Verantha in Chandigarh, India asks:
"I have been told I have a disc prolapse that should improve with conservative treatment. Could you explain what this means? Will I always have back pain?"
T J Salih, Senior Chartered Physiotherapist at the back2normal back and neck clinic, London replies:
"Conservative treatment is a common term used for describing treatment that is non-surgical. As most people who have low back pain don't need surgery, conservative treatment plays a major role in treatment and should always be the first option when you have lower back pain that is not caused by major trauma.
"Lumbar discs are composed of two main parts: a tough fibrous outer layer (annulus) and a jelly like inner part (nucleus). The discs act as shock absorbers and dissipate the force through the spine. All discs have sensory nerve endings in the outer portion of the disc and are known to be a potential source of back pain - normal discs do not cause pain. Abnormal discs with either tears of the outer layer or a prolapse (a leaking) of the jelly like inner part of the disc will cause pain. If the disc is 'bulging' because it is slightly degenerate or the prolapsed material is touching a spinal nerve pain will often be felt into the buttock and down the leg.
"Early intervention by a qualified healthcare professional is vital to help prevent further 'leaking' of the nucleus and to minimise the likelihood of further episodes of lower back pain. Studies have shown that after the first episode 90% of people improve and do not have another episode of low back pain. After a second episode of lower back pain, 90% improve and 50% of these have a relapse at some future stage. Following a third episode, 90% improve and 10% relapse.
"This means, of 100 people with a disc prolapse 90 will improve and have no pain again, while 10 will have further problems. Of the 10 people who have a second episode of pain, 9 will improve but 5 will have another episode of pain in the future. Of the 5 people who have a third episode of pain, 4.5 will improve and 0.5 will not, but all 5 are likely to have further episode of lower back pain.
"Basically, the more episodes of low back pain that you have the less chance you have of improving and there is an increase in the likelihood of repeated episodes of pain. This is why early intervention by a qualified healthcare professional is vital.
"Physiotherapy treatment aims to relieve pain and inflammation, prevent further damage and also re-train muscles that provide stability to the spine and help 'absorb' the forces put through the spine. A Chartered Physiotherapist is also able to give specific advice regarding posture and recommend changes to work and sporting practices which will help prevent back problems. Generally, positions of flexion such as bending over and sitting exacerbate the disc prolapse and should be avoided. An understanding of the causes of low back pain can be explained by the Chartered Physiotherapist. In most cases poor posture and a lack of muscular stability are usually implicated.
"In the very acute phase (first 48 hours) of a disc prolapse, various anti-inflammatory procedures can be used to reduce inflammation and pain. Acupuncture and ultrasound may be helpful although Non Steroidal Anti Inflammatory medication have been shown to be most effective for pain relief in this stage.
"Once the acute period has passed physiotherapy treatment aims to minimise joint stiffness. This is achieved using passive joint mobilisation, manipulation of the spinal joints and self mobility exercises/postures. Usually, the main exercise you will be asked to do is that of extension which is leaning backwards by propping yourself up on your elbows when lying on your front. This mobilises the joints but more importantly closes the area of the prolapse and reduces the disc prolapse. If the disc prolapse is reduced the tear in the disc can heal.
"After the initial pain has subsided, remedial exercises to strengthen the spine are very important to restore normal spinal movements and muscle strength. The main aim of exercise is to encourage mobility, reduce muscle spasm, prevent further deterioration in the muscles and speed recovery.
"A Chartered Physiotherapist will tailor your exercise program for you and it normally depends on the type of condition, its severity and your fitness level. Exercises should be performed in all planes of motion, that is forward/backward, side/side and twisting as these are the motions that occur during everyday activities. There are now specialised clinics that specialise in 'Spinal Rehabilitation' such as the back2normal clinic in London. Not only do these clinics have spinal specialist staff, but also unique equipment which is able to very accurately measure, re-train and improve spinal function."