It’s time for another Austin-area sports medicine 101 class!
Today we’re discussing lumbar disc pain and disc herniations.
Introduction and Injury Causes:
Disc herniations refer to an injury to the discs (rubber-like, donut shaped cushions sitting between the vertebrae of the spine) and have the middle portion of the disc push outwards and often push past the disc wall. This extrusion of the nucleus pulposus (middle portion of the disc) can push outwards to varying degrees and may ultimately compress nerve roots leaving them with altered sensation (numbness, pins/needles) or weakness down the legs or into hips or pelvis . Disc injury and herniations are common with many different athletic and work activities and may develop over time (weeks to months) or happen acutely with an injury.
4 Stages of Severity with Disc Injury:
1. Disc Degeneration: Due to ongoing lower back compression and resultant chemical changes associated with aging, discs can be compressed without herniation.
2. Prolapse: Also named a bulging disc or a protruding disc, the form or position of the disc changes with some slight impingement into the spinal canal and/or spinal nerves.
3. Extrusion: The nucleus pulposus (inner gel like sac) breaks through the outside wall (annulus fibrosus) but remains within the disc.
4. Herniated or Sequestered Disc: The nucleus pulposus breaks through the annulus fibrosus and can then go outside the intervertebral disc.
Diagnosis and Initial Treatment
An MRI or CT Scan is usually the key clinical indicator of a herniated disc. Sometimes a myelogram is used where you receive an injection of a dye. This dye will show up well on a CT scan, enabling your physician to more easily see the damaged areas of the disc.
An X-ray may also be used to look more closely at bony structures which can rule out other causes of Lumbar Spine pain. Many herniated discs will have associated numbness, tingling and/or pins and needles being felt in a certain distribution down the leg. Muscle weakness can also be present with larger disc herniations.
Acute Treatment for Herniated Discs:
- Rest in supine 90/90 (90 degrees hip flexion and 90 degrees knee flexion)
- ICE for first 48 hours (10-15 minutes every 2-3 hours), later heat can be applied
- Muscle Relaxers, NSAID’s, Epidural Steroid Injection