Physio Penrith Disc Related Back Pain Treatment
Treatment of Disc Related Back Pain at Sydney Muscle & Joint Physio Penrith
What is disc related back pain?
Intervetrebral disc degeneration is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery well hydrated discs lose integrity as a normal process of ageing. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
Lumbar disc herniation is also a major contributor to low back pain and has been associated with disruption of the annulus fibrosus, extrusion of the nucleus pulposus and stimulation of nerve fibers, leading to pain. However, more recently, Rajasekaran et al. suggested that disc herniation is more commonly the result of endplate junction failure rather than annulus fibrosus rupture. It is important to remember that herniated discs are found in 30–40% of asymptomatic people.
What are some common names for disc related back pain?
Disc related back pain can include degenerative disc disease, disc degeneration, internal disc disruption, lumbar disc herniation, lumbar disc bulge, lumbar disc protrusion, lumbar disc sequestration, slipped disc and annular tear of the intervertebral disc.
What are the symptoms of disc related back pain?
Disc related back pain will present with back pain usually localised to one side, but this can refer across the low back in a central band. Pain will be aggravated with cough, sneeze and valsalva, made worse with prolonged sitting, bending and driving. Generally there is a large component of morning pain and stiffness, which improves with standing and walking as the day progresses. Pain can refer down the leg beyond the knee if the nerve has been irritated.
Diagnosis of disc related back pain
Diagnosis of disc related back pain may include pain provocation during lumbar range of motion with lateral shift and flexion likely to be most aggravating. Seated lumbar compression, slump test, straight leg raise test, valsalva maneuver, muscle spindle reflex, dermatome and myotome testing. Further diagnostic imaging should include CT scan or MRI to investigate the health of the intervertebral disc.
Treatment of disc related back pain
At Sydney Muscle & Joint Clinic Penrith our physiotherapy philosophy is to provide research supported interventions for disc related back pain. Most recently a model of care has been developed through the ACI Musculoskeletal Network in consultation with the ACI Pain Management Network and is called "Management of people with acute low back pain – Model of care". Core treatment principles acknowledged and used by our physiotherapists at Sydney Muscle & Joint Clinic Penrith are active physical therapy encouraged, begin with simple analgesic medicines, only image those with suspected serious pathology and encourage pre-determined times for review.
Passive modalities: initial focus is to reduce pain and irritability in the low back. This may involve passive interventions such as heat or cold therapy, joint mobilisations, soft tissue work and education and advice. Typically bed rest is to be avoided and movement is the best for disc related back pain. Passive interventions are to be used in the short term to reduce pain and encourage movement.
Active modalities: as disc related back pain reduces and irritability is low and there are minimal flare ups, our physiotherapists at Sydney Muscle & Joint Clinic Penrith integrate active movement based interventions into your treatment. These can include McKenzie method, neuromuscular control exercises and general strengthening of your trunk, low back muscles and hips.
Combined interventions: at Sydney Muscle & Joint Clinic Penrith typical physiotherapy treatment approaches are multimodal or combined interventions. This is where you may receive some manual therapy, including joint mobilisations and soft tissue work and then move onto some repeated movements (McKenzie method) and other strengthening exercises.