How can physiotherapy help a lower back disc prolapse?
Lower back pain is never a fun time - it impairs your work, family time, exercise routine and even the ability to do simple tasks such as getting dressed or cleaning the house.
One of the most common causes of lower back pain in adults is a lumbar disc prolapse, also known more commonly known as a 'slipped disc' or a disc herniation. Yikes! That sounds pretty serious, but we as physiotherapists would love to shed some more light on this topic and explain how we can help you.
The anatomy of your lumbar spine:
The lower part of your back is known as the lumbar spine and is made up of five bones called the lumbar vertebrae.
In between each of these vertebrae is a disc, which helps with shock absorption as you walk, run, jump and do any activity. The disc also helps to join the vertebrae to each other which allows for nice smooth movements of the spine (think of bending forwards and backwards or bending from side to side).
This intervertebral disc consists of a soft inner jelly-like core called the nucleus pulposus and is surrounded by a tough fibrous covering called the annulus fibrosus.
This tough fibrous layer consists of many layers of fibrocartilaginous sheets which cross each other diagonally as they run over each other. This adds a great amount of strength to the disc so that the spine can move.
There are many ligaments that attach to the lumbar spine in order to add more stability, along with muscles which help you to move your spine in smooth movements.
The vertebrae (spine) also houses the spinal cord, which runs from the brain all the way down and ends at the bottom of the spine. Many nerves branch off from the spinal cord inside the vertebrae and go to various parts of your body.
What is a disc prolapse?
A prolapsed disc is also known as a slipped disc or a disc herniation.
This happens when the inner sheets of the annulus fibrosus (the fibrous covering of the disc) start weakening, allowing the soft jelly-like nucleus pulposus to protrude outwards radially and herniate.
A tear in the annulus fibrosus can also occur, further allowing the nucleus pulposus to protrude.
The bulging disk can compress your nerves, resulting in uncomfortable neurological symptoms (such as referring pain to the legs due to sciatica), and inflammation around the area can do the same.
Repetitive flexion/bending forwards (picking up your children, bending over to do laundry etc).
Lifting heavy objects (weight lifting, stacking heavy boxes, picking up your children).
Sitting for long periods of time.
Obesity (adds a lot of load and pressure on the spine).
Sedentary lifestyle and poor posture.
What are the symptoms of a prolapsed disc?
Lower back pain
Pain that may radiate to your legs if a nerve root is involved (sciatica).
A feeling of weakness.
Some people may have very few or no symptoms at all.
Note: If you experience a loss of bladder and bowel control and have no sensation around your perineal area, then it is important that you make an appointment to see your doctor as you may have cauda equina syndrome (explained below).
How can you prevent this from happening?
Use ergonomic chairs if you sit for most of the day while working.
Take regular breaks from sitting and walk around for a few minutes.
Include regular exercise as part of your lifestyle.
Make good technique a priority if weightlifting.
Speak to one of us and we can help you make adjustments to any activities that may be the causing factor.
Herniated discs are usually treated conservatively with the first line of treatment being non-steroidal anti-inflammatory drugs and physiotherapy combined. The vast majority of people get better with conservative management including physiotherapy for slipped discs / disc bulges.
Epidural injections may be helpful for those who have disabling and serious amounts of pain, and is a second line of treatment.
Surgical treatment is only done when conservative treatment fails or if you have cauda equina syndrome.
This will either be a laminectomy where they remove a part of the vertebra called the lamina to make more space in the spinal canal, or a discectomy which is when a portion of the abnormal disc is removed. The two procedures are also usually both done together.
Cauda Equina syndrome is a serious condition where the nerve roots of your cauda equina (the collection of nerves at the end of the spinal cord) become compressed and impair nerve function (sensory and motor impulses) to your legs and bladder.
Physiotherapy for a prolapsed disc:
There are a variety of physiotherapy treatments for a prolapsed disc that we can use to help you depending on your unique case. After a thorough evaluation, we will be able to help you identify the cause of the prolapse and get you on the road to recovery with a treatment programme.
A few things we can help you with include:
Re-education of movement and motor control exercises.
Exercises for proprioception.
Strengthening and stability exercises which will help to protect the area.