​ASKPHYSIO

Disc irritation, protrusion or herniation can cause low back pain.  The disc is a structure which sits between the vertebrae of the spine.  The discs act as shock absorbers, and allow the spine to move.

When you bend forwards the disc material gets compressed and pushed backwards.  With twisting, a torsional stress is placed on the disc material.  If these movements are repeated over time (especially with load) then this can lead to a bulge.  The most common disc region to be affected is L5-S1, where the relatively immobile sacrum connects to the more mobile L5 level.  Therefore a lot of load is transmitted at this one level.

• Centrally located pain (but can also be on one side or both)

• Aggravated with movement, especially bending forwards, sitting, and turning over in bed

• Possible pins and needles
  
  Immediate assessment must be sought if you have any of the following symptoms:

• Disturbance to normal bladder, bowel, or sexual function

• Problems walking normally

• Associated unexplained weight loss

• Severe night pain unrelated to movement

• Discs generally don’t like bending or twisting.  Therefore, a movement involving excessive torsion or compression can irritate or damage a disc.

• Prolonged sitting/driving due to sedentary job and lifestyle

• Joint stiffness

• Trigger points within surrounding muscles (quadratus lumborum, erector spinae, glutes)

• Poor lumbopelvic stability

• Increased neural tension

• Poor activation and weakness of core stabilising muscles

• Reduced back extensor muscle endurance

• Tight hip flexors which increase lumbar lordosis

• Poor posture

• Unsupportive seating (e.g. no lumbar support)

• Reduce pain and inflammation with medication provided by your doctor or recommended by your pharmacist

• Use ice to reduce pain and inflammation if the injury has occurred in the last 2 days.

• Otherwise if it is chronic heat can be used to reduce pain and relax muscle spasm

• Avoid aggravating activities (especially heavy lifting, prolonged driving)

• Rest in a comfortable position.  Bed rest in severe cases may be required, but should not exceed more than 2 days, otherwise you can become weak and stiff.

• If exercises have been obtained, ensure they do not cause worsening pain or symptoms in the legs

• Returning to normal activities (within pain limits) is advised as soon as possible to prevent long term habits of avoiding normal activities due to fear of pain and injury.

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• X-ray is warranted if there has been trauma such as a fall, and fracture is suspected.

• MRI is the most useful investigation for suspected disc injury.

Back pain is often scary to experience.  Therefore, your physiotherapist will thoroughly question you to determine the specific source of your low back pain, and identify various contributing factors which led to its onset

If the pain is not being managed, they may refer you to your GP for pain relief medication.  Investigation may or may not be required.

Treatment can include:

• Joint mobilisation

• Massage and trigger point release

• Pilates education

• Prescription of exercises for flexibility, range of movement, and stability

• Acupuncture and/or dry needling

• Electrotherapy

• Taping

• Hydrotherapy

• Assessment of posture and advice on improvement or correction

• Review and modification of exercise or lifestyle activities

• Ergonomic/workstation set-up assessment and review