Low back pain is a common condition which occurs as a result of a lumbar sprain, spinal stenosis, disc herniation, and due to various other degenerative spinal disorders. The topic of discussion today, however, focuses on discogenic lower back pain; a degenerative condition. Discogenic low back pain refers to painful symptoms caused by the degeneration, damage or injury of one or more intervertebral discs along the lumbar spine.
Symptoms of Discogenic Low Back Pain
As we get older, our bodies undergo numerous changes. For instance, our hair may begin to turn gray or thin. Similar changes have an effect on the complex structures of the spine, specifically on the intervertebral discs. Disc degeneration doesn’t necessarily cause severe pain or any other symptoms for that matter, but back pain may occur, if the degeneration becomes too advanced. Typically, discogenic pain is related to activities that increase the pressure within the intervertebral disc, known as intradiscal pressure.
- Sitting, bending forward, coughing and sneezing can increase discogenic pain.
- Leg pain caused by pinching of the nerves in the lumbar spine, called radiculopathy, may also accompany low back discogenic pain; particularly while sitting, walking or standing.
- Discogenic low back pain is generally a chronic disorder.
How Discs Cause Pain
The same as other areas of the human body, each intervertebral disc has a nerve supply. Discs are constituted of 2 parts; the annulus fibrosus, an outer ring-like structure, and nucleus pulposus, a gel-like interior. The nucleus pulposus is void of nerves. However, nerve fibers are contained by the outer third of the annulus fibrosus.
One type of discogenic disorder is medically referred to as an Internal Disc Disruption, or IDD. An IDD takes place when the disc tears or cracks, creating a fissure which enables the nucleus pulposus to come in contact with the annulus fibrosus. While this happens, a chemical called a protecogylcan might be flooded into the nucleus pulposus. The annular nerves may then become irritated causing an inflammatory response as well as pain and discomfort. For reasons that are unknown, some people have annular tears and can remain symptom free.
Diagnosing Discogenic Low Back Pain
Degenerative disc changes can best be observed through magnetic resonance imaging (MRI). If a couple of spinal discs are suspected as the pain source, the doctor may order a discography or a discogram. During this procedure, the suspected discs are injected with a contrast dye to make each disk visible under fluoroscopy. Provocative discography helps the doctor see the form and dimensions of the intervertebral discs. The pressure is altered by the injection of the contrast dye within the disc and may ‘excite’ or replicate the patient’s pain pattern helping to isolate which disc may be the source of their symptoms.
There are different types of treatments to help alleviate low back pain and radiating symptoms. Frequently, treatments are combined for symptom relief or control.
- Medication: Opioids, anti-inflammatory drugs, anti-depressants.
- Physical Therapy: passive therapies such as ultrasound, transcutaneous nerve stimulation, or TENS, and massage could be used with a disciplined program of strengthening exercises. Core strengthening, or the strengthening of the abdominal and low back muscles, is often helpful in relieving pain in degenerative disc disease. When the muscles around the disc become stronger, they may protect the intervertebral discs and might reduce pain.
- Spinal Injections: local anesthetics combined with long-acting corticosteroid injections. This medication combination may be injected into the facet joints or around the nerves of the back to reduce symptoms.
- Bracing: braces, or orthoses, help support the spine and limit movement which may provoke painful episodes. Rarely is bracing a treatment for back pain. Long-term bracing may lead to weakened back and abdominal muscles that might provoke muscle strain.
- Alternative Therapies: acupuncture, yoga.
- Lifestyle Modifications: Nutrition and dieting to reach a more ‘back friendly’ body weight, smoking cessation, and physical activity help keep a healthy spine.
Minimally Invasive Procedures
Many spine surgical procedures can be performed with minimally invasive techniques. For instance, spine surgeons utilize these methods to correct scoliosis, treat herniated discs, and perform spinal fusion. The advantages to the individual may be significant and include smaller incisions, shorter time hospitalized, less post-operative pain, and a quicker healing. By replacing the disc with cages and bone, related back pain may be alleviated by spinal fusions. Artificial cervical and lumbar discs have become another option to replace damaged intervertebral discs. Depending on your type of symptoms and spinal health issue, it’s essential to talk to a healthcare professional to properly determine the most appropriate type of treatment for your discogenic low back pain.
Chiropractic Care for Discogenic Low Back Pain
Chiropractic can be another non-surgical treatment for discogenic low back pain. Chiropractic care is a well-known alternative treatment option which focuses on the diagnosis, treatment and prevention of a variety of injuries and/or condition associated with the musculoskeletal and nervous system. Correcting discogenic lower back pain for a chiropractor is similar to treating several musculoskeletal disorders; it is about reducing the inflammation from around the disc but most importantly, it is about restoring the muscles to take the pressure off the disc so that the same forces are not going through it.
Chiropractors and physical therapists, or physiotherapists, specialize in the non-surgical treatment of discogenic low back pain. Chiropractors and physical therapists concentrate on functional improvement and pain reduction. A chiropractor, or doctor of chiropractic, commonly utilizes spinal adjustments and manual manipulations to carefully correct any spinal misalignment, or subluxation, which may be affecting the natural integrity of the spine. Other common treatment methods include mechanical diagnosis, the McKenzie Method, as well as nutritional and fitness exercise programs and advice. By realigning the spine, chiropractic care can help reduce pressure around the affected intervertebral discs, decreasing inflammation and improving circulation to eliminate the compression of the soft tissues, ultimately improving back pain symptoms. Furthermore, stretches and exercises recommended by a chiropractor can help improve strength, mobility and flexibility in order to speed up the rehabilitation process.
Physical therapy can also be useful for correcting discogenic lower back pain. Physical therapy focuses on restoring the patient’s original strength. Strengthening the core, the lower abdominal muscles, including the pelvis, as well as stretching the hip flexors can restore the original integrity of the spine, reducing additional stress on the spine and decreasing back pain symptoms. Strengthening the muscles of the back as well as restoring the aligned of the spine will allow the intervertebral discs to begin healing themselves naturally. Utilizing chiropractic care together with physical therapy can ultimately help decrease the pain and discomfort associated with discogenic low back pain.
Dr. Alex Jimenez’s Insight
Low back pain is a common, modern day health issue which carries a tremendous burden on those who suffer from it. With more cases of low back pain being diagnosed every year, understanding the causes of low back pain can be essential towards its proper treatment. Discogenic low back pain refers to symptoms of pain and discomfort along the lumbar spine caused by the degeneration of the intervertebral discs. A variety of treatment methods, including non-surgical procedures, can help improve the symptoms associated with this degenerative condition. Chiropractic care is a safe and effective alternative treatment option which can help restore the original integrity of the spine, reducing pain caused by discogenic low back pain.
Oral drugs and/or medications are often used to help control symptoms while the patient engages in several of the treatment methods mentioned above. While these don’t treat the problem, they can help to control the inflammation as well as the pain and discomfort while a patient corrects their biomechanics and participates in stretches and exercises or physical therapy. Within the treatment itself, there are some treatment modalities, such as massage, ultrasound, traction, and electric stimulation that could help to control the pain and symptoms without the use of drugs and/or medications. If chiropractic care or physical therapy doesn’t improve a patients symptoms, the healthcare professional can refer the patient to another back pain specialist which can work alongside their current treatment to help improve discogenic low back pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.