Between each vertebra in the spine is a disc. It is very firmly connected to the bone above and below it, to the point where even if the bone becomes unstable, the disc will hold it in place.
Disc Bulges and Herniations
The image above shows a couple of common issues. To understand the difference, first you need to know a bit about the anatomy. Intervertebral discs are formed of a tough outer ring with a soft centre. When the outer layer is weakened, it can cause the inner to push against it and form a bulge. If the problem is significant enough, it can allow the centre to push right through the outer layer as a herniation.
Although in theory, a herniation sounds worse than a bulge, this is not necessarily reflected in the patient experience. Pain levels and other symptoms can vary across both issues. Prognosis is not necessarily worse for a herniation either, in fact some research suggests that the body reabsorbs and resolves a herniation quicker than a simple bulge. In either case, the problem is unlikely to be with you for life. As we age, the discs lose height as a result of dehydration. This is partially why we “shrink” as we get older. The good news there is that a dehydrated disc is less flexible, and thus less able to bulge. Back pain in the later years is more likely to be associated with the joints as they come closer together. But again, this is within our remit and there are things you can do to limit your symptoms and slow the progression. Nerve pain like sciatica is less likely to be a problem with spinal joint osteoarthritis too.
Diagnosis
People often wonder if they should try and book a scan to aid diagnosis. Not only is scanning not a routine pathway here, it’s actually not recommended for simple cases. Back pain with straightforward sciatica would not constitute a complex case.
By the age of 40, roughly half of the population will have evidence of a bulge at at least one level of the spine. But under 50% of 40 year olds have significant lower back pain that we could attribute to it. This is because bulges commonly occur without symptoms. If they’re pushing straight back, they might not hit a nerve and therefore have little reason to cause pain. Even if they do go slightly off to one side and catch a nerve, this won’t always be symptomatic either.
Instead of imaging, we use your case history and movements to diagnose a disc issue. If nerve pain is involved, that helps us to narrow down the spinal level involved. That means you can come to your osteopath before seeing anyone else, and typically leave your first appointment with a diagnosis, treatment, and a plan to meet your goals.
Sciatica
Not all disc bulges lead to sciatica, but in the right area, it can happen. The sciatic nerve is formed from a number of nerves in the lower back, so bulges at these levels can push on the nerve and cause symptoms into the leg.
In the neck, bulges that press on a nerve can cause the same symptoms into the arm, but this is not sciatica as the sciatic nerve is not involved. The technical term is “radiculopathy” but people will usually call it a trapped nerve or similar.
Your Osteopath’s Role
Lower back pain is one of the most common issues we see in clinic, so we are well placed to give you a diagnosis and help you. A combination of hands on treatment and exercises can go a long way. Book below to find out more.
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