Internal disc disruption

Lumbar internal disc disruption

Lumbar spinal internal disc disruption is a very frustrating condition of the low back. The term internal disc disruption implies that the structure and integrity of the intervertebral disc has been compromised (disrupted). This occurs when the disc develops tears within it. These tears are typically not recognisable on low back standard MRI scans. (Dehydration and high intensity zones will be) Therefore, it is possible to be in pain with no obvious low back issues on MRI (hence many peoples frustration).

For added complexity, some tears within the disc are symptomatic and others are not, we are not quite sure why. It is thought that these tears in the disc are caused by ongoing laborious occupational (sitting included) or sporting activities or trauma and injury to the spine as we age and we refer to this a degenerative disc disease. There may also be a genetic predisposition for tearing in the low back discs. Tears can be graded from grade I to III. Grade I tears are small and in the centre of the disc. Grade III extend all the way though the disc (full thickness). Tears usually start in the middle of the disc and extend out but full thickness tears (Grade III) can also start on the outer edge and go all the way in. There are only pain receptors in the outer third of the disc. If the tear is not in the outer third it will not be felt.

Generally speaking there are a few types of tears that a disc can have, but two more common ones. One is a radial tear that extends straight through a disc and the other is concentric (circumferential) tear that goes around the disc and spits its layers (imagine separating an onion layer). Both can be extremely painful. Radial tears are usually thought to be from flexion and extension type overload such as bending or chronic lifting and concentric are thought to be from twisting movements such as golf swings.

Symptoms of low back internal disc disruption

Low back pain is the hallmark of internal disc disruption in the low back and is usually located about the level of the tear in the back, however there is some evidence to suggest that pain can project from a disc in the low back down the back of the leg just like in sciatica without nerve involvement and this is why some patients may experience radiating pain from a tear in the disc. Pain is usually worse with postures that increase the pressure in the disc such as slouching or going to the toilet. Pain can radiate on one side or both, into the bottom, front of the pelvis and down the legs.

Treatment of low back internal disc disruption

In the vastly majority of patients, chiropractic and physiotherapy, along with Mother Nature will allow for a full recovery. Low back internal disc disruption is a troubling and long-term condition, with some data suggesting up to 18-24 months before full recovery. At Sydney Spine & Sports Centre (S3C) we typically see results far quicker. Our chiropractic and physiotherapy treatments are centred on improving function and reducing the pain associated with the tear. It is important to remember that we feed our intervertebral discs and remove waste products within disc through pressure gradients and thus it is very important that patients do not rely on bed rest and get plenty of movement each day and enough sleep as the diurnal cycle of disc hydration is very important to deliver nutrients and remove waste from a disc. Our chiropractors and physiotherapists will give you all the advice; reassurance, exercises and treatments to ensure the most favourable outcomes are achieved.

Causes of low back pain

The following conditions are common causes of low back pain.