Acute low back pain from a disc: five common questions answered

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hello, everybody, and welcome to the Restoring Human Movement podcast. This is your co-host, Dawne Costantino, and I actually have a guest with me here today. His name is Garrett. He is my intern, mainly on Wednesdays and Saturdays, and so he's going to help us out with talking about five of the biggest questions that we have about acute low back pain, or mainly what most people have about acute low back pain. Say hi, Garrett. Hello, everyone.

The delay. So we were discussing before we started the podcast today about ways that we were going to introduce Garrett, and I thought, how about you just share a fun fact about yourself? And he got really nervous, and he said, I'm not a fun person. I'm very boring. And then he came up with some stuff. So what do you have now? I have two fun facts. I drink copious amounts of caffeine, and I don't eat vegetables. He doesn't eat vegetables. He definitely has a very childlike diet. I've seen it myself. Fun fact about Dawne Costantino. She used to play the violin when she was younger and wish I still did. So that's me.

Yeah. Well, we're going to hop right into it. So basically, we are letting AI help us out with today's podcast. It's going to be short and sweet. We just typed in what questions do most people have about acute low back pain. So, Garrett, what's our first question? Our first question is, what exactly is discogenic low back pain? Discogenic low back pain. I think we did really, when we typed this into AI here, whatever we're calling this thing these days, chat GPT. We really wanted to narrow down what kind of low back pain we're talking about here, because if you're listening, there are different reasons why.

Garrett, what are the top three things you've seen causing low back pain? It's mechanical. So, body position. So, the way people are moving between joints. Inflammatory. So, if you have pre-existing conditions and systemic issues that can cause low back pain flare-ups. And then, honestly, age. Yeah. Age is another factor that is common. Young people that do too much and old people that don't do enough. Absolutely. So, kind of probably the number one and number three. So, mechanical and age. There's certain structures in your spine that can really be the pain generator. And we are talking about the disc itself today.

So, when we call it discogenic low back pain, it means it's just coming from the structure of the disc. That is what is sending the pain signals. So, what exactly is discogenic low back pain? Oh, I think I just answered that. Ultimately, it is pain that is coming from the disc. There's different things you'll find with a disc issue. The most common thing is bulges, herniations, annular tears. When it comes to age-related discogenic pain, it could be more. There's just some drying up. What do you call that? There's a word for it when it's losing the water in the disc. I just... Not deterioration, but I don't know.

Some disc height. Yeah, there's a word for it I'm looking for, but that's okay. It'll come to me later. But ultimately, when you're a bit younger, you have just a lot more fluids and juice and blood and water and all kinds of cool stuff in the disc that makes them taller, I guess you can say. And then as we get a little bit older, we have a little less of the fluid in there. And so, we have decreased disc height. And that can cause different types of low back pain, too. So, yeah, discogenic. A lot of times can be very local. It'll feel like a sore low back. It can feel sometimes like a sharp stabbing pain in the area.

A lot of times doesn't feel too good with sitting for long periods of time, bending over repetitively. You know, a lot of times it's this like, I just went to go pick up my keys off the counter and my back went out. People... What are the things that you hear people say with their back? It's like it's out of place. Spasms. What else have you heard? I just bent over one time, picked something up. So vulnerable. I woke up and my back started hurting. Yep. So, it's usually, it's not picking up your keys that did it. It's kind of an accumulative over time. We haven't really been paying attention or listening to our body talking to us, telling us that, hey, we need to maybe pause on something or take a step back.

So when you do something as simple as bending over to grab something off the floor and your quote unquote back went out of place, which that doesn't happen by the way, but that's what people like to say. That's the kind of pain we're talking about today. So, yeah, I think I've described it. How would you say you're in your one of your clinics, you're working with one of the students out there and they're like, what's causing my back pain? And you think it's disc. How would you describe that to them? Simple, easy. So, essentially, the pain with disc is we look if it radiates anywhere else. And so, when I'm asking questions about their low back pain and we're getting down to the history and finding out what's causing it, basically, if it's localized and there's no radicular symptoms, I'm like, okay, this might be something we can fix with similar exercises, some core bracing.

I'll dive into, you know, what do you do on a consistent basis? Because that'll tell you a lot, what people repetitively do, how they repetitively act. And then I'll ask them what they've done to make it feel better. And usually, if there's something that makes it feel better, if it's position-related, if it's just the way they sit, move, stand, lean, that gives you a lot of indications of the way the back pain is presenting and how we can solve it. Even in that point, it doesn't necessarily matter whether what's generating the back pain. If we can find a position that's causing some relief, then that gives us an indication of where it's coming from and how we can begin to fix it.

Yeah. I think we can talk all day. And I'm sure you guys, if you've been following us for a while, welcome back, by the way. If you're new to the podcast, hello. We have tons of other podcasts that we've made about similar topics, as well as hip and neck and shoulder and all that. But we can discuss rehab and stretches and treatment all day long. But I think the thing that Garrett and I, working together with some patients, have noticed is really diving into lifestyle and habits can go a super long way. What's the... I'll answer my own question, too. But I'm curious what the most common habit you see in each person with discogenic pain.

What are you typically... What are you trying to change there? For example, for me, I need people to walk more. We don't walk enough anymore. We reach in our daily steps. I think that's a super easy one to start to change for people. A lot of people have dogs. Go walk your dog a little bit longer. They'll love you for it. So just getting more steps in throughout the day can be really, really helpful for a pain like this. What kind of habits are you changing? Depending on how the patient presents, but a lot of times it's nutrition. So really low-hanging fruits, if you're a little overweight, it's going to amplify all the pain that you have.

And also, if you're carrying more weight, think of it in a different way, but think of it like a pregnant mother who's like the baby. The position. Yeah. So you have a lot more stress put on the low back because they're upholding another human inside of them. Well, if you, say, even if you're a male and you're gaining weight in that area, that's going to put a lot more stress on your low back. So the lifestyle change you can make though is like, okay, how's our diet? Are we eating a lot of processed foods? Like, are we just sticking to basic whole foods? What's your diet like? What's your exercise like?

Those are the first, along with walking and then dive into how we're walking and moving. But you have to hit those low-hanging fruits. Low-hanging fruit. Absolutely. Yeah. And even like on the topic of just kind of being overweight, I'm not a stickler for like, you need to be super ripped, have a six-pack. And, you know, that's not what we're saying here. I really, I think on a, just in a different perspective, it's more about the type of inflammation that is chronically happening inside of the body that, you know, if we have a disc, let's say disc herniation, and then there's a tear that's occurred, I mean, the body will go and attack that in a way.

So we put something we're sensitive to, we're going to have an inflammatory response around that area. And that shit's painful. I myself have had that before. And you know what? I personally have been a number one person to experience a change in diet or staying away from things you're sensitive to. I had pain that I'd wake up with first thing in the morning. Couldn't do a full yawn because it would hurt. It would stab me. The only time I would feel it really. Red wine would make it worse. And I now have realized that dairy makes it worse. So those were my two triggers. It's really nice to at least now know what's causing it and then make educated decision on whether or not you want to eat it that day and suffer the consequences later, right?

Cool. What other question? What's our next question? Do you need an MRI or imaging to confirm the discogenic low back pain? Short answer? No. Not really. Yep. I think what's important here is we're not against imaging, right? You don't, especially with a disc issue. And we're just talking just simple discogenic pain. We're not saying it's pressing on a nerve, radiating down your leg, causing muscle weakness, causing reflex issues, pressing on your spinal cord, causing bowel and bladder. Dysfunction. If you've noticed this stuff and you have, you know, this is some symptoms that you're dealing with, please go see a provider today, right now, because that's something that you need to get on as soon as possible.

But if it's just an irritated disc that's not affecting anything else neurologically, you usually don't need an MRI. I'll send people for MRIs if something on their neurological exam tells me it's necessary. I'll send them for MRIs if we've done a trial of care for about four to six weeks and there's been no changes at all. If something's being missed there and I want to know why, that's kind of some of the reasons I would send for imaging. Just to clarify, I said Garrett intern, he is not yet licensed, but when we're talking about his experience of working with patients, it's been under me, under other providers he's worked with, under their license, he's still in school, graduating soon.

But I'm curious, have you had to send anybody for an MRI yet for a low back pain? I have not. But I have had to have the question of asking them if they want to get images. Sure. And I preface it similar to like you were talking, it's like, don't necessarily need it until maybe exam findings indicate it, but also in the same breath, if it's going to result in any productive outcome, any actual item from it. If even say you need surgical intervention, if the patient wants her surgical intervention, is it worth getting the MRI? No. Will that change at all? How they're going to approach this? No.

Probably not. I have had that conversation. Yeah. I like that. I think that's a really good point here is it's, it's not, I always tell people, at least I try to remember to always say this when I'm meeting a new patient, this is not me telling you what to do. We are a team from here moving forward. There's always multiple ways to accomplish a goal. Do you feel like you need imaging? Would it help you sleep better at night knowing exactly what's going on inside of there? Right? The thing about imaging is sometimes there's incidental findings. So then if we find something else, it's not the cause of your pain.

Now we start stewing on what that is. We're creating, you know, more of a psychological issue there. So there's, there's time and a place for imaging and it really is always a team effort and discussing why or why we would not get some imaging done. But I like that what you said there, it's kind of like, do you feel like you want some? Right? It's super important to make sure that the provider you're seeing is including you in your decision-making process here, not just telling you what to do. So awesome. What's our next question that people have? How long will it take to heal? Simple answer? Is there one?

It depends. It's always there. That's always there. There's a, there's a basic timeline you'll hear just across the board, which is usually what, four or six weeks, six to eight weeks to see some changes, right? And then really defining with discogenic pain, like how long does it take to heal? Do they ever heal? Do they ever fully heal? How bad is it? Right? Is it a protrusion, a bulge, a herniation, an excursion, a sequestration? These are all types of grades of disc herniations. And so depending on how bad it is, it might take longer. Sometimes they're always there, but they don't always cause pain, right?

Like I currently have a disc bulge. I'm not in pain, right? So you can have these things and you can get better and you can function better. But yeah, those timelines are hard to answer. I think a fair timeline to see changes is about that, let's say, just conservatively six to eight weeks. Usually it's quicker. But there's just so many factors when it comes to humans as far as like, what are you doing on a day-to-day basis? What kind of job do we have? Are we sitting all day long? Are we somebody who works 12 hours on our feet? Like all of this stuff is taken into account when it comes to how long it's going to take for you to heal or feel better.

Yeah. And to add on to that similar, you know, what you just said is there's a difference between healing some maybe physical dysfunction and healing the pain. Because we may work together as a team to heal the pain. That's awesome. That's great. We don't want you in pain. But when we get past that point, there's a level of dysfunction maybe somewhere in the body, especially if it's a mechanical dysfunction. And whether that caused the issue or something developed because of the issue, you walk different, you move different because of the pain, you create a pattern. Now we kind of have to undo and there is a process to that in rehab as well.

So there's the other side of pain or get back to performance or function as a human. That's a healing aspect to rehab as well. So it all depends on the person, what your goals are, how long you have the patients. To get back to what you feel is normal. What got you here in the first place, right? There might have already been some dysfunctional patterns leading up to this. So once pain's gone and let's quote unquote, this disc is healed, has all of those dysfunctions improved, right? What do we usually see with people? It's like there's some range of motion deficits in their hips, their thoracic spine above the low back doesn't move very well.

That stuff usually didn't just happen because the disc herniation, all of these things probably were there before leading to this injury in your low back taking on maybe too much load. We're not moving well, things of that sort. Yeah, absolutely. Anything else you want to add? No. All right. Question number four. What are the best treatments for discogenic pain? Best treatments. Well, I'll just give all that. I'm biased if I'm going to say best treatment. It's going to be performance places treatment. My biased view, how to treat discogenic low back pain. I love the McKenzie method. I do think finding a directional preference for somebody can be really, really helpful.

It helps you feel like you have a sense of control over some discomfort. Help educating people on positions of comfort, right? Especially in those first 24, 48 hours of this happening, it's really just about listening to your body and finding tolerable positions to be in. Staying active to a certain threshold. It's all about the education in the beginning and finding maybe movements or positions that just help you tolerate the pain in the beginning. From there, moving forward, stabilizing the area can be really helpful with some rehab or some exercise. If you're already in the strength training world, finding ways to modify those movements so you can still remain active in strength training, just with some modifications to not continue to provoke it.

Yeah. What would you add to that? Anything else? I mean, repeat it again within the first 24, 48 hours or even through the length of the pain. The best treatments are what you can do consistently and things that you can control. So you can control maybe our sleep, nutrition, hydration habits. Those are going to play a huge role in two flare-ups as we heal the pain you're ongoingly have. And inactivity is we don't necessarily want that. We need to stay relatively active within constraints of what's causing you pain, but we need to find ways to keep the body moving so we don't develop other problems, sedentary issues as well as like nutritional habits usually go poorly when you're sedentary.

So that's another layer to that. That's the point when you're sad and in pain. You want to eat ice cream? You just watch TV, see, yeah, eat ice cream. That's going to flare it up. As a band-aid, if you want to make you feel better, you can eat ice cream for a day. Sure. You can get back to eating healthy foods, whole foods. And just to pivot off a little bit, listen to foods that make it worse. Pay attention. Pay attention too. If there's anything you're eating that goes along with a food diary, but pay attention to what you're eating if it causes your back pain to be worse. That's an area you could dive into and maybe something you have control over that you can help mitigate your pain.

Absolutely. I think this answer too, really, I was just thinking how when people don't necessarily, I don't want to point out any one particular healthcare provider at all, but it's more of a like, if we don't have enough time to spend with a patient, we're just told to rest. And then that patient is allowed to define what rest means for them, which is a good thing. But I think a lot of times that means people are going to sit on the couch for four to six weeks. They're going to lay down for four to six weeks. They're going to stop exercising. And that's not what we mean by rest. Listen to your body.

Yeah. And again, in those first 24 to 48 hours, it is going to be a lot of like sitting and laying down and just finding positions of comfort. But after that, it is truly about just finding what your threshold is, respecting that for a little while and slowly starting to push it as we see improvements. So whatever activity looks like for you at this moment, when we have this injury, it's a take a step back. It's not stop at all or stop altogether. And I think that that's been, I don't know, I see that a lot. People are like, well, I was told to rest. So I did nothing for the last two months. I'm like, oh, what?

Okay. Well, this isn't your fault. I think that whoever told you to rest just didn't take the time to really define that for you. Right? Outside of our world's best treatments for discogenic pain, I'm a huge advocate for other things. There's, you know, we can't prescribe this, but I know that just anti-inflammatories can be helpful, ibuprofens, Tylenols, things of that sort. In the chronic world of discogenic pain, some injections can be really, really helpful so that you can get through a rehabilitative program. On the more extreme ends, there is surgical interventions. If, you know, conservative care doesn't work for you or, you know, there's been a couple people I've had where just their lifestyle doesn't allow them to change habits, build this type of program or routine into their life, and the surgical intervention is the best route for them.

Anything else that you can think of, maybe outside of our scope that people can consider? Yeah. You covered it. Yeah. It's also not our expertise, so we might be missing some things, but I know that there's a lot of stuff out there. So, yeah. I think we got one more question. And it kind of leads off the last one. It's, will I need surgery? Will I need surgery? Do you want surgery? Yeah. Good follow-up question. Do you want it? Again, it is, there are some people who, like, that's just the right route for them. I think the, like, professional athlete world, this is kind of, we don't have a timeline to wait for that normal recovery window, right?

If we're in the middle of the season, sometimes going, getting the surgery and being back next season is what we need. So, those are people who, like, yeah, the surgery is right for them. Depends on the tissue, depends on your timeline, depends what the goal is. There are emergency times, right? Bowel and bladder dysfunction, balance issues, numbness, tingling, things of that sort. Where it's like, this isn't something that we have a window to heal here. We need to go get this fixed and we need to get it fixed now. So, there are emergency times that we need surgery, yes. Majority of the time, Garrett?

Probably not. No. And when you make a point, it's like knowing from a clinician standpoint or a rehab practitioner, coach, whatever you're in. You have to know your patient, client. Like you said, a professional athlete, timeline's shorter. A lot more money on the line. They don't have time to wait around for necessarily conservative care. But if you have the time, yeah, try conservative care. Try something that works and doesn't work. Okay. Maybe surgical intervention is for you. But a lot of times, I have friends in Canada who operate a different healthcare system they do in the United States.

A lot of times, they have to wait a long time for surgery, but they do conservative care. And by the time they have rescheduled surgery, they don't need it. And there's sometimes in the United States here where they opt you for surgery right away, but you decide to do conservative care and you don't need the surgery. So there's both ends. Well, that's the same spectrum, two different examples. But do you need surgery? Will it change the outcome? Do you want surgery? Those are patient-based. Timeline is super important based on who that is. There's never one answer when it comes to us as humans.

It's complex. And you should always have a say in what the next step should be for you. So if you feel like whatever provider you're working with is not listening to you, is not spending the time, is not considering your words, your input, keep looking. There's a lot of really good care out there, I promise. Sometimes it can be really frustrating. I hear stories all the time. I've gone everywhere. I've tried everything. Keep trying. I promise you, you will find something. And we at Performance Place, we offer telehealth services. We do virtual. If you want to just start a discussion, send us an email.

Give us a call. Any last words, Garrett? Nope. Thanks for listening in. And look to see you next time. Nice first podcast, Garrett. See you later, guys.