If you’re like me, you are terrified of disc pain. Disc injuries happen in old and young alike (for different reasons) and are among the most common causes of back pain. In fact, experts estimate that 40% of back pain cases are somehow disc-related.
Your spinal discs are one type of back “pain generator.”
As the name suggests, a “pain generator” is a specific location to which the pain you experience can be traced to. Most of the time, an M.D. is the one who does the tracing, as a way of definitively determining the locale from which the pain arises. The sleuthing is done by M.D.s because they are licensed and qualified to run tests such as MRIs.
Pain generators usually have some type of abnormal physiology going on, the result of which leads you to experience symptoms and feel pain.
But some spine and joint problems are simpler than others. What then?
In this case, tests to find pain generators may not be necessary. For example, if you pull a muscle in your back, you may only need to take it easy for a few days – not to undergo a whole slew of appointments and tests – in order to feel better and get on with your life.
A Lot of Money to Find Out You Strained a Muscle
While MRIs are meant to show potential problems in soft tissues that may require medical management or surgery – for example, disc herniation – they are also given for the “take 2 and call me in the morning” type pain. Again, these are things that generally speaking, you or I could handle ourselves just fine.
Many M.D.s would likely back me up. The American Academy of Family Practitioners tells their doctors not to do any type of imaging tests – X-rays, MRI, CT scans, etc. – for the first 6 weeks unless the doc sees specific warning signs for doing so when she examines you.
The standard battery of such tests (X-ray, MRI, physical exam and possibly a CT scan and/or EMG) when they are given, may cost you or your insurance around $3000.
And here’s the real kicker, numerous research studies inform us that most back pain goes away on its own anyway.
Back and joint problems that generally don’t require testing tend to be due to poor body alignment, tense and/or weak muscles or imbalanced muscles. Simple soft tissue strain injuries fall into this category, as well. Usually a skilled movement approach can help a lot – once you’re past the acute (or flare-up) phase.
MRI for Disc Pain – Should You or Shouldn’t You?
Disc problems are regarded as more serious than strains and pains, and often, they actually do benefit from MRI and subsequent medical treatment.
Pain arising from intervertebral discs can be mild or severe.
When they’re severe, you’ll know it. Disc injuries can be excruciating and often refer pain and electrical sensations down one leg or arm. The leg or arm might also grow weaker or become numb. These symptoms usually indicate that it’s time to see an M.D. for tests and treatment.
Mild disc problems can grow into more serious ones over time. My opinion is, in this case, an MRI could be useful, although that’s not a guarantee.
Why? Because many studies have been done that show people who endure much back pain have clean and clear MRIs, i.e., no problems detected that can be related to the pain the patient feels. OTOH, the same studies show that people who enjoy life without back pain often have really messed up spinal structures as seen on an MRI.
Even with this near-hypocrisy, information from an MRI may help you make health care decisions for your disc issue, as well as come up with safe and effective exercise plans.
4 Most Common Types of Disc Problems
I get a lot of questions from readers and clients about what in the h-ck their MRIs and doctors’ notes mean. I can’t cover every possible test readout, but I would like to present a few of the most common types of pain that may arise from your spinal discs.
Outside In Injury that Causes Disc Pain
Perhaps the most common type of disc related pain is due to an injury to the outside of the structure. These injuries include disc herniation and annular tear. Here’s how to understand this:
A typical disc is like a jelly donut, with strong outer material containing a soft, inner, near liquid type substance. This substance is located in the center of the disc and serves a movement purpose. With a liquid center, the disc is able to “swivel,” which allows our spinal alignment to adapt during movement. Discs enable the spinal column replace rigidity with flexibility and responsiveness. This may come in handy when you have to react to things in your environment quickly, or participate in sports or dance activities.
Discs ability to swivel helps you do more with less injury risk.
Anyway, even though the outer container material of a disc is super strong, breaking, fraying or tearing of their fibers is still possible. When this happens, the inner liquid may “escape” from the confines of the disc container – either partially or wholly.
Disc Pain Caused by Herniation
When this is the case, the liquid usually (but not always) lands on a nearby nerve root. Nerves and nerve roots are very sensitive to anything they touch, so when they come into contact with the disc liquid you’ll likely feel pain and have other unpleasant sensations as well.
This injury is called herniated disc, or bulging disc, depending on how bad it is. Things that can lead to it include having the long term habit of rounding your spine over instead of bending at the hips and knees when you lift heavy objects, and/or twisting the spine while it’s rounded over (and especially don’t do this when you’re lifting or exerting some other force.) These kinds of repeated movements can set you up for a disc bulge or herniation.
An annular tear is similar to a herniated disc, just not as intense. An annular tear occurs when the outer fibers start to fray a bit. This injury can cause pain, but likely the liquid center won’t spill out onto the nerve. It stays in the disc, intact. Nerves and chemicals located in those outer fibers may give rise to pain related to an annular tear.
Internal Disruption-Related Disc Pain
Where a disc herniation or annular tear comes at the disc from the outside in, a disc disruption does just the opposite. In this case, certain changes in the disc lead to degeneration of the liquid center we talked about above.
Mind you, this is not a case of degenerative disc disease, here. Degenerative disc disease comes about mainly because we age – it’s almost to be expected, in fact. See below for more on that.
No, disc disruption is something else. Doctors call it internal disc disruption, or IDD. Again, IDD affects the soft, liquid center in the disc and some of the surrounding fibers that are closest to the liquid. But rare does this injury reach those tough outer fibers that make up the disc “container.”
If you have this type of disc problem, bending forward and back will probably bring on the most pain, according to a 2001 study that was published in Pain Practitioner.
Degenerative Disc Disease, or DDD
One very common condition people get diagnosed with – especially as they age – is degenerative disc disease, DDD. DDD is a natural process of wear and tear of the disc that may give you pain.
Spines can experience degeneration in other areas, too, but degeneration as a spinal process tends to start at the disc.
Staying active (in a pain free zone) and especially doing core strengthening work is one way that many people manage the pain of DDD, and remain happily active well into their senior years.
Infection as a Cause of Disc Pain
All the disc issues I’m talking about in this post could benefit from medical attention, but with this last one, it’s mandatory for your health, and possibly even your survival.
And that issue is infection. If you have a fever, abdominal discomfort and/or back stiffness, check with your doctor. It’s always critical to get treated for infection as soon as possible. Not only is this for your health, but also the health of the people around you.
- De Sricker, D., Internal disc disruption. Physiopedia.
- Fruman, M., M.D.,et. al. Cervical Disc Disease. Medscape. March 2018.
- Owens, R., et. al. Back pain improves significantly following discectomy for lumbar disc herniation. Spine J. Feb 2018.
- Simon, J., MD, et. al. Discogenic Low Back Pain. Phys Med Rehabil Clin N Am 2014.
- Sizer P., et. al Disc related and non-disc related disorders of the thoracic spine. Pain Pract. 2001.
- Imaging for Low Back Pain. American Academy of Family Practitioners website. Choosing Wisely.