LUMBAR DISC INJURIES : PREVENTION & TREATMENT

HAVE YOU ever had a lumbar spine disc bulge, herniation or prolapse ? Have you had sciatica ? Or do you get low back pain from sitting or bending forward ?  Do you sit a lot or bend forward a lot in your job ?  Has someone in your family had disc problems ?  Then you must read on as you will probably find the following information valuable in helping you to reduce both your current back pain and the likelihood of further injury to your discs.
Disc injuries may go un-noticed for years before they begin to cause pain (one study revealed that 35% of disc injury cases were non-symptomatic).  The problem therefore is that there are many factors that cause disc injuries and so you need to address as many as you can beginning with a simple understanding of anatomy and posture.
ANATOMY & POSTURE The lumbar disc is made up of a tough circular wall inside which is a thick jelly-like substance, in other words a bit like a giant jelly donut surrounded by a car tyre. The discs have unique shock-absorption ability which helps the spine handle impact and allows easy bending, arching and twisting of the back.  Unfortunately when the discs are damaged through too many repetitive forces in the wrong direction they will begin to age more rapidly.
HOW DOES THIS HAPPEN ?  When you bend forward or sit in a poor posture (as in slouched sitting) the spine moves from its neutral/ideal position (a gentle "S" curve from the base of the neck through to the junction with the pelvis) to a large "C" curve.
Over time if these non-ideal postures and movements are repeated or sustained, the pressure on the front of the disc will increase, causing the gelatinous centre to migrate towards the back and eventually rupture as the fibrous tissue progressively weakens and stretches. 
When this occurs it may bulge towards the spinal cord and nerve roots, causing pain (local pain in the back or into the buttocks and legs).  This may occur slowly resulting in pain when sitting or it may happen suddenly after one bending movement which causes sharp severe pain that may travel down one or both legs.
CAUSES AND PREDISPOSING FACTORS
There are a lot of factors that lead to disc injury, but there is a greater likelihood of injury if you have a family member who has a history.  Other major causes are:
a)  repetitive bending and lifting (150% to 220% pressure),
b)  sustained sitting (140%) when compared to standing,
c)  a sedentary lifestyle,
d)  poor spinal posture especially in heavy lifting,
e)  driving,
f)   physical inactivity, 
g)  weak core muscles,
h)  previous full term pregnancy, and
i)   having a tall stature (tall people suffer more disc problems).

LUMBAR DISC INJURIES : FIRST AID AND PREVENTION

A trained physio can usually effectively diagnose a disc bulge from taking a client's history and assessing the loss of movement, extent of pain and area of symptoms.  If symptoms are severe the physio may recommend further investigations such as CT or MRI scans.
Visiting a physio as soon as possible following a disc injury is important as they will provide valuable guidance, advice and instructions during the first few weeks.  Most clients will be advised to rest from aggravating activities such as bending forward and sitting (especially slouched sitting and sitting for too long). They will also be encouraged to do a lot of small movements, stretches and exercises to assist in getting better more quickly, such as:
Lying on the back with knees bent or calves up on a chair is usually the best resting position when in acute pain as it will reduce muscle spasm and pain in the back as the disc pressure can drop to about 25% of that experienced in standing.  (Sitting, especially inappropriately, causes the greatest pressure to be passed through the discs.)

The McKenzie Extension is often the number one and most effective stretch in order to reduce a disc bulge and improve movement generally.  It is also one of the best preventative exercises a person can do long term to assist in preventing recurrences.  If practised regularly this exercise can become as routine as brushing your teeth - and just as effective.  (Please note certain conditions of the lumbar spine can be aggravated by doing this exercise - so it is advisable to consult your physio first.)
To do this exercise:  lie on the stomach, palms slightly in front of shoulders, push up through the arms while keeping the pelvis in contact with the floor.  The upper body should lift off the floor, the head and neck need to stay in line with the upper body, and buttocks and the back should   be relaxed.  Breathe in while raising the upper body, breathe out and hold the position for 2 seconds at the end of range (stop short of pain), then slowly lower.  Aim to do 10 reps every 2 hours when in pain, then 2-3 sets of 10 once a day or 1 set 3 times a day as ongoing maintenance routine.
For all back injuries it is advisable to undertake a core stability and postural rehabilitation program. This phase will also include instructions in how to safely and effectively strengthen the back, core and legs to improve  overall physical ability and spinal strength, as well as advice on correct lifting and carrying techniques, what not to do and great postural habits to adopt.  (Note:  this advice is also important for new mums with weakened abdominals having to carry and manouvre their babies and children in and out of cots and cars).
A longer term core strengthening programme such as Pilates (one-on-one or small group supervised classes) is a great idea as the exercises although challenging at times, are fun and help maintain motivation.  Be assured that most cases resolve over time and people with disc injuries usually get back to normal life as long as they are guided through the injury and adopt appropriate preventative exercises throughout their life. 

                                          PHYSIOTHERAPY EXERCISE PRESCRIPTION
PHYSIOS are well-placed to design exercise programs for individuals with injuries or chronic diseases such as cardiovascular disease, diabetes, hypertension or osteoporosis, as well as those people who simply want to maintain a healthy lifestyle.  Physios a trained to design exercise regimes that take into account the pathology of an injury or chronic disease as well as other health/lifestyle issues while focusing on functional outcomes.
For those who are already aware of the benefits of regular exercise, a structured exercise programme is usually a high agenda item.  There is often less awareness that Physios are well trained in preparing exercise prescriptions for clients with injury or chronic disease.  These people often require more specific guidance with respect to developing and maintaining healthy lifestyle and exercise habits as their exercises need to be gradually progressed to avoid flareups. 
EXERCISE PROGRAMMES FOR HIGH RISK & LOW RISK PATIENTS Physio exercise prescription is suitable for both groups as it takes into account pathology and specific health needs.
For high risk clients, therapeutic exercise is an integral part of their physio treatment.  The physios in our practice are skilled in assessment and clinical decision-making which enables them to consider the individual as a whole, factoring in likely complications so as to avoid any potential detrimental effects when preparing exercise prescriptions for their clients.
The lower risk group includes those individuals who simply wish to maintain or regain a healthy lifestyle.  For this group our physios will prescribe exercises that are preventative, promote good health and wellbeing and assist in the maintenance of an active, healthy lifestyle. 
THE LIFEFORCE APPROACH TO EXERCISE Our physios will take into account the pathology of an injury or chronic disease, focusing on functional outcomes.  Unlike exercises designed solely around biomechanics and enhancing sports performance (in which they also have expertise), they will deliver a comprehensive treatment program using their broad knowledge, training and experience to encourage their clients to return to long term physical activity and exercise safely, whilst promoting healing and musculoskeletal conditioning.
Following a detailed initial assessment, our physios can determine appropriate exercise models, keeping in mind possible limitations.  With regular reassessment, they are able to adjust the exercise program accordingly whilst working toward an end point where normal exercise may resume.  They aim to reduce the potential risks of physical activity, particularly in cases where clients have chronic and/or complex conditions, by working closely with the client, and where required, with the client's medical team. 
LIFEFORCE PHYSIOS OVERSEE AND ASSIST a person's routines, goals and lifestyle which can impact on how well they recover from an injury.  As well as having in-depth knowledge of anatomy, biomechanics & pathology physios are experienced teachers, communicators and understand the importance of motivation.  Motivating clients is something our physios take very seriously.