Lower Back Pain From Disc Herniation
What Is It?
The lumbar spine consists of five vertebrae and is specialized for weight-bearing and strength. Fibrocartilage intervertebral discs are between adjacent vertebral bodies that help provide shock absorption, allow mobility, create space between the vertebrae, and assist with load distribution. The discs consist of a strong outer ring called the annulus fibrosus, a gel-like center called the nucleus pulposus, and two cartilaginous endplates. A portion of the nucleus pulposus is displaced from the intervertebral space during a disc herniation. In some instances, a herniated disc injury can put pressure on the exiting nerve roots from the spine, resulting in nerve compression and irritation. When a lumbar nerve is compressed or inflamed, it can result in numbness, tingling, burning, pain, muscle weakness symptoms, and reflex and sensation changes in the low back, buttocks, and lower extremities.
How Does This Injury Occur?
Age-related wear and tear on the spine and discs are common reasons for lumbar disc herniations (disc degeneration). As we age, it is normal for the water content in the discs to reduce, the discs to become less flexible, the discs to decrease in size, and the intervertebral space to reduce. A herniated lumbar disc can also occur due to injuries such as a fall, repetitive heavy lifting, twisting, or a car accident.
Who Does This Injury Impact?
Having certain risk factors can increase your chance of having a lumbar disc herniation injury. Individuals between 30 and 50 years old have a higher prevalence with a male to female ratio of 2:1. Being overweight, living a sedentary lifestyle, and smoking are modifiable risk factors that can help reduce your risk of a herniation with diet and regular physical activity.
How Is This Injury Treated?
Unless a severe neural compromise is present, conservative treatment, including physical therapy, is often very successful for most people. Physical therapy will focus on individualized restoration of spinal joint and soft tissue mobility, reducing nerve irritation if present, and progressive core, glute, and lower extremity muscle strengthening based on stages of healing and symptom response. The good news is that discs can heal! Depending on the disc herniation injury severity, healing times can range from 3-18 months on average.
Do I Need An MRI?
A study done in 2015 by Brinjikji et al. found that 60% of 50-year-olds and 84% of 80-year-olds without back pain had a disc bulge on imaging. If conservative management and physical therapy are not helping to improve symptoms and function after 4-6 weeks, additional imaging and interventions may be necessary.
Check out what injuries we commonly treat and what to expect during an appointment.
Jessica Moore grew up in Oregon and has called the west side of Portland home. She was a competitive softball pitcher for 15 years and graduated from Sunset High School. Her treatment style combines hands-on manual therapy techniques and functional movement exercises. She strives to provide the highest quality care to all of her patients and is passionate about making therapy a positive, fun, and engaging experience. References: Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173 Biomechanics of Lumbar Intervertebral Disc Herniation. (2021, August 2). Physiopedia. Retrieved 20:44, November 10, 2021 from https://www.physio-pedia.com/index.php?title=Biomechanics_of_Lumbar_Intervertebral_Disc_Herniation&oldid=279825. Herniated disk in the lower back – orthoinfo – aaos. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/. Accessed November 10, 2021. Lumbar Anatomy. (2021, July 24). Physiopedia. Retrieved 20:33, November 10, 2021, from https://www.physio-pedia.com/index.php?title=Lumbar_Anatomy&oldid=279099.