Back pain: Disc protrusion vs. herniation

Back pain is one of the most common conditions in the world. About 80% of all people will experience some level of back pain in their lives. There are many different causes of back pain, some more common than others. In this post we will be talking about one of the most common causes for back pain: disc protrusion.

What is a disc?

Your spine is made up of many vertebrae stacked on top of each other, with your spinal cord running through the middle and nerves branching out from between the vertebrae. Between each vertebrae are discs, which are rings of cartilage filled with a jelly-like fluid. These discs allow for movement of the vertebrae in the spine and provide shock absorption. Throughout the day, these discs respond to your movements and posture, which causes the jelly fluid to shift and squeeze out water content over the course of the day.

Disc protrusion versus herniation

Although our spines are very resilient, repetitive strains can cause changes to the discs in the spine. If you spend a lot of time in certain positions (like sitting with poor posture) or lift heavy loads often, the jelly in the center of the discs can get compressed and shift to one side of the disc. This shift can push on the cartilage ring and cause it to bulge out. In many cases, the disc protrudes onto a nerve coming out from the spine, which can cause symptoms like pain, tingling, or numbness that might be felt near the site of the injury in the back or referring out to one of the extremities. This is called disc protrusion and is very common!

A herniated disc occurs when the disc forms a crack where the inner fluid can begin to push out. This injury often occurs from a specific event like lifting something especially heavy or performing a movement with poor posture, and usually presents with more severe symptoms than a protrusion. Other terms for disc herniation are “ruptured disc” or “slipped disc”, although it is important to note that your disc is still very secure in place!

Disc protrusion or herniation are very common occurrences as we age, and often having these changes does not cause back pain. This is important to keep in mind when we look at imaging for the back: we might see one or more disc-related changes, but that does not mean they are the cause of back pain!

I don’t have any back pain anymore, but my leg/arm is now in pain!

Back and neck pain can have some weird presentations when there are nerves involved. There is often pain, numbness, and/or tingling that is felt somewhere along the arm or leg as well, and in some cases, this referred pain is still present even if the back or neck pain has gone! This makes a proper physiotherapy assessment very important for arm or leg pain to determine if the back or neck is involved.

Treatment for disc protrusion

If your physiotherapist suspects that you have a disc protrusion, there are a few types of treatment that they may try with you.

  • McKenzie Method: An evidence-based treatment method to correct a disc protrusion is to do repeated movements to help redistribute the fluid in the center of the disc and to improve stiffness that might have built up with this injury.
  • Postural and core strengthening: To support your back and help prevent this injury from recurring, your therapist may recommend strengthening exercises for your core muscles and other muscles that support your posture.
  • Dry needling: In some cases where stiffness or weakness has a large effect on your symptoms, dry needling can help kickstart improvements in mobility and strength to improve your back pain.

Treatment for a disc herniation often looks the same as a disc protrusion. In many cases, a disc herniation can recover in the same way a disc protrusion can, and you can finish treatment symptom-free. However, in some more severe cases medical management or surgery may be considered. It is important to work with your physiotherapist to determine the best course of action!

If you are suffering from back- or neck-related pain, contact us to book an appointment today!

About The Author

Jonathan Rankin obtained his MSc in Physiotherapy at McMaster University, and also completed both a BSc and an MSc in Human Kinetics from the University of Ottawa. He has a strong background in exercise, from working as a personal trainer at the University of Ottawa to conducting research on exercise during pregnancy in his master’s degree.

One Comment

  1. Pingback: Whiplash - What a Pain In the Neck! - Physiovive

Leave a Reply

Your email address will not be published. Required fields are marked *