Over the years I have seen many many threads on how to manage low back injuries. This thread will dive into the different types of lower back injury and the appropriate ways to manage them.
First off, this thread by forum legend, Doc Sust is a must read. http://forums.steroid.com/injuries-r...ine-rehab.html
The low back or Lumbar Spine is defined as the 5 vertebra at the bottom of the spine. The vertebra and the inter-vertebral disc in this area are the largest and most durable of the entire spine. However because of the forces that are transmitted through the lower back, it is a very common area of injury. Something that is unique about the lumbar spine is that the spinal cord actually terminates at about the L1 or L2 vertebral level and branches out into a bundle of nerves called the Cauda Equina. Remember this structure as we will be diving into its important later. There are actually many different causes or types of back pain, because of the many different structures that can be injured and generate pain.
To start we will dive into anatomy and its common patterns of injury.
Inter-vertebral disc:
The inter-vertebral disc is basically a fluid filled shock absorbing structure between each of the vertebra. Within these disc is a structure called the Nucleus Pulposus. This is a water/gel like substance that is acidic in nature but is very good at absorbing compressive forces. On MRI imaging, how much water or hydration content that is in this area tells the doctor the relative health of the disc and its ability to function properly or if it is healing properly after injury. The second important structure in the disc is called the annular fibers or annulus. This is basically a thick fibrous sack that holds the nucleous pulposus in place. These fibers are actually so strong, in a health individual that has some sort of traumatic injury such as a fall or car accident. The disc will actually crush the bone instead of rupturing. Think of the annulus as the steel belt that surrounds the the nucleus like and inner tube in a tire.
Annulus fiber tear and injury:
The annular fibers you can think of as a round tendon that is laminated. Many overlapping layers are what cause the disc to be so strong in nature. However with either repetitive stress, or acute injury these fibers can start to fray or tear just like a tendon can. These tears are often painful and can cause an ache or even shock like pain when they first happen. The disc as a whole is very good at resisting compression, but is not as good at resisting rotational forces. That is why you are not suppose to bend and twist at the waist when you pick up something, and is often a common way that these fibers can become torn. This tears can be minor in nature or can be quite severe.
Herniated/bulging disc:
Most people know or hear about this but often do not exactly know what it means. A herniated disc is a disc that has lost the integrity of its shape. The annular fibers we talked about above have become worn, stretched or torn. This causes the inner part of the disc to "bulge," or herniated into an area it is not suppose to. At any one time a person will have one or more of their disc bulging to a certain degree. It really only because a problem when the disc bulges or presses on a sensitive structure OR its inner contents "leak," out.
The disc can bulge or press on the spinal nerves, this is called Nerve Rood Compression. This is also commonly called a
"pinched nerve," or is one of the common causes of nerve compression. This is basically where the disc bulges and compresses a spinal nerve as it exits the spine. The interesting thing about this, depending on what part of the nerve is compressed symptoms can be vastly different. However, generally someone will have pain. Sciatic pain is often one we think of and we will talk about more in-depth later. It can also cause muscle weakness, sensory changes such as decrease in hot/cold sensitivity, balance/proproception, organ function, and so on.
Although uncommon but most commonly in weight lifters is something called Cauda Equina Syndrome. This is actually where a weight lifter will lift something heavy, hear or feel a pop and have instant pain. The disc will rupture and compress one or more of the different nerves that go to the bowels or bladder. The compression will actually cause a change in the function of the bowel or bladder, either causing problems starting or stopping the bowels or bladder or even cause severe sexual dysfunction. THIS IS A MEDICAL EMERGENCY, because the compression can be so bad that the brains signals to the bowel and bladder or blocked completely and one can't go to the bathroom or control going. The compression if left untreated will cause irreparable nerve damage and can lead to even death. Treatment for this when identified is immediate neuro surgery.
The inner disc material (nucleaus pulposus) is acidic in nature as I mentioned above. Because it is acidic it can damage and irritate other tissues in the lower back. It can cause damage to the vertebral body by dissolving the bone, cause inflammation to the ligaments and other tissue surrounding the disc and generally keep inflammation and pain in the area. Most people describe it as a deep boring pain that is typically not relieved by position or movement. Over time the body will wall off the acidic material and create a cyst if you will that the body will absorb which can take months to years depending on the severity of the initial injury. These cyst can become a problem if they migrate, press on a sensitive structure or cause pain. They can be surgically removed, but often are not because of the typical short duration they remain usually.
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Originally Posted by Marsoc
