Have you ever talked with your physician about back pain and felt like they were talking over your head? Or it was the opposite problem. They didn’t have anything helpful to say and you didn’t know what to ask. Bit of an awkward visit.
Maybe you received your imaging report and there was a load of words that sounded long and scary. Reading it makes you feel like you are doomed to have pain forever.
Or you hear a few terms all the time, “pinched” nerve, or degenerative disc disease (DDD), but feel like no one ever really knows what it means and what to do about it.
It’s time for some exploring in the vast world of low back pathology definitions. This should be a whirl of a time!
The disc: Is it degenerating, bulging, herniating? What is it?
Degenerative disc disease. I hear that a lot. Please don’t panic if you’re told you have DDD. It’s expected that you will have some degeneration of the disc as you age.
DDD refers to some level of breakdown in the disc that has led to a change in the structural properties and height of the disc.
DDD is a real thing that can lead to real problems and pain. But, like most everything we’re going to highlight today, it doesn’t mean your doomed to have pain forever. Not even close.
Disc herniation simply means there is damage to the outer layer of the disc, called the annulus fibrosis.
When the outer layer is damaged in the form of a tear or delamination, it becomes easier for the inner layer to leak out from the center. This inner layer, the nucleus pulposus, is the consistency of thick phlegm. That’s a nice word right there, phlegm.
Disc herniations are classified as partial or complete and can be further classified as a disc protrusion, prolapse, extrusion, or sequestration. A disc bulge is another way to refer to a prolapsed disc, meaning the nucleus has leaked far enough to push the annulus outward.
Herniations might sound scary and they can be downright painful and terrifying at first. The body is miraculous though and you can get out of pain. Disc herniations actually do resolve and the body can remove the herniated nucleus material (Benson, 2010). How amazing is that!
The message I’ll say again and again if you’re told you present with one of these pathologies: it doesn’t mean you have to be in pain.
For those of you wanting more (maybe it’s just me), I’ll write up a separate blog all about the process of disc degeneration and pathology. There’s a lot we could dig into but it’s beyond the scope of this little section.
The following terms are quite the mouthful. If you don’t look closely you might think I’m just using the same word three times over: spondylosis, spondylolysis, and spondylolisthesis.
Simply think of spondylosis as some degeneration in the spine. It’s actually quite normal as we age and it’s presence does not correlate with the presence of pain.
Spondylolysis involves a stress fracture that occurs at a certain spot on your lumbar vertebrae called the pars interarticularis. This injury is more often seen in adolescent athletes who perform repetitive, loaded lumbar extension, i.e. gymnasts, dancers, and football players to name a few.
Spondylolisthesis is typically a progression of a spondylolysis. This term refers to the displacement of a specific vertebra, typically in the anterior direction, which would then be referred to as an anterolisthesis (Garet, 2013).
Whew! That was a difficult section to keep my spelling in check. I hope you enjoyed reading that mess of letters.
Radicular pain, sometimes also referred to as radiculitis, sounds a bit, well…rediculous (had to get that in there). But the symptoms are anything but comical.
Radicular pain is very distinct. It occurs as a lancinating, electrical pain that shoots down one or both legs. This shooting pain will feel like a narrow line, two to three inches wide.
It is most likely caused by compression on an inflamed nerve root or dorsal root ganglion. Notice the nerve root has to be inflamed to produce this pain (Adams, 1995).
If you’ve been told you have a “pinched” nerve and think all hope is lost, it’s most likely not. If you learn the strategies to keep your spine and nerves happy, it will no longer be inflamed and will stop producing pain, no matter what an image shows.
The nerves we’re discussing have two major functions: sensation and muscle activation. Radiculopathy involves changes in one or both of these functions, which is referred to as a neurological symptom.
If the sensory pathway is disrupted, you may experience numbness or tingling. If the motor pathway is disrupted, you may experience weakness, and if left alone for long enough, muscle atrophy (Adam, 1995).
This disruption can occur simply from a disc pathology as discussed before, and your nerve function can return to normal once you treat the source of the issue at the spine. I’ve seen it plenty of times and it’s always incredibly fun for me to witness the recovery!
To clarify, radiculopathy is not the same is radicular pain, because pain has nothing to do with radiculopathy symptoms. You can have radiculopathy with or without radicular pain, but they are separate symptoms that are both important in diagnosing your pathology.
And radicular pain and radiculopathy are separate from referred somatic pain, which is the more common of these diagnoses. I wrote a completely separate post on somatic referred pain that you can find here.
Fear-mongering might be a bit of a surprising topic to complete this piece, but it captures the entire reason I have constructed this article, along with some previous and some to come.
The words I have defined that are associated with low back pain have at times become fear-inducing tactics to push patients into drastic decisions. Whether the tactic is sales motivated or due to ignorance of a better way is a different topic, but it happens none the less.
My desire is that the next time you see an imaging report with some of these words or have a friend telling you about the “diagnosis” they were given just based on an image, you’ll be better equipped for an insightful discussion with your clinician or friend.
Especially if someone tries to tell you that you’ll just have to deal with your pain for the rest of your life. I hope you’re better prepared to question them hard as to how they know that.
Most of the pathologies we discussed don’t have to be painful, and the pain can be resolved with improved movement and recovery strategies. Your body is incredible at healing! It just needs a little help at times, and it doesn’t always require cutting you open to make it happen.