This guide is for patients who have low back or buttock pain caused by a painful or weak intervertebral disc. A disc can be painful in its own right (because of damage to pain-sensitive fibres of the back or side of the disc), or it can cause achy muscles (as the muscles of the low back work over hard to protect the disc).
If your disc problem is also causing sciatica in the leg (you have sciatic pain, numbness or pins and needles in the upper or lower leg) this guide still applies, but with modifications.
The patient who this guide applies to will likely be in the age range 30-55.
There are other more common causes of low back pain, particularly sore joints, muscles and even ligaments. These tend to resolve with proper care over about two weeks.
But discs are slow to heal, and particular attention for up to three months is needed to avoid relapse and promote recovery.
The typical IV (inter-vertebral) disc has a tough fibrous outer layer and a more gel-like inner layer. A healthy disc works very well to cushion low back stress by acting as a pressure-resistant mobile ‘spacer’. Sometimes the outer wall of the back and sides of the disc can be strained, and this might cause pain. Occasionally, the gel-like inner compartment can try to push back through the outer layer. This is known as a herniating disc.
A slipped disc (more appropriately called a prolapsed disc) is when some gel material has escaped out of the back or sides of the disc. In this situation, it may trap a passing nerve root and cause sciatic pain in the leg.
Two types of medication can be used to manage pain in these situations.
The first is regular painkillers that work by directly blocking the brain’s perception of pain – for example, paracetamol.
The second is anti-inflammatories, which work by reducing inflammation from the injured tissues, and thus indirectly reduce pain (because inflammation causes pain).
Painkillers and anti-inflammatories can be taken together to get a combined effect. You must not take two or more types of painkiller or two or more types of anti-inflammatory. For example, some people take both aspirin and ibuprofen, not realising they are both anti-inflammatories. Check with your pharmacist or your doctor if in any doubt.
You must have adequate pain relief. Don’t grin and bear it. Over the counter pain medications may not be strong enough, and you must see your doctor as soon as possible if you feel you need stronger medication.
A common side-effect of anti-inflammatories is a feeling of nausea or an upset tummy. If you get this, reduce your intake of anti-inflammatories, take them with food, and mention this to your doctor. Any previous history of gastric ulcers or asthma requires much more care over the use of anti-inflammatories, even over the counter aspirin or ibuprofen (a brand name of the latter is Nurofen).
Compared to the muscles and joints of the low back, or even ligaments, the disc does not have a good blood supply. Joint or muscle strains can settle within a couple of weeks, but a disc problem may take up to 10 weeks to settle, even when the pain has subsided quickly. You must not be fooled by the absence of symptoms into thinking that an injured disc has finished its healing, or you may have a relapse at some point.
Avoiding sudden or sustained rises in intra-discal pressure (IDP)
Imagine you have a pressure meter probe inside the disc which reads from 0% (good) to 100% (bad). The higher the pressure, the more strain on the injured areas at the back or sides of the disc. Lying on your back, the meter would read low. Walking would also be quite low. Standing still is not so good. Leaning forward (e.g. assembling furniture, cleaning teeth, washing up, doing the car) is high pressure. Sitting (even proper sitting) is bad. Sitting in a slumped position is almost disastrous. Of course, the longer you maintain the wrong position, the longer the adverse effects of high IDP have to work. Regular breaks from sitting, every 10 minutes or so, and even if only for a minute, give time for the straining fibres to move back into position.
The critical factor is – are your back muscles relaxed? Just remember that preventing your back muscles from working too hard or too long will keep IDP under control. For example, sitting too far away from your desk and reaching for the keyboard or mouse will trigger significant back muscle contraction, leading to peak rises in IDP.
Disc health may be helped by improving nutrition. Drink more water to hydrate the body. Consider taking 1000 mg of vitamin C and a capsule of vitamin E to assist in tissue healing, if only for a few months. Smoking is especially bad for disc health; consider cutting right down through any healing period.
Movement is quite good for the healing disc as long as movements are gentle and do not produce sudden or sustained rises in IDP. If the disc is painful and the injury is very new, then rest rather than movement is indicated. But as the pain subsides and time passes, the right way to speed up healing and promote proper tissue formation over the injury site is to add good movement.
Remember, the fact that your low back might hurt through action does not imply that any harm is done. As long as the pain is not sharp or severe, and as long as there is no increase in pain after the activity has finished, some movement may well help as long as you don’t overdo it.
If you have low back pain (and no sciatica) from a painful or weak disc, surgery is not a viable option except for the most long-standing and severe cases.
Surgery for sciatica, however, can work well and is possibly indicated for intractable sciatica of over 6-10 weeks duration.
When all else has failed to help low back pain, and a surgeon believes a disc is the cause of it, a steroid injection may be considered, and in the future, other more progressive techniques will likely be available.
In the early stages, rhythmic movements of the low back while lying on your back will help. Later, walking and gentle swimming (less so breaststroke) are also excellent.
Gym work may be useful during the intermediate stages of a healing disc. However, rowing, cycling and up-hill treadmill are all inadvisable.
Abdominal sit-ups should not be done at all.
At the appropriate time, resistance exercises for the arms and legs will indirectly help the low back, providing emphasis is placed on proper posture and technique during the exercise.
For cardio-vascular fitness, try cross-trainers or stair-masters. Road cycling may be fine for the disc, especially mountain biking where the body is inclined forward, and the bodyweight is borne through the arms.
Specific exercises to strengthen the muscles of the lumbar spine will be necessary, but you should discuss this with your therapist or trainer.
Heavy manual labour is challenging for freshly injured discs. If you have to work, then try workwear support belts. These increase intra-abdominal pressure, causing the area in front of the spinal column to be more of a supporting column in its own right, thus reducing intra-discal pressure. The belt also transfers lumbar loading to the hip and leg system.
My advice would be to use the belt sparingly, when you really are using the back muscles a lot, and not while you are just walking around.