Lower Back Disc Rupture: What is it and What are my Recovery Options?

Many people suffer from back pain and sciatica. Unfortunately, a variety of terms are used to describe this, common descriptions include “slipped disc”, disc bulge, disc protrusion, disc herniation, and disc rupture. These terms really all mean the same thing, with the exception being disc rupture, as this does indicate a more damaged disc that frequently has a worse prognosis (at least in the short-medium term).

Disc problems may also come about after a heavy lift with a forward bend or a light trivial bend. As the disc bulge progresses and worsens over time, or with subsequent episodes of back pain, the disc may bulge far enough to compress the nerve and cause referred leg pain (sciatica).

Disc ruptures tend to have a more severe clinical presentation. And they refer to breaching of the last layer of the annulus fibrosis, where the nuclear material is now no longer ‘contained’.

Not all ruptured discs are picked up on imaging like MRI, but when they do the term disc extrusion or disc sequestration is used.

Even though a disc rupture can present with severe pain the clear majority do get better with time, and the body can resorb the extruded fragment (Chiu et al 2014). I personally had a sequestrated disc when I was 21 years old, and I never had surgery and on MRI scan some years later the fragment was gone (along with the pain!).

Even in the case of lumbar disc rupture, natural history and time can be very favourable. Most of these disc ruptures will be absorbed by the body and these problems often resolve over a period of 6-18 months for around 90% of people.

The big problem is that while time can sort the problem, many sufferers are in significant pain with their sleep, work and activity being greatly impacted by sciatica and leg symptoms.

The role of surgery and medication to assist whilst the body heals itself:

Medication, usually anti-inflammatory aim to reduce the irritation and nerve pain.

The anti-inflammatory medication aims to ‘mop up’ chemicals released from the disc that are irritating the nerve root, providing chemical stimulation of the leg symptoms. Injections such as a guided (CT scan guided to ensure accurate placement) nerve root injection can also provide significant relief in some people.

Surgery is usually a last resort given that most of these problems will resolve with time. It should be reserved for those who are not coping despite optimising medication, and failing to improve with less invasive options like a nerve root injection.

For more information about sciatica come and see our McKenzie Method specialist physiotherapist Joel Laing at Absolute Health & Performance in Melbourne’s CBD.