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The Truth About Discogenic Lower Back Pain
The Truth About Discogenic Lower Back Pain
What is it?
As we all know, our spines are made up of vertebrae which are connected with each other by discs. These discs are responsible for absorbing the shock our spine experiences and they also allow and limit our movements. These discs are made up of an outer layer called the annulus fibrosis while an inner layer consisting of a gelatinous material known as the nucleus pulposis. This can be best describe as your jam filled doughnuts. When someone proclaims that “I have slipped my disc” they are actually describing a the pain they felt on their lower back which is really called the discogenic lower back pain. Even though the disc itself has not slipped, this has become the generic term for such injury. A more precise and to the point description of discogenic lower back pain is the disc bulge or a disc herniation, but this will also depend on how severe the injury may be. Disc bulge happen when an internal disruption of the disc and the inner gelatinous nucleus material or the nucleus pulposis moves to the outer edges otherwise known as the annulus fibrosis. This creates a bulging effect. The outermost part of the disc is highly innervated (nerve supply), and this bulging can cause serious discomfort.Mechanism of Injury
An injury to the spine, otherwise known as disc bulge or herniation may be caused by lifting heavy objects, pain can also be triggered by minor activities such as bending to pick things up from the floor. A person can be injured without his knowledge because the inner part of the disc has no nerve endings that will trigger pain, it is only when the outer part begins to show signs of tearing that pain is felt. And this is best describes as “the straw that breaks the camel’s back”. Aside from repetitive heavy lifting of objects, sitting for a prolong period of time is also a common cause of injury to your lower back because it places great stress to the discs. Individuals who suffer lower back injuries often have some pre-existing condition regarding their proximal stability or weakness to their postural muscles. Signs and Symptoms
- Severe pain is felt on one side of the lower back, down to one leg and it is also common that the same pain is felt even down to the toes
- Once pain is felt, bending forwards and other movements are restricted especially when getting up from sitting.
- When experiencing neurological signs such as pains of pins and needles, numbness, weakness or bladder and bowel dysfunctions a careful consideration must be given because these may be signs of more serious disc injury.
- The most common treatment method to follow is the McKenzie Technique - It involves proper exercise that reduces the pressure on the injured disc and it allows healing.
- While dealing with the posterior disc bulge or herniation of the disc, extension based exercise is essential .
- Taping the lower back can help maintain comfortable posture and can help reduce muscular spasm to relieve pain.
- Spinal mobilization and soft tissue massage to restore movement.
- Clinical Pilates can help regain stability of the proximal muscle.
- Find out more about body position and certain activities to avoid pain and allow healing to your back.
- Enrol in a Pilates based strengthening program.
- Improve your posture by using lumbar rolls.
Chronic Pain
Chronic Pain
Pain is NORMAL. It is the body’s way of alerting us to what it thinks is DANGER. The interesting thing about pain is that we don’t actually experience pain until our brain interprets a signal from the body as being pain. It is important to accept that YOUR PAIN IS REAL – IT IS NOT IN YOUR HEAD!! There are many things that contribute toward the brain signalling pain: Thoughts Fears Past experiences Family issues; My mother has cancer could this be what is happening to me?, Who will look after the family? Work issues; Will I have to have time off? , How much money will I lose? Anxiety/stress can increase the sensitivity of the nervous system Exercise can help turn down pain signals by releasing chemicals that help to quieten the nervous system. All of these things make a difference as to whether or not your brain will interpret the signals from the body as pain. The important thing to understand is that the brain can still signal pain long after the original injury in the tissues has healed. When you initially have an injury, signals are sent to the brain to alert it to danger. The brain then interprets the signal, remember factors mentioned above will play a role in the brain interpreting the signal, and this is where the pain experience starts. This is all necessary so that you don’t go and do anything which may injure you further. However these messages can persist and lead to chronic pain.Chronic pain is when you continue to experience pain long after the original injury has healed
This is due to central sensitisation. This is when the brain sends chemicals to the spinal cord to meet the signals coming from the tissues. These chemicals can be excitatory, which means they multiply the signals coming from the tissues and therefore send a much stronger signal to the brain then the original signal from the tissues. The brain can also send messages to the tissues to release more inflammatory substances – the body thinks it can heals faster this way, but doesn’t know when to turn off this inflammatory process. This type of inflammation is not helped by medication and explains why there can still be inflammation present many months later. This causes the nerves to become hypersensitive and send earlier and more signals to the brain, again this is an over sensitivity of the nervous system. Over time, the cycle continues which results in increasing sensitivity of the brain and therefore more and more pain. Pain can become a habit – your body anticipates and remembers it and it takes very little to trigger it, sometimes when things are really bad even thinking about moving can trigger the pain. The brain has lost its ability to differentiate between painful and non painful input, so just to be safe it triggers everything as pain. The brain has also lost its ability to distinguish between body parts so you may find your pain spreading or moving. The good news here is there is no damage in the tissues causing the pain, it is just that the brain is so used to feeling the pain that it continues to signal even though the damage has healed. It is the sensitivity of the nervous system that is causing this. The important things to understand is that PAIN DOES NOT EQUAL DAMAGE!! The solution is to make the brain understand that there is no longer any damage in the tissues and it is time to desensitise. We can do this through a graduated return to normal activity.TAKE CONTROL
1. Any new injury or disease requires a prompt medical examination. 2. Understand any prescribed help. Ask for appropriate scientific evidence supporting what is offered to you. 3. Make goals that both you and your clinician understand. Aim for physical, social and work goals, which allow your progress to be measured.How regularly should I get a Remedial Massage?
How regularly should I get a Remedial Massage?
The frequency in which one should get a Remedial massage will depend on a few factors. Such as if their pain or postural issue is a long standing chronic condition, or a new acute injury. Also, lifestyle factors will vary depending on the individual, and this will affect how regularly remedial massage would be recommended. A new Injury (acute): A new injury or pain presentation can usually be treated within a few treatment sessions, with each treatment session being 3-7 days apart for most effective results. It’s good to get a few sessions in consecutively. Long-standing conditions (chronic): Whereas a long-standing condition will usually entail a series of treatments to return the area back to balance and normal functioning. This is because chronic conditions have had a longer time to set in a dysfunctional way and therefore need a longer time to correct. Also, chronic pain often has a few areas involved due to compensation patterns, so the resolving on pain in one area may lead to the next compensating area involved. With long-standing conditions, a number of weekly massages are recommended for best results, which can gradually be spaced out in frequency until a maintenance stage is reached. Maintenance Massage: Ideally, a maintenance remedial massage should be performed regularly. Maintenance massage is usually recommended on monthly basis, or at times quarterly (so around four massages per year), depending on the individual. This is to promote mobility, strength, improved muscle function, and to stop conditions from becoming painful and problematic. To put things in perspective, most people service their car every year, what about your body? Do you service that regularly? It’s your most important vehicle! Individual factors and Lifestyle factors: However, everyone's an individual so their needs will be a little different depending on their lifestyle, but it’s safe to say that regular remedial massages work best. Lifestyle factors like jobs that involve repetitive movements, or an individual’s sport and recreational activities all play a part in how regularly they’ll require remedial massage. For example, someone who plays competitive sport might need more regular remedial massages so that they can perform at their best. Factors such as age and health status also play a role on how frequent remedial massage would be recommended. For advice on what’s best for your body’s needs, ask your remedial massage therapist today how regularly you should have a massage to function optimally. Rosie Rayner Dip RMT Ad Dip SST
