Lower back or “lumbar” pain is the most prevalent and costly musculoskeletal condition worldwide. In the United States, we spend as much on the treatment of lower back pain annually as we do on the treatment of ALL cancers. Worldwide, lower back pain is among the leading causes of disability, and a top reason for why people give up work and other critical life activities. The good news is that most lumbar pain and types of lumbar disc injuries are treatable with physical therapy.
This blog focuses on lumbar disc injuries, and describes the types of lumbar disc injuries as well as lumbar disc exercises and treatments that are effective in reducing lumbar pain. The best news is that most lumbar disc injuries can be treated successfully without surgery or prolonged periods of disability.
Lumbar Discs and How They Work
If you’ve ever been told that you or someone you know has a ‘slipped disc,’ ‘blown disc,’ ‘lumbar disc tear’ or ‘herniated disc,’ it sounds pretty scary, and it’s confusing too. Let’s start with what a lumbar disc is and how it works.
The lumbar spine is at the bottom of the spine, right above where your buttocks are and your tailbone lives. The lumbar spine has 5 vertebrae, and a lumbar disc sits in between each vertebrae.
Above is a close-up image of a lumbar disc. In this diagram, you are looking at a cross section of a lumbar disc as if the body were cut in half and viewed from above looking down toward the floor. The lumbar disc is on the belly side of your body and the spinous process is on the back of your body.
See how the disc has two sections? The outer rim of the disc is called the annulus fibrosus. It creates the structure to the disc. The outer rim is made of firm ligament tissue. The outer lumbar disc has a blood supply and nerve supply. This means the outer third of the lumbar disc can heal after a lumbar disc tear and other types of lumbar disc injuries.
Now look at the inner portion of the lumbar disc, which is called the nucleus pulposus. The nucleus makes up the center two-thirds of the lumbar disc and has the consistency of crabmeat. It can move and squish within the annulus as you move and bend your back. The center of the disc has no nerve or blood supply.
Because of this unique structure, the lumbar disc is designed to provide flexibility to the lumbar spine and take on heavy loads in a variety of directions and positions.
Types of Lumbar Disc Injuries
There are many types of lumbar disc injuries, and as I mentioned earlier, people call them funny names like slipped disc or blown disc. Here are the main types of lumbar disc injuries.
Herniated Lumbar Disc Injury
With this type of injury, the outer shell of the lumbar disc called the annulus sprains and eventually gets a small tear in it. The inner portion of the disc called the nucleus is then able to move out through the tear. A herniated lumbar disc injury can be very painful and if the herniated nucleus aggravates your spinal nerve, you may experience weakness, sensation changes or pain into one or both of your legs. Get evaluated by a medical provider. Even with a herniated lumbar disc, you can recover with good physical therapy.
Prolapsed or “Bulging” Lumbar Disc Injury
Unlike the herniated lumbar disc injury, with a prolapsed lumbar disc injury, the outer wall of the disc (the annulus) is still intact. The outer lumbar disc is, however, thinner and weaker, and the inner disc material (the nucleus) bulges into the weakened area of the annulus with movement. While many of us may show a prolapsed lumbar disc on an MRI, this type of lumbar disc injury may have nothing to do with your back pain. In fact, more than half of people over the age of 60 show lumbar disc prolapse on MRI images and have no back pain. Don’t assume that a lumbar disc prolapse is the cause of your lumbar pain.
Degenerative Disc Injury
All of us will have degenerative disc injuries at some point in our life. Degenerative is just a fancy word for aging. If your hair is grey and your skin has some wrinkles on it, then you are familiar with the concept of aging and the body changes that go along with it. Over time, our lumbar discs change with age. The lumbar discs’ cell structure, outer walls, and sometimes height change with age. Again, this finding on an MRI may not be the cause of your back pain and doesn’t need to be a worry. Worry about degeneration of the lumbar discs as much as you worry about your hair going grey, which I hope is not much at all!
Lumbar Disc Injury Recovery Time
After reading about the lumbar spine and types of lumbar disc injuries, let’s get into lumbar disc injury recovery time and slipped disc exercises.
Lumbar disc injuries can heal even up to 2 years after an injury. The lumbar disc injury recovery time can be positively affected by the following factors:
- Working with a physical therapist who specializes in lumbar disc injuries and exercises
- Reducing inflammation of your lumbar disc injury in the first 2-4 weeks
- Performing daily slipped disc exercises prescribed by your physical therapist
- Reducing the stress and work load for the lumbar disc as it heals
- Stopping smoking, which delays healing time by 30%
A complete and thorough assessment by a qualified physical therapist is the first step in a comprehensive lumbar disc injury treatment plan. To find a good PT in your area, please refer to my previous blog on How to Find a Good PT and visit apta.org
Lumbar Disc Injury Exercises
Lumbar disc injury exercises and lumbar disc injury treatment prescribed by your physical therapist will include:
- Daily slipped disc exercises to reduce swelling and remodel the outer disc wall. I typically prescribe slipped disc exercises in sets of 10-25, performing 100-250 daily repetitions.
- Posture and activity modification to reduce stress across the lumbar disc injury. Working on a healthy lumbar lordosis curve in sitting, standing and walking helps unload excess force across your healing lumbar disc injury
- Every lumbar disc injury patient needs a full strengthening program for the lumbar spine. These exercises target the pelvic floor, deep abdominal and deep lower back (muscles that make up your “core.”) Lumbar disc injuries heal faster once our core muscles are working and engaged to support our body weight as we move through the day.
The transverse abdominal muscle in the picture above is a lumbar spine work horse. This muscle is engaged all day long to support all the lumbar vertebrae and lumbar discs as you move, walk, sit, stand and go about your day. Weakness in these muscles can be a predictor of lumbar pain and injury. If you feel you are weak through the mid section, see a physical therapist before you get a lumbar disc injury. You don’t need six pack abs to stay healthy, but you do need a strong core lower back, deep abdominal and pelvic floor in order to prevent lower back pain and all types of lumbar disc injuries.
For more information on lumbar disc injuries, lumbar disc tears, slipped disc exercises, lumbar disc injury treatment and prevention, feel free to email one of our physical therapists at firstname.lastname@example.org. In the meantime, work on your posture, your strength and your overall fitness to prevent all types of lumbar disc injuries. If you are in pain and live in the Portland, Oregon area, contact us at 503-295-2585 to schedule an evaluation.
Sandra Stryker, PT, MPT, COMT, FAAOMPT