Disc Injury, Lower Back Pain and Sciatica

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Eric Nichols
5 years ago
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Disc Injury, Lower Back Pain and Sciatica Disc injuries are the most common cause of lower back pain and sciatica, the sharp, shooting pain that radiates from the lower back into the buttock, thigh,

1 Disc Injury, Lower Back Pain and Sciatica Disc injuries are the most common cause of lower back pain and sciatica, the sharp, shooting pain that radiates from the lower back into the buttock, thigh, and leg. Discs, the weight bearing organ of the spine, function as shock absorbers. Discs have two parts a series of fibrous, annular rings that surround a fluid, gel nucleus During movement, weight bearing stress is absorbed by the gel nucleus and disbursed outward - like waves through the ocean. As the waves strike the surrounding annular rings, the rings expand to contain the energy, then rebound and reload. In neutral, upright posture, weight bearing stress is transmitted evenly through the gel nucleus to the annular rings. In forward bending, weight strikes at the front of the gel nucleus and is transmitted primarily to the rear portion of the annular bands;

2 in back bending, weight strikes at the back of the gel and is transmitted primarily to the front of the annular bands. Bending forward - the posterior rings absorb the weight bearing stress. Bending backward - the anterior annular rings absorb the stress. The Cause of Disc Injury The most common cause of disc injury is damage to the posterior annular rings from a traumatic lifting event, or, from repeated forward bending stress. In either case, tearing occurs in the annular rings and the annular wall fails. Repeated episodes of worsening lower back pain are strongly suspicious of a developing weakness in the annular wall. There are three levels of wall failure. A partial failure, in which the wall weakens but remains intact, allows the nucleus to bulge outward resulting in an acute, painful episode of lower back pain. If the annular wall tears completely, disc material may protrude through the annular rings creating a disc herniation. In the most severe case, nuclear gel may extrude through the wall and break free, becoming a loose fragment.

3 All three of these events a bulging disc, a herniated disc, or an extruded fragment result in severe lower back pain and, if the disc material presses on the spinal cord or a root of the sciatic nerve, will also cause the radiating pain of sciatica.

4 Treatment and Rehab of Acute Disc Injuries The primary goal in the treatment of acute disc injuries is returning the nuclear gel to its normal, central position. This allows the annular rings to return to their normal shape and size and permits the disc wall to heal and strengthen. Proper rehab exercise is the key factor in the treatment of a bulged or herniated disc. If these rules are followed, the initial acute pain should resolve within a short period, normally in a week to 10 days. The rules of rehab of a posterior disc bulge or herniation are simple: Rule #1: Eliminate all forward bending until the acute pain resolves. Do not sit, stand, or perform any action in a way that involves bending forward at the waist. The rationale for this rule is obvious forward bending will push the gel nucleus toward the direction of injury and worsen the bulge or herniation. Rule #2: Begin a rehab program based on exercises that extend or arch the lower back, forcing the nuclear gel toward the center of the disc and away from the injured posterior disc wall. Rule #3: Use local ice packs liberally - hourly is ideal, but at least several times daily for minutes. Over-the-counter anti-inflammatory meds are helpful during the acute phase. The first exercise is a prone spinal arch, aka the Sphinx. This exercise should be done in sets of three with the position held for approximately 30 seconds each time. When the Sphinx can be done without pain, add the second exercise.

The second exercise is the active arch. In yoga, this exercise is called the Cobra.

With the lower body firmly on the floor, begin to arch from the head and neck, extending the arch

If possible, the arms should extend fully with the elbows locked.

5 The second exercise is the active arch. In yoga, this exercise is called the Cobra. Start by lying prone in the push-up position. With the lower body firmly on the floor, begin to arch from the head and neck, extending the arch through the shoulders, using the arms to fully arch the spine. If possible, the arms should extend fully with the elbows locked. Cobras should be done in sets of 10 each hour. Each set should be followed by the application of an ice pack to the back for 15 minutes. If it is not convenient to perform the prone cobra, standing back bending may be substituted.

6 The complete sequence of disc rehab exercises looks like this: Sphinx to Cobra

7 Pain during Rehab Exercises During the early stages of rehab, some pain may occur during back arching. This pain is functional, as it indicates that therapeutic pressure is being applied to the disc bulge. This pain should only be felt during the exercise, but should stop when the exercise is completed. As rehab progresses, you should feel progressively better after each exercise session. When the Pain is Gone Most people who follow the program get relief of their pain in a week or two, depending on severity. When the initial acute pain is completely gone, it is time to begin the second phase of rehab, the program to achieve lumbar/core stabilization. dr. tuck kantor 225 main street westport, ct drtuckkantor@optonline.net

Disc injury is a common source of neck pain associated with radiation of pain into the upper back, shoulder, and arm.

Disc Injury - Neck, Shoulder, and Arm Pain Disc injury is a common source of neck pain associated with radiation of pain into the upper back, shoulder, and arm. Intervertebral Discs, located between the