Lumbar Disc Pathology

What is lumbar disc pathology?

Lumbar disc pathology varies from minor strain to major rupture of disc, with or without neural compression

Classification:

• Annular tear (internal disc disruption):
  • Concentric tear – Runs along the line of the fibres
  • Radial tear – Runs from the centre outwards
  • Rim tear – Tearing away from the endplate.
• Herniation/Bulge/Prolapse:
  • Protrusion – Base of bulge is wider than apex with the annular wall still intact (analogy – toothpaste can get back in tube)
  • Extrusion – Apex wider than the base so that the disc is narrower than the material outside the disc (analogy – toothpaste can’t get back inside the tube)

What causes it?

Poor lifting technique, flexion (bending) or poor posture causes injury to the disc.

Signs and symptoms

• Unable to bend forward
• Loss of movement
• Muscle spasm
• Shooting pain down your leg
• Pain location – Midline, bilateral or unilateral
• Local or referred pain
• May have nerve root involvement
• Pins, needles and numbness
• Weakness.

Treatment

Decrease mechanical strain on disc:

• Advice regarding postures and positions that lower disc pressure
• Extension exercises
• Taping to limit flexion
• Bed rest if severe.

Specific physiotherapy techniques:

• Manual therapy:
  • Joint mobilisations
  • Soft tissue massage
• Therapeutic exercise:
  • Mobility
  • Muscle retraining (i.e. stabilising exercises)
  • Extension exercises.

Address contributing factors:

• Correct posture
• Improve physical fitness
• Encourage a variety of movement
• Ergonomic advice (i.e. workplace set-up, e.g. lumbar roll, computer height etc)
• Address psychosocial contributing factors.

Encourage normal activity and work.