Sydney Inner West Allied Health Centre
leaders in Physiotherapy, Psychology, Podiatry, Ex Physiology, DEXA scanning, fitness training

Lumbar Disc Disorders

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Chronic low back pain: is it your disc, muscle, nerve or facet joint?

Chronic back pain can be caused by many things. The most common source of back pain presentations in our clinic is discogenic in origin. The intervertebral disc is a fibrocartilaginous pad between each vertebra to help absorb pressure and shocks to the spine. The disc can herniate and cause sharp pain down your leg called sciatica. The disc can also tear in the outer ring called the annulus fibrosis. Annular tears are very painful and can cause relapses after the initial injury has healed.

Your physiotherapist will assess what the source of your back pain is and then make recommendations on appropriate treatment and exercises.

If you are experiencing severe back pain it is important to see a physiotherapist as soon as possible. Usually the most severe pain responds best to early intervention. Sciatica usually takes longer to settle and is not as responsive to treatment in the first week or 2.

In severe cases of chronic back pain that is unresponsive to conservative treatment we will refer for special tests such as MRI or discogram (see the images below). Severely degenerated discs can be replaced with an artificial disc or fused. The results now for surgery is very promising for sufferers of chronic back pain.

discography of disrupted L4 intervertebral disc

This is a lateral (side on) view of a degenerated L4 disc. There are 3 discs injected with dye: L3, 4, and 5.

L3 and L5 discs contain the dye whereas L4 does not contain the dye which has leaked out of the front and the back of the disc. This patient will have a disc replacement to treat the chronic debilitating pain she has suffered for the past 5 years

Discogram of disrupted L4 disc AP view

This is a front on view (AP) of the degenerated disc as described above. Note again the leaking of the dye at L4 level. Note the dye is contained within the 2 healthy discs above and below the diseased disc.

Case Study: patient "CF" Chronic lower back pain

Anterolisthesis L3 on L4

Patient "CF" consulted me because of chronic lower back pain. She was a gymnast in her childhood. The MRI illustrates an anterolisthesis of her L3 on L4. This means her L3 vertebra has slipped forward over the L4 vertebra below it. This is due to a pars defect, a part of the vertebra is damaged and does not restrain the facet joint from slipping apart. This problem is prevalent in gymnasts and fast bowlers. The white shade of the 2 adjacent vertebral bodies demonstrates modic type 1 changes of the bone. This means that swelling has extended into the bone. This is due to shearing forces of the 2 adjacent vertebra. Recent research published in 2013 also found that a bacterial infection can occur within the disc in potentially 50% of the population with modic type 1 changes in the vertebral body. This research could be a precurser to future treatment of chronic lower back pain with antibiotics.

This patient responds well to manual therapy in a flexed position. She is focussing on improving cardiovascular fitness and core stability. There is strong evidence of the benefits of exercise for this condition, although it takes 100% commitment! Her alternative option is surgical fusion of the L3/4 vertebral bodies: a valid and reliable treatment in this case