ASKASK the DoctorDoctor Lower Back Pain by Dr. Craig Schisler, DC.

Dear Doctor, Axial Pain: When a patient has a symptomatic degenerated disc The other day I threw my back out. I’ve been diagnosed with (one that causes low back pain and/or leg pain), it is the disc space a disc problem in my lower back and I have pain that runs from itself that is painful and the source of pain. my back down my leg. I’ve been told it’s a herniated disc and I’ve Radicular Pain: This what is commonly referred to as a pinched been told it’s a bulging disc. What’s the difference? nerve. When a patient has a symptomatic herniated disc, it is not the disc space itself that hurts, but rather the disc herniation is pinching There are many terms describing disc injury which includes, a nerve in the spine. This produces pain that is called radicular pain “slipped disc,” “pinched nerve” or “throwing your back out” that are or radiculopathy (e.g., nerve root pain) leading to pain that may be non-specifi c and used by the general public. Other terms like herniated referred to other parts of the body, such as from the low back down the disc and bulging disc are more specifi c and used by the medical leg or from the neck down the arm. Leg pain stemming from a pinched professions. nerve in the lower spine is usually described as sciatica. Before I get into specifi cs, I’ll go over some basic anatomy. Often, herniated discs are not diagnosed immediately, as each The Lower Spine patient comes with undefi ned pains in the thighs, knees, or feet. Other The lower spine consists of a stack of fi ve bones we call vertebrae. symptoms may include numbness, tingling, and muscular weakness. In between the bones are discs. Discs separate the bones and provide a If the herniated disc is in the lumbar region the patient may also cushion for any forces acting on the low back such as gravity. experience sciatica due to irritation of one of the nerve roots of the Discs are composed of two main parts, an outer layer of cartilage sciatic nerve. Unlike a pulsating pain or pain that comes and goes, called the annulus fi brosis and an inner layer of fl uid and softer which can be caused by a muscle spasm, pain from a herniated disc cartilage called the nucleus pulposis. is usually continuous or at least is continuous in a specifi c position of We can think of the disc as a jelly doughnut; It has a harder covering the body. and a soft inside. When a disc gets damaged or compressed the outer Typically, symptoms are experienced only on one side of the body. layer can bulge, like grabbing an end of a water balloon, or the jelly If the bulge is very large and presses on the spinal cord in the lumbar in the doughnut can leak out through cracks or tears in the annulus region, both sides of the body may be affected, often with serious causing a herniation. consequences. Nerve compression can cause permanent nerve damage When a disc is damaged it can lose the ability as a shock absorber or paralysis. The nerve damage can result in loss of bowel and bladder and damage to the spine and/or nerves can occur. control as well as sexual dysfunction. If a herniation or bulge occurs, either can put pressure on the If symptoms such as loss of bowel and bladder control occur it is spinal nerve root which lays directly under each disc. A herniation in important to contact your emergency medical doctor right away. this area can put direct pressure on a nerve, which in turn can cause Causes sciatica. Pain that radiates down the leg and is caused by a herniated Herniated or bulging discs occur most frequently from trauma, disc is called a radiculopathy. such as a car accident or sports injury. There is also some research that Lumbar Herniated Disc Symptoms indicates spinal degeneration may run in families. Approximately 90 per cent of disc herniations will occur toward Treatment the bottom of the spine at the bottom two segments. Disc herniations There are many forms of treatment for disc herniation or disc at the bottom two levels can cause pain in the L5 nerve or S1 nerve, bulges. Treatments may include medication, physiotherapy, massage, respectively. chiropractic and acupuncture. If a patient does not see results, other L5 nerve impingement from a herniated disc can cause weakness treatments are available such as traction, cortisone shots or surgery. in the big toe and potentially in the ankle. We call this condition foot If symptoms persist beyond a few days it may be a good idea to seek drop. It can also cause the symptoms of numbness and tingling that professional help since complications can occur if pain is ignored. SW can be felt in addition to pain on top of the foot and the pain may also If you have any questions or concerns regarding back injury, radiate into the buttock. herniated or bulging discs please contact the Schisler Spine and Pain S1 nerve impingement from a herniated disc may cause weakness Centre at 519-988-0220. in ankle push off (patients cannot do toe rises). Numbness and pain All information from Ask The Doctor is for educational purposes can radiate down to the sole or outside of the foot. only. For specifi c medical advice, diagnosis and treatment consult Low back pain can be classifi ed into 2 main categories: your doctor.

10 Simply Windsor Magazine