

Each individual has different goals they wish to achieve and perhaps limitations that need to be taken into consideration before an appropriate program is arrived at. Once again this should be driven by the person with the problem and not the expectations of a therapist. An overall program is then tailored to the individuals needs and can be as simple or complex as is required to meet the individual’s goals.

Finally appropriate long term self treatment strategies can be put in place to minimise the chance of recurrence and maximise your chance of remaining independent should symptoms return.

Reduce reliance on therapists and expensive treatments. There is no miraculous cure for back or neck pain as some may proclaim. Certainly the symptoms of a particular episode can sometimes be rapidly relieved by some passive form of treatment and this can be mistaken for being cured. However in reality the potential for a recurrence of symptoms or some degree of ongoing symptoms remains relatively high and with it the need to spend more money and time attending for more ‘treatment’.

Relying on others means we surrender control. This lack of control is in itself worrying for people, added to that being in pain and a loss of function (sometimes dramatic) and those worries increase. This reliance and increased concern about the problem actually has the potential to make the problem we experience far worse and far more debilitating.

Lower Back Pain

In most cases low back pain is the result of a disruption of components of what is termed the motion segment. This includes structures like the intervertebral disc, the facet joints, joint capsules, ligaments and the associated muscles and connective tissue. In the lumbar spine or lower back a fault involving the intervertebral disc is thought to be the most common cause of pain.

Regardless of what the structural fault it is worth considering the following points before making a decision as to the most appropriate treatment.

  • Periods of back pain are a normal part of life for the majority of people.
  • Up to 75% of adults experience back pain at some time in their life.
  • Around 40% of adults will experience an episode of back pain in any one year.
  • Up to 20% of adults will be experiencing back pain at any given time.
  • Back pain is often persistent or will recur.
  • 79% of people will suffer some degree of symptoms beyond 3 months.
  • Over 30% have a long term problem
  • Only a few people will suffer chronic symptoms that significantly interfere with normal life

At Spine Care we look to minimise the impact of the painful episode and minimise the risk of recurrence. Spine Care offers expert assessment into the unique underlying features of each individual case.

Injury specific education is the key to confident self management. Like other forms of spinal pain a future recurrence of pain is common, making self treatment the most desirable outcome if a long term solution is to be found.

The greater understanding an individual has of their problem the greater ongoing control they have over it, and the less they have to rely on others for relief.

Self management is supplemented by individualised strength or flexibility programs. Where necessary research has shown that manual therapies like manipulation can be useful in assisting an individual reach a point where self treatment becomes possible.

Low Back Pain and Sciatica / Radiculopathy (Leg Pain) / Myelopathy (Leg Pain and muscle weakness)

Sciatica, or pain in the leg/s that is the result of a low back problem is relatively common.

  • Up to 35% of people who suffer an episode of low back pain will go on to develop a bout of sciatica.
  • Most episodes of sciatica are managed without surgery.
  • Most people return to normal activity.
  • Many people experience some degree of ongoing pain but this is usually not a significant barrier to normal lifestyle.
  • There are a number of different faults within the spine that can result in sciatica
  • Resolution times vary significantly with some resolving over a few weeks and others taking up to a couple of years.
  • A small number will require surgical intervention.

Sciatica is most commonly the result of an injury to a lumbar intervertebral disc.

  • If disc wall integrity remains intact it is often rapidly reversible
  • If the disc wall has failed then recovery is typically slower

Other causes include;

  • Nerve Root Impingement
  • Lumbar Stenosis

At Spine Care we look to minimise the impact of the painful episode and minimise the risk of recurrence. Spine Care offers expert assessment into the unique underlying features of each individual case.

Injury specific education is the key to confident self management. Like other forms of spinal pain a future recurrence of pain is common, making self treatment the most desirable outcome if a long term solution is to be found.

The greater understanding an individual has of their problem the greater ongoing control they have over it, and the less they have to rely on others for relief.

Self treatment is supplemented by individualised strength or flexibility programs. Where necessary research has shown that manual therapies like manipulation can be useful in assisting an individual reach a point where self treatment becomes possible.

Neck Pain

It is reasonable to describe Neck Pain as a normal part of life, commonly persistent and / or recurrent, with severe debilitating symptoms usually being short lived.

  • Neck pain is reported to affect 13.6% of men and 22.7% of women each year.
  • 36.6% of problems resolved over the course of a year.
  • 32.7% reported improvement over the course of a year.
  • 37.3% reported persistent symptoms and 22.8% had a recurrence during the 12 months.

At Spine Care we look to minimise the impact of the painful episode and minimise the risk of recurrence. Spine Care offers expert assessment into the unique underlying features of each individual case. Injury specific education is the key to confident self management.

Like other forms of spinal pain a future recurrence of pain is common, making self treatment the most desirable outcome if a long term solution is to be found. The greater understanding an individual has of their problem the greater ongoing control they have over it, and the less they have to rely on others for relief.

Self treatment is supplemented by individualised strength or flexibility programs. Where necessary research has shown that manual therapies like manipulation can be useful in assisting an individual reach a point where self treatment becomes possible.

Neck and Arm Pain (Brachialgia)

Some neck problems cause pain to radiate into the arm. In most instances this is due to the neck injury causing irritation of, or pressure on a nerve. The nerves that supply the arm are collectively known as the Brachial Plexus.

  • Mostly the nerve is compromised or irritated by a disruption of the intervertebral disc. Where this is the case a natural history (time taken to recover without treatment) is 16 weeks.
  • The outlet of the nerve can also become narrowed. This is usually related by the normal affects of aging or wear and tear. With the narrowing a nerve becomes a little more susceptible to being impinged resulting in arm pain.
  • In more extreme cases the function of the nerve can be affected resulting in specific numbness and / or muscle weakness within the affected arm.

At Spine Care we look to minimise the impact of the painful episode and minimise the risk of recurrence. Spine Care offers expert assessment into the unique underlying features of each individual case.

Injury specific education is the key to confident self management. Like other forms of spinal pain a future recurrence of pain is common, making self treatment the most desirable outcome if a long term solution is to be found.

The greater understanding an individual has of their problem the greater ongoing control they have over it, and the less they have to rely on others for relief.

Self management is supplemented by individualised strength or flexibility programs. Where appropriate manual therapies, including traction can be useful in assisting an individual reach a point where self treatment becomes possible. Full manipulation of the joints in the presence of a neck problem radiating pain into the arm, should be approached with caution. This is especially true where numbness and / or weakness in the arm / hand has resulted from the injury.

The Slipped Disc, Bulging Disc or Disc Derangement

These are just a few of the common names used to describe an injury to the disc that is causing pain. They all relate to a disruption of the internal workings of the disc that cause pain and/or limitation of function. Depending on the degree of disruption symptoms may vary from the mild low back stiffness and discomfort right through to severe debilitating lower back pain and sciatica.

However it is important to realise much of the disruption that occurs within the disc over our lifetime is due to normal wear and tear and doesn’t cause symptoms. We know this from studies where scans of the spine are performed on people who had never experienced pain. These scans still identified changes occurring in all the tissues of the spinal joint.

What Is The Disc?

The disc is made up of 2 parts. In the centre there is a softer, semi fluid tissue called the nucleus. This is surrounded and contained by a wall named the annulus. The wall is layered like the rings of an onion.

When we move we cause pressure to build up on one side of the disc and the soft nucleus is forced to move away from the pressure (like a bar of soap between wet hands). The longer we stay in one position the more the nucleus moves. The surrounding wall limits the amount the nucleus moves.

The structure of the disc changes during our life. These changes are normal but they can impact on the ability of the disc to cope with the stresses of our lifestyle.

How The Disc Changes.

The disc wall gradually develops fissures or cracks and the central nucleus gradually looses water content (dehydrates). Problems arise if the pressure exerted on the disc wall cause it to fatigue and bulge outwards and has the potential to cause symptoms.

For instance when sitting for a prolonged period pressure is placed on the front of the disc resulting in the nucleus moving backwards. The movement of the nucleus should be restrained by the back wall of the disc. If there is sufficient weakening of an aspect of the back wall it can yield and allow extra displacement of the nucleus resulting in a focal bulge in the disc wall. This can often be painful and restrict movement in the short term.

Where the disruption inside the disc is smaller and the outer wall remains strong the displaced nucleus can be returned to its normal position. In this case symptoms can be rapidly reversed with self treatment. This is usually achieved by movements in the opposite direction to those that caused the displacement.

If the pressure on the outer wall becomes too much the wall fails and this is what we term a disc prolapse …(learn more).

A thorough evaluation of the kind offered at Spine Care Clinic has been shown to be effective in identifying the specific problem affecting the joint and thus the appropriate management plan.

Due to the high rate of recurrence the greater understanding and independence each person has in treating their problem the greater their ability to minimise this risk of recurrence and self manage future episodes.

Spondylolysis / Spondylolisthesis

Spondylolysis is the name given to a specific stress fracture in the spine.

Spondylolisthesis is the name used when, because of the stress fracture (spondylolysis), there is a forward slip of one vertebra on the one below.

  • The stress fracture occurs in around 5% of the population.
  • 25% of these develop the forward slippage (spondylolisthesis).
  • The forward slippage doesn’t normally increase over time; ie it is usually stable.
  • It is not necessarily painful. This means that not everyone with spondylolysis or spondylolisthesis has pain.
  • Most commonly it develops during the teenage years.
  • It is 2-3 times more common in young athletes compared to the general population.
  • It is more often seen in athletes who are involved in gymnastics, weight lifting, wrestling, diving, and cricket bowlers (especially fast bowlers).

Why Does It Happen?

  1. Adaptive:
    In most cases these changes are “adaptive”. This means that the stress fracture develops because of the activities the person is involved with. It is a gradual process, where a load is passed through the spine repeatedly over time. The spine attempts to modify its structure, or adapt, in order to cope with these loads more efficiently. The load that cause these stress fractures to form usually involves extending (arching) the spine. One of the effects of the formation of the spondylolisthesis is to allow more movement when extending the lower back. They are more common in those involved in sports like gymnastics or fast bowlers in cricket as these sports demand more movement into extension.
  2. Congenital
    There are sometimes inherited variations in the structure of the spine that leave a person more likely to develop this stress fracture.
  3. Degenerative
    The normal wear process of the spine can sometimes lead to the slippage (spondylolisthesis) of one vertebra on another. This is because the wear process of the spine allows increases in shear stresses (greater movement forward and backward of the vertebra on one another). This can weaken the restraining joint resulting in the slip.

How Are They Diagnosed?

There are several radiological studies that can be done to confirm the diagnosis. The easiest is a XRay taken at an oblique angle. This will pick up many of these stress fractures. A bone scan (scintigram) is sometimes used and highlights inflammation at the sight of the stress fracture. The presence of inflammation suggests the stress fracture is causing pain. The most accurate image of the stress fracture is carried out using a CT scan.

Treatment

  1. Conservative (non-surgical):
    Most of these problems can be well managed with a programme of exercises that are specific to each individual’s problem. These exercises will aim to unload the stress fracture and thereby relieve pain. Specific strengthening exercises then help to support the area and potentially reduce the risk of the pain returning.
  2. Surgical:
    Sometimes it is necessary to stabilise the area via surgery. This is only performed where it is unlikely conservative treatment will be successful and the symptoms are causing significant problems in normal daily activities.

Headaches

This remains a complex problem. The musculoskeletal system is one of a lengthy list of possible causes. Differential diagnosis, that is identifying the actual cause from all the possibilities, can be difficult.

For example headaches can be caused by problems affecting the brain and/or its blood supply, the ears, eyes, nose and sinuses, the throat, dental issues and stress. Headaches can also present as a component of imbalances in body chemistry, hormonal levels, or issues affecting blood pressure.

At Spine Care we deal with headaches caused by the musculoskeletal system. Like all other conditions the pattern of the symptoms, what is provocative, what is reductive etc. gives us valuable information as to how to best manage each individual problem.

Many headaches that originate from the musculoskeletal system have a postural element. It is common for people to carry the head and neck protruded forward of the body. This places undue stress on a number of structures which over time will often result in headaches and neck pain. There are some relatively simple exercises to correct for this type of problem.

The overall posture that results in this forward head position will, among other things, impact negatively on our breathing pattern and in turn our ability to cope with stress. Correction of the postural fault and breathing pattern can have a dramatic influence on headaches, the impact of stress and our general feeling of wellbeing.

A movement fault at one of the cervical (neck) vertebra is another way the neck can cause headaches. This can be a recurrent problem and once again there are commonly simple exercises that can be used to treat the complaint. Joint mobilization and manipulation are also effective treatments of the presenting symptoms but targeted self treatment still has the greatest chance of achieving a long lasting solution.

Spinal Instability

The spine changes during life. There are associated problems that can arise during this process. In this case there is a suspicion that the pain is the result of reduced stability around a joint in the lower back. This handout is an attempt to further explain what is happening.

The “lower back “ is called the “lumbar spine”. There are 5 lumbar vertebra stacked one on top of the other. Each is joined to the next by 3 separate joints. These joints allow movement to occur while attempting to keep the vertebra in a position where it can cope with the loads that pass along the spine. To understand the problem we must first look at the function of these joints and changes that occur in them over time.

The Joints

  1. The main blocks of bone, the vertebral body, stack in the front portion of the spine. Between each bone is a specialised cartilage known as the disc. This acts a little like a shock absorber between the bones while being flexible enough to allow movement. It is the normal changes that occur within the disc that sometimes leads to a problem.
  2. The other 2 joints are between the bones themselves and are called the “facet joints”. They are situated behind the disc with one to the left and one to the right side. These joints are like most others in the body (e.g. hip, knee, and elbow…). Each has a joint capsule that holds the bones together and a lubricating substance inside.  Ligaments and muscles add further support to the facet joints. They form part of the ring of bone that protects the spinal cord. However in the low back their main role is to limit movements that might damage the disc or spinal cord.

Normal Changes

The disc develops fissures or cracks as we get older. These usually occur in the inner part of the disc. The outer wall of the disc then comes under more strain. As this occurs the disc looses water content and narrows. This means that the space between the bones gets less and this leaves the facet joints more compressed.

These cracks in the disc allow more movement to occur between the adjacent vertebra. For instance the vertebra might be able to slide further forwards when bending or backwards when arching the back or to the side when bending side ways. While the actual increase in this rocking type movement is only small it has several effects.

  1. The facet joints, now under more pressure because of the narrowing of the disc, also have to work much harder to stop the increased movement.
  2. The outside wall of the disc comes under more strain because there is less support from the inner portion of the disc

The diagrams above are a side view of the spine, in cross section to show the inside of the disc.

The lumbar segments must then rely more on the surrounding muscles and ligaments for support. These act like the guy ropes of a tent. If these muscles and ligaments are also in poor condition the segments start feeling very “fragile”. The body reacts to protect the area and does so by producing pain and a feeling of stiffness. This limits movement and lessons the load on the joints.

Commonly the area will ache and feel stiff during movement. Often there can be acute twinges of pain that “take my breath away” or cause an involuntarily yelp. This usually happens when moving suddenly or when starting to move after being still for a while.

Are X-Rays Or Scans Needed?

The majority of the diagnostic process comes from looking closely at the symptoms produced by the problem, the limitation of function, and a thorough examination. In most cases x-rays and scans are used to “fill in parts of the puzzle” or confirm a diagnosis. When the diagnosis is quite clear then it is better to avoid unnecessary tests as it has been shown that their results don’t significantly influence the treatment.

Most often further imaging studies are required when the problem is not responding as expected, when a surgical solution is being investigated, or when the symptom behaviour of the problem is atypical. In these cases the information we gain is very important.

So What Is The Answer?

In essence the stability of the joint must be improved. This is sometimes done by surgically fusing together the vertebrae at fault, a last resort. Most are managed without surgery and a solution based around self-management offers the greatest chance of independence from treatment and a sustainable improvement.

First and foremost there is a need to increase the support around the joint. The muscle system is targeted to supply the support. There are some specific muscles that act to stabilise the spine. There are quite specific exercises to improve both muscle condition and its function in protecting the joint.

The second component to managing the problem is in becoming aware of the things that provoke the problem or settle the pain down when present. From this we can become skilled in minimising the stress on the joint and give it less to complain about. Likewise when the pain is present there is likely to be a way of settling it quickly.

Each problem is different and unfortunately this means there is no recipe of exercises that are right for everyone. It is important to remain as active as symptoms allow. The rule to follow is that it is all right to cause some pain during movement or activity as long as the pain settles within 1 hour of changing position or stopping the activity. It is also important to note that it is not necessarily the most vigorous activity that does the most damage, in a lot of cases it is in fact the position we get into most often during the day (eg. sitting). Guidance is normally required to set up a problem specific and effective self-management programme.

Spinal Stenosis (Lumbar Spine)

Spinal stenosis occurs when there is a narrowing of the canal around the spinal cord (central stenosis) or a narrowing in the course traveled by the nerve to its outlet (lateral recess stenosis). Sometimes the narrowing is enough to put pressure on the nerve tissue and produce symptoms (symptomatic lumbar stenosis). Symptomatic lumbar stenosis is most common in the middle aged and elderly population, and men are affected slightly more than women.

Cause

There are many factors that can contribute to the narrowing of the spinal canal. Some of these factors can be congenital and some are acquired.

Congenital factors relate to the inherited make up of an individual’s spine. For instance the size and shape of the spinal canal vary, or significant spinal curvatures (eg scoliosis) can impact on canal size. Some of these inherited features can leave an individual with a greater chance of suffering stenosis during their lifetime. It is uncommon for these changes to be the sole cause of stenosis.

Acquired conditions relate to the changes that occur in the spine during life and are the most common cause of stenosis. The changes are many and varied and in respect of stenosis relate specifically to those changes that result in narrowing the spinal canal. Some examples are narrowing and bulging of the intervertebral disc, the formation of bony spurs in the canal, or thickening of the joints that surround the spinal canal etc.

Effect of Narrowing

Simply put the narrowing can cause a build up of pressure within the canal. The build up of pressure gradually compresses the nerves, starts affecting nerve function, and results in symptoms.

The Symptoms

The symptoms can be varied. The pain will start in the low back and will normally cause symptoms to radiate into the leg, or legs, as the problem worsens. The symptoms will radiate to one leg when the stenosis is affecting only one side of the spinal canal (lateral recess stenosis), and both legs when the stenosis affects the central portion of the spinal canal (central canal stenosis).

The symptoms in the legs can be in the form of pain, tightness, altered sensation, or a combination of these. It is only in severe cases that nerve function will be compromised sufficiently to produce true weakness in the muscles supplied by the affected nerves. Also in severe cases of central canal stenosis the function of the bladder and bowel can be disrupted.

Activities and Positions That Influence Symptoms

When stenosis is present activities or positions causing further narrowing of the spinal canal become a problem. People with stenosis will find these activities or positions difficult to sustain for any length of time, as the symptoms will steadily intensify till intolerable. For example standing and walking are commonly limited and painful when stenosis is present. These increase extension in the lumbar spine, that is where the spine arches backwards, and results in narrowing of the spinal canal.

To relieve the symptoms the opposite is true. That is activities or positions that increase the space in the spinal canal will reduce the symptoms. Flexion of the spine, that is where the spine is bent forwards, has this affect. Commonly people will sit, stand leaning forward and supporting themselves on something, squat down, or stand with one foot on a step to achieve this and relieve symptoms.

Treatment

Where the symptoms are very debilitating surgical options have the greatest chance of success. It is necessary to increase the space in the spinal canal to decompress the nerves. For more specific information your GP, or the author of this handout can recommend a spinal surgeon to consult.

Non surgical treatment is limited and needs to focus on education about the problem and ways to best manage it. The principles of self-treatment are quite simple, and the aim is to control symptoms while keeping as active as possible. For more information see your GP or contact the author.

Nerve Root Impingement

This is a term that is used by some to cover all conditions that affect the nerve and cause radiating symptoms into the limb (arm or leg) or around the chest wall. However I would suggest that it becomes too generalised when used in this manner. We are becoming progressively more capable of making more accurate and specific diagnosis of what structural problem is to be the cause. Many of these conditions that cause radiating symptoms are covered in more detail and include the prolapsed disc, slipped disc or stenosis.

For me Nerve Root Impingement refers to the impinging of a spinal nerve at its oulet. Anything that narrows the oulet space, called the foramen, leaves the exiting nerve with less space to exist in (essentially producing a form of foraminal stenosis).

Many things impact on this foraminal space. For instance the normal changes of wear and tear result in narrowing of the disc and often some associated bulging of the disc wall, hypertrophy (thickening) of the local ligaments, hypertrophy (thickening) of the local bony structures, and often the development of bony spurs known as osteophytes. All these normal changes have the potential to reduce the size of the foraminal outlet as does the development of a cyst or some other space occupying lesion.

In essence the nerve root can sometimes become impinged within the narrowed outlet. The presentation of symptoms will be quite predictable. Movements that cause further narrowing of the foraminal outlet on the affected side eventually produce or increase symptoms once sufficient pressure is imposed on the nerve. Likewise the opposite is also true in that the opening of the foraminal outlet is likely to have a relieving effect.

Given that we all get a degree of narrowing as life goes on it is normal and the nerve will typically tolerate it well. It is only when the nerve becomes irritated, e.g. by a traumatic event or excessive pressure, will symptoms be produced.

Regardless where in the spine the same movements typically cause narrowing the foraminal outlets. These are the movements of extension (arching backwards / looking up), rotating or side bending to the spine (where narrowing occurs on the side rotating or side bending towards). Combining the various movements will alter the degree and nature of the narrowing that occurs. The provocative movements will therefore depend on the degree of irritation and / or impingement occurring.

Settling the irritation around the nerve is often sufficient to relieve symptoms. This can usually be done with appropriate exercises and short term modification in aspects of normal lifestyle that are currently provocative. The use of medication and some manual therapy techniques might also assist in resolution of symptoms. Long term self management strategies have the potential to minimise the chance of recurrence.

Disc Prolapse / Herniated Disc

This handout was written to help better understand a disc prolapse.

While this may seem like a major injury to the spine it is not altogether uncommon and the vast majority of people recover and return to their normal activities and sports. Time is a key part of recovery, and there are things people can do to get the best outcome for themselves.

What Is The Disc?

The spine is made up of individual bones that are stacked one above the next to form a column. The disc sits between the main blocks of bone and acts as a shock absorber while still allowing movement in the spine.

The disc is made up of 2 parts. In the centre there is a softer, semi fluid tissue called the nucleus. This is surrounded and contained by a wall named the annulus. The wall is layered like the rings of an onion.

When we move we cause pressure to build up on one side of the disc and the soft nucleus is forced to move away from the pressure (like a bar of soap between wet hands). The longer we stay in one position the more the nucleus moves. The surrounding wall limits the amount the nucleus moves.

The structure of the disc changes during our life. These changes are normal but at a certain point in this wear process the chance of the disc prolapsing becomes greater.

How The Disc Changes.

Inside the disc wall fissures or cracks gradually develop. As this occurs the soft nucleus starts to loose water and gradually dries out making it less mobile. During this process there is a risk that some of the nucleus will be pushed into a crack in the disc wall causing the outer wall to bulge. Where the disruption inside the disc is smaller and the outer wall remains strong the displaced nucleus can be returned to its normal position (learn more) . If the pressure on the outer wall becomes too much the wall fails and this is what we term a disc prolapse.

The diagrams above are a view from the side and in cross section to show the inside of the disc.

Why Does The Pain Go Down The Leg?

As the disc prolapses a bulge appears in the disc wall. This bulging of the disc will often push into the space normally occupied by a nerve. The disc bulge places pressure on the nerve and causes it to become inflamed. The result is what we call sciatica, which is a referred pain into the leg. During assessment of the problem there are tests designed to show when the nerve is involved.

The diagrams are a view of the gradual disc bulge and its pressure on the nerve. The view is from above.

Are Xrays Or Scans Needed?

The majority of the diagnostic process comes from looking closely at the symptoms produced by the problem, the limitation of function, and a thorough examination. In most cases x-rays and scans are used to “fill in parts of the puzzle”. When the diagnosis is quite clear then it is better to avoid unnecessary tests as it has been shown that their results don’t significantly influence the treatment.

Most often further imaging studies are required when the problem is not responding as expected, when a surgical solution is being investigated, or when the symptom behaviour of the problem is atypical. In these cases the information we gain is very important.

What are the options?

In most cases the problem resolves over a 3 – 6 month period. The worst of the pain usually starts reducing in the first 2 – 3 weeks. Normally it is possible to self manage the problem, minimising the recovery time and the chance of recurrence. It is important to get a good understanding of the problem and the specific exercises to use.

In a minority of cases surgery is required. This is normally to relieve extreme pressure on the nerve, or where the normal improvement of severe symptoms hasn’t occurred. When surgery is the preferred option, full details of the procedure and expected recovery will be supplied by the surgical team.

Each problem is different and unfortunately this means there is no recipe of exercises that are right for everyone. It is important to remain as active as symptoms allow. The rule to follow is that it is all right to cause some pain during movement or activity as long as the pain settles within 1 hour of changing position or stopping the activity. It is also important to note that it is not necessarily the most vigorous activity that does the most damage, in a lot of cases it is in fact the most commonly adopted position we get into on a daily basis (eg. sitting). Guidance is usually required to set up a problem specific and effective self-management programme.

Author Cameron Green

  • Spine Care Clinic
  • Epsom, Akl.
  • Ph. (09) 6306400

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