A Leading Culprit Of Lower Back Pain Is Commonly Undiagnosed By Many Physicians
If you suffer from chronic low back pain, you have likely run the gamut of searching for solutions only to be left with more questions and mounting frustrations. A major obstacle to successfully diagnosing and treating lower back pain is not understanding that a leaky disc is often the source of your pain. Many patients are diagnosed with Degenerative Disc Disease, however, it isnt actually a diseaseits a name given to discs that have degenerated over time from normal wear and tear, causing them to steadily leak and become dark and flat.
Leaky Disc Syndrome is a term coined by Dr. Pauza because he found himself continuously explaining to patients how their low back and leg pain was likely caused by annular tears, which allowed the inner portion of the disc to leak onto the spinal nerves, causing inflammation and pain. Many patients are told their symptoms are caused by a compressed nerve. While this is true in some cases, Dr. Pauza believes most pain and numbness experienced in the extremities is caused by leaky discs that have progressed into a herniated and bulged discs.
What Is Lumbar Disk Disease
The vertebral column, or backbone, is made up of 33 vertebrae that are separated by spongy disks. The spine is divided into 4 areas:
Cervical spine: The first 7 vertebrae, located in the neck
Thoracic spine: The next 12 vertebrae, located in the chest area
Lumbar spine: The next 5 vertebrae, located in the lower back
Sacral spine: The lowest 5 vertebrae, located below the waist, also includes the 4 vertebrae that make up the tailbone
The lumbar spine consists of 5 bony segments in the lower back area, which is where lumbar disk disease occurs.
Bulging disk. With age, the intervertebral disk may lose fluid and become dried out. As this happens, the spongy disk becomes compressed. This may lead to the breakdown of the tough outer ring. This lets the nucleus, or the inside of the ring, to bulge out. This is called a bulging disk.
Ruptured or herniated disk. As the disk continues to break down, or with continued stress on the spine, the inner nucleus pulposus may actually rupture out from the annulus. This is a ruptured, or herniated, disk. The fragments of disc material can then press on the nerve roots located just behind the disk space. This can cause pain, weakness, numbness, or changes in sensation.
Most disk herniations happen in the lower lumbar spine, especially between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra .
Myofascial Release And/or Massage May Help Reduce Pain
While myofascial pain may not be the original source of lumbar pain, it may be a secondary source of pain originating from a lumbar herniated disc as well as other structures.2 This can be worsened by poor posture and inactivity. Myofascial release is a form of manual therapy that has been shown to improve low back pain. While postural training and myofascial release can be initiated in physical therapy, there are methods that can be done at home in the meantime.
- Use a lacrosse ball or massage cane to put pressure on tender/trigger points in the lumbar area.
- Once a tender/trigger point is identified, maintain constant pressure for 1 to 2 minutes to allow for release of the muscle.
- Repeat these steps for multiple trigger points in the lumbar area.
- This technique may initially worsen pain as pressure is being placed onto inflamed muscles. It is highly recommended to use cold therapy after myofascial release to reduce pain.
Read more about Myofascial Release Therapy
While the pain from most lumbar herniated discs typically resolve in 6 weeks, you will want to manage it in the meantime and take control of your pain management. These tips may not work for everyone, and it may take time before finding what works best to help relieve your lumbar herniated disc pain.
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When To Consider Surgery
If pain and sciatica persist for three months or more, its considered chronic and may need a higher level of care. Many people at this stage start thinking about surgery.
Injections of anti-inflammatory steroids into the area near the inflamed nerve and ruptured disc may help to delay surgery, but they arent a long term solution. Injections can provide relief for up to a few months, but the relief will wear off. There are limits on how many injections you can safely have in a given year.
The most common surgery is called diskectomy. Surgical techniques vary, but diskectomy removes part of the ruptured disc so it doesnt press on the spinal nerve roots anymore. In many cases, it can be done as an outpatient procedure.
Disc surgery is not guaranteed to work, and the pain might get worse. The disc may rupture again later, or a different disc may fail.
What Is A Herniated Lumbar Disc
A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall .The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if low back and/or leg pain is going to resolve it will do so in about 6 weeks.
Different terms may be used to describe a herniated disc. A bulging disc occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal.
Most herniated discs occur in the lumbar spine, where spinal nerves exit between the lumbar vertebrae, and then join together again to form the sciatic nerve, which runs down your leg.
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What Are The Risks For Lumbar Disk Disease
Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.
Why Is This Happening To Me
While chronic back pain is usually age-related, it can happen to almost anyone at every age. Common causes for back pain include:
- Spinal Stenosis
- Degenerative Disc Disease
- Bulging or Herniated Disc
Perhaps one of the most common sources for low back pain comes from a herniated or bulging disc. Disc problems cause excruciating pain for most people, with pain so intense that they go immediately to the emergency room.
A herniated disc can even cause sciatica pain. When a bulging or herniated disc puts pressure or touches the sciatic nerve, many people feel intense pain that radiates from the lower back, down the buttocks, and then down the back of the leg, sometimes all the way to the foot.
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What Is The Best Slipped Disk Treatment
You may need more advanced treatments if your symptoms aren’t getting better. Your healthcare provider might recommend:
- Medication: Your provider may prescribe an anti-inflammatory pain reliever or muscle relaxant.
- Physical therapy: A physical therapist teaches you an exercise program to help relieve pressure on your nerves. Exercise loosens tight muscles and improves circulation.
- Spinal injections: Called an epidural or nerve block, a spinal injection is a shot of steroid medication directly into your spine. The medication reduces swelling and inflammation of the nerve from the disk herniation. This will allow your body to heal and return to activity faster.
- Surgery: In rare cases, a large herniated disk might injure nerves to the bladder or bowel. That may require emergency surgery. For nonemergency cases, surgery is an option when other treatments fail. There are various ways to perform spinal decompression surgery, but the goal is to relieve pressure on the nerve.
Diagnosis Of Disc Problems
The diagnosis of disc problems involves:
- taking a medical history to:
- determine predisposing risk factors and conditions
- identify any associated spinal nerve involvement
Investigations are carried out if:
symptoms persist for more than six weeks despite remaining active, or there is concern the disc is affecting a spinal nerve.
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How Is It Diagnosed
Your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:
- How and when did the pain start?
- At what time of day is it worse?
- What type of discomfort do you feel, and where do you feel it?
- What canât you do right now, in your daily life, due to the pain?
Your physical therapist will perform tests on your body to find physical problems, such as:
- Difficulty moving.
How Can I Avoid Getting A Herniated Disk
It’s not always possible to prevent a herniated disk. But you can reduce your risk by:
- Using proper lifting techniques. Dont bend at the waist. Bend your knees while keeping your back straight. Use your strong leg muscles to help support the load.
- Maintaining a healthy weight. Excess weight puts pressure on the lower back.
- Practicing good posture. Learn how to improve your posture when you walk, sit, stand and sleep. Good posture reduces strain on your spine.
- Stretching. Its especially important to take stretching breaks if you often sit for long periods.
- Avoiding wearing high-heeled shoes. This type of shoe throws your spine out of alignment.
- Exercising regularly. Focus on workouts that strengthen your back and abdomen muscles to support your spine.
- Stopping smoking. Smoking can weaken disks, making them vulnerable to rupture. Consider quitting smoking.
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How To Heal A Herniated Disc Quickly
A herniated disc occurs when the soft center of a vertebral disc, called the nucleus, leaks out of a tear in the casing of the spinal column. Sometimes herniated discs occur without any pain or other symptoms. However, in some cases, they cause pain, numbness, or weakness.
There is no “quick fix” for a herniated disc. Some herniated discs, also called slipped discs, heal on their own in a few weeks to a few months. The best way to foster healing in these cases is to rest, avoid activities that cause pain, and take over-the-counter pain killers like acetaminophen or ibuprofen to relieve symptoms.
During your home treatment, you can also:
- Alternate applying heat and cold.
- Stay as active as you can. Take walks to avoid becoming too stiff from resting too often.
- Try alternative treatments like acupuncture, massage, or chiropractic.
If your symptoms do not go away after a few months, your doctor may recommend other treatments, including:
- Muscle relaxants
- Prescription-strength pain killers
If your symptoms are still present after these interventions, your doctor may recommend physical therapy. You will work with a physical therapist to learn exercises that can minimize pain from a slipped disc and strengthen your back muscles to foster healing.
It is unlikely you will need surgery for a herniated disc. However, it is usually recommended in cases of slipped discs when:
Causes Of A Disc Tear
Most disc tears occur because of aging. The spinal discs are under constant strain from supporting the neck and back. By age 30, these discs begin to deteriorate and weaken. In addition to weakness due to aging, twisting or bending can also cause a torn disc.
In younger people, a traumatic injury to the back may tear the outer layer of the disc. These tears can happen because of:
- Sports like gymnastics, football or mountain biking
- Strenuous occupations that involve digging, building or lifting
- A car crash, fall or other accident
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What Not To Do When You Have A Bulging Or Herniated Disc
Its natural to want to look for ways to relieve pain and prevent a reoccurrence of a herniated or bulging disc, but there are some dont that you should pay attention to as well, such as:
- DONT put off a diagnosis or treatment plan. Complications can arise.
- DONT jump right back into your regular activities when you start to feel better
- DONT lie in bed all day. You only need about 48-72 hours of rest. After that, you must get up and get moving to prevent doing more damage to your spine
- DONT lift anything heavier than what your chiropractor recommends
- DONT do anything that will jerk your spines, such as amusement park rides or dancing
- DONT wear high heeled shoes
- DONT sit on very low types of furniture, such as beanbag chairs.
- DONT do any activity or exercise that causes you to twist your back or do straight leg exercises, such as sit-ups with straight legs.
- DONT go running until your chiropractor OKs it. Walking is OK, running or jogging is not.
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If you have low back pain or believe you might have a herniated or bulging disc, or if you have suffered from sciatica, dont hesitate to request an appointment for a same-day appointment. We will gladly check with your insurance for coverage and will work hard to restore you to a life full of excitement and activity. No one should live in pain. Please call us today.
What Caused My Disc To Herniate
Herniated discs can occur as a result of a heavy strain or fall, which causes the nucleus to break through the wall of the disc and place pressure on the nerves that branch out from the spinal cord. For example, lifting a heavy object after sitting down for a long period of time can cause a disc to herniate.
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Secret #: Get Acupuncture Or Epidurals
Almost no one likes the thought of needles, but for those with chronic health problems that lead to bulging or herniated discs, such as spinal stenosis or degenerative disc disease, epidurals and acupuncture can be another means of controlling pain.
The majority of people can heal naturally with non-invasive treatments from their chiropractor, but when healing isnt possible, other methods might need to be employed.
Epidural steroid injections to areas where herniated discs are causing intense pain can not only provide long-lasting pain relief, but they can also prevent or delay the need for surgery.
Acupuncture uses extremely thin needles to stimulate the bodys own painkillers, as well as promote healing and a sense of well-being.
Speak with your chiropractor about whether either of these options might work for you.
What Can I Do At Home To Relieve Herniated Disk Pain
In most cases, pain from a herniated disk can go away in time. To ease pain while your disk heals, you can:
- Rest for one to three days, if the pain is severe, but it important to avoid long periods of bed rest to prevent stiffness.
- Take an over-the-counter pain reliever, such as ibuprofen or acetaminophen.
- Apply heat or ice to the affected area.
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What Treatments Are Available
Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, physical therapy, home exercises, hydrotherapy, epidural steroid injections , chiropractic manipulation, and pain management. With a team approach to treatment, 80% of people with back pain improve in about 6 weeks and return to normal activity. If you donât respond to conservative treatment, your doctor may recommend surgery.
Are There Complications With A Herniated Disc
Unfortunately, if left untreated, a severely herniated or slipped disc can lead to permanent damage of the nerve. It can cut off the feeling aspect of the nerve, causing you to lose bowel or bladder control.
You could also suffer from a complication called saddle anesthesia. This means you would lose feeling in areas where a saddle would touch, such as your inner thighs, the bottom portion of your buttocks, the rectum, and the backs of your thighs.
This is why a diagnosis and treatment plan should begin right away.
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Left Side Low Back Pain
Many people experience muscle pain on only one side of their back. This can be due to compensating for a sore joint, like a hip or knee. For example, if one of your hip joints is weak, you may be putting strain on the opposite side of your lower back to make up for that.
However, lower back pain on your left side may also be due to:
If you do pull a lower back muscle, there are several things you can help relieve the swelling and pain.
Team Approach To Pain Management
For some, an integrated team of specialists may be best suited to manage the chronic lower back pain from degenerative disc disease. A team will usually comprise some combination of the following health professionals:
- A pain management specialist, such as a physical medicine and rehabilitation physician or anesthesiologist focused on pain management
- A physical therapist or physiatrist focused on rehabilitation
- A psychologist and/or psychiatrist for co-existing mental health issues, such as depression and/or difficulty sleeping
- An occupational therapist to assist with functional rehabilitation
In addition, a specialized nurse case manager or another health professional may work with the team to coordinate the care needed to treat depression, disability, and chronic pain.
Sometimes the combination of treatments is more effective than individual treatments. For example, the use of cognitive behavioral therapy has been shown to improve the benefits of physical therapy3 and reduce sleep problems.
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