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Author

Dr Tristan Joss

Disc injuries are often misunderstood…

A disc sits between the vertebrae of the spine.

It helps with shock absorption and holding the vertebrae together.

Intervertebral discs are a bit like a jam donut with a soft inside and a harder outer part.

Things change as we get older, the discs become harder and firmer, like a jam donut that is a few days old, the inner part becomes less fluidy. We think that’s why people become shorter as they get older, the discs have less squishy stuff in the middle.  

What directs us to a disc injury compared to other causes of back pain?

A disc injury in the lower back usually presents with lower back pain, pain may be shooting down the legs, tingling or numbness in the foot, and sometimes muscle weakness.

An injured disc in the neck presents with neck pain, potentially shooting pain down the arm, tingling or numbness in the hand, and sometimes muscle weakness.

Disc injury through the middle section of the spine is very rare and usually not felt. Its estimated they make up only 0.5% to 4.5% of all disc injuries.

We can also mildly irritate a disc that will present as low back or neck pain with no tingling, numbness or pain in the legs or arms.

Sciatica | disc injury | disc and MRI |disc bulge

How do you confirm the diagnosis?

Taking a thorough history will point to what the issue is, by asking lots of questions it not only helps us uncover what the issue is but it gives us a background into what causes the problem in the first place and why the disc has taken on extra pressure. 

We then confirm this diagnosis by doing some orthopedic tests, some tests to rule things out and others to confirm what we are thinking. If we are not sure of what is going on or it seems like a severe disc bulge or its not improving after a few treatments, we might order an MRI.

Why don’t you order an MRI in the first place?

Very good question with some interesting answers. There have been lots of studies into MRI results, we assume that an MRI will show us where the pain is coming from, but if we look at the table below we see lots of people have disc and spine issues but they are not in any pain!

Any MRI will reveal a disc injury and you’re more likely as you age, but what is shown from an MRI doesn’t necessarily indicate the cause of back pain.

The research now says that its common for people with no back pain to have underlying disc or back issues. This is tells is how important our history taking and examination before a diagnosis and treatment is, and it tells us not to rely solely on scans because most people would be diagnosed with a disc issue that might not be causing there pain.

spine MRI | degenerative disc

So if you have questions about disc injuries and whether you need a scan or not consider if it will change how it is treated.  In clinic we find that the picture on the scan doesn’t change how we approach the disc, in most cases.

Instead of going down the scanning route, why not have a think about what injury may have caused an imbalance in your spine in the first place to create the pressures on one area.  Many cases of this are in the legs.  Something like:

  • broken bone – even a pinky toe!
  • knee injury
  • foot pain
  • achilles issues
  • pelvic history including birth related post-partum recovery

Have a think.  Disc injuries don’t just happen, there is always a history behind them!

 

Want to see us for your pain? Book online or by calling reception on 9859 5059.
References:
  1. Brinjikji, Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.
  2. https://scholar.google.com.au/scholar?hl=en&as_sdt=0,5&as_ylo=2010&as_yhi=2019&q=age+specific+prevalence+estimates+of+degenerative+spine+imaging+in+asymptomatic+patients
  3. Fogwe DT, Mesfin FB. Thoracic Discogenic Syndrome. [Updated 2019 Mar 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470388/
  4. https://www.sciencedirect.com/science/article/abs/pii/S1529943009010602

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Phone : 03 9859 5059

Shop 3/74 Doncaster Road, Balwyn North 3104
The Village – Balwyn North

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