One of the most common complaints an orthopaedic physical therapist receives is that of low back pain. The National Institute of Health records that 8 out of 10 adults will experience some back pain during their life. Back pain costs Canada 8 billion dollars and the US 86 billion. This issue will touch all of us if 80% of people suffer from it at some point.
There are many types of low back pain. Protruding and herniated discs, sciatica, stenosis, degenerative disc disease and spondylosis are among the leading causes. Each of these conditions has its own etiology and treatment options. There are options one has to try to prevent and minimize the risk of many of these conditions. In part I of this series, I will review general disc conditions and explain what the different terms means.
A disc bulge means that the outer rings (annulus) of the disc extends extend out into the spinal canal- generally up to 3mm. The disc and its material will impinge on the natural flow of the spinal cord and the surrounding spinal nerves. This causes mild to severe pain. With proper recovery, the disc can be repositioned into the correct alignment and long-term pain minimized with exercise.
A protruding disc is generally when the disc material has not breached the annulus but is pushing the annulus more than 3mm out of its space and into the canal. This will cause much more severe pain across multiple levels as many sections of the spinal cord and spinal nerves will be implicated. While longer than a disc bulge, this condition can be recovered from.
A disc herniation means the disc has ruptured and the jelly-like material inside the disc is now pressing into the spinal canal and impinging on the spinal cord and spinal nerves. While slightly more complicated due to the permanent nature of the damage to the disc, this condition can also be managed with rehabilitation and exercise.
An extruded disc, or transligamentous disc (“displacement of disc material through the posterior longitudinal ligament”) occurs when the annulus tears all the way through and some disc material actually pushes out beyond the boundaries of the disc and nearby ligaments, but has not broken away from the disc itself. Essentially, the disc itself does not move but is so damaged that’s its contents spread all over the spinal canal and impinge on multiple nerve segments.