by Alan Jordan
Discs lie between vertebral bodies and have a useful role in offering shock absorption, allow space for nerves to come out of the spinal cord to supply muscles, skin & other organs, facilitate movement and also offer stability. No wonder that when these structures fail, there is a multitude of possible symptoms that can give a reason for an individual to seek medical help.
Disc disease can occur in one level or it could be multi-segmental. It is important to identify whether the problem stems from one traumatic incident, repetitive strain/poor postural habits or systemic and inflammatory diseases.
When a patient visits the physiotherapist with suspected degenerative disc pathology, detailed account of onset, progression and family history should provide indication of severity and diagnosis. Depending on the subjective information and physical examination, the clinician would discuss options with the patient, varying from conservative treatment consisting of non-steroidal anti inflammatory drugs, manual therapy, exercise and acupuncture.
Duration and progression of symptoms also plays an important part in decision-making. Should there be persistent neural symptoms then this might require further neurosurgical investigation. On the other hand, if there is a particular family history with specific symptomology, then rheumatological examination would be more adequate.
Type of damage
Degenerative Disc Disease – associated with age-related changes. This can be precipitated by repeated trauma and poor posture.
Disc Herniation – inner jelly-like structure of the disc exits the body of the disc through a failure of the outer casing
Internal Disc Disruption – disruption of the outer casing of the disc without leakage of the inner structure of the disc
These different scenarios may cause inflammation and pain in facet joints (supporting joints on either side of the disc), nerve irritation and/or entrapment, muscle weakness and altered sensations (pins & needles, numbness, burning sensation).
Treatment and management
Manual/Manipulative Therapy – targeting joint and muscular stiffness, faulty movements and restoring ideal status for muscles strengthening, stretching of tight structures and postural awareness. Simply, it is difficult to obtain good results if you exercise a stiff and painful structure.
Acupuncture – Helps with pain management and muscle spasm. Works very well as manual therapy and acupuncture complement each other perfectly.
Exercise Therapy – When pain is managed and movement restrictions are addressed then exercise is crucial in dealing with the offending weaknesses and poor habits. One should note that in the previous statement, pain management does not necessarily mean that there should be no pain before rehabilitative exercise is commenced.
Diagnostics – Very often imaging is used to diagnose, administer treatment, such as epidural and facet joint injections, and to monitor how the disease is progress over a period of time.
Specialist Referral – As mentioned earlier, specialist management may be necessary before or during physiotherapy treatment to help maximize the benefits of the therapy received. Drugs and injection therapy can achieve pain relief, control of inflammation and neural symptoms. Surgical intervention is discussed in a different blog.