Discogenic low back pain (it’s a pain in the butt!) 

Back, Physiotherapy

Discogenic low back pain (LBP) is a common condition that affects many individuals, characterized by pain originating from the intervertebral discs. Unlike radicular pain or nerve root compromise, discogenic LBP does not involve pain that radiates along the nerve pathways or significant neurological deficits. Here, we delve into the nuances of discogenic LBP, from its clinical presentation to effective management strategies.

Common Presentation

Pain Characteristics:

  • Area of Pain: Typically general and diffuse, discogenic LBP can present as somatic referred pain in the legs or buttocks but usually does not extend below the knee. The pain is often not specific to a nerve pathway and does not involve tingling or numbness.
  • Description: Patients often describe a dull ache that can become sharp with certain movements. The pain may be bilateral but is often more pronounced on one side.
Patient sitting with low back pain

Aggravating Factors:

  • Flexion-biased activities tend to worsen the pain:
    • Sitting is more painful than walking.
    • Getting up from a seated position.
    • Putting on shoes and socks.
    • Walking uphill is more painful than downhill.

Easing Factors:

  • Extension-biased activities generally provide relief:
    • Walking (pain may decrease over time).
    • Lying down.
    • Anti-inflammatory medications.

24/hr Symptoms:

  • Pain is typically worse in the morning due to increased disc volume overnight but often settles within 30 minutes or after a hot shower.
  • Pain during turning in bed, but patients usually do not wake up due to pain, unlike those with radicular pain.
  • Pain is often worse in the morning, improves during the day, and may worsen again in the evening, especially for those with sedentary jobs.

History:

  • Onset: Pain can arise from an isolated incident, such as lifting or bending, or it may be insidious, often linked to increased flexion activities like caring for a new baby, a new desk job, or increased cycling.
  • Previous History: Patients may report occasional back pain or stiffness in the past. Severe disc injuries often have a history of low back pain.

Objective Examination:

  • Observation: Patient often show a list (shoulders move away from the side of pain). Correcting this can affect symptoms.
  • Active Movements: Flexion is painful and limited, often worsening with repetition. Extension may initially be painful but can improve with repetition. Side flexion is usually more painful on one side.
  • Neurological Tests: Typically not required unless pain extends past the buttocks or leg symptoms are present.

Treatment Strategies

Tailored Extension Exercises: Some patients respond positively to improving lumber extension and notice an ease in their symptoms. 

Guided exercises to correct posture and painful list- Often chronic back pain patients develop postural and habitual movements away from pain creating tightness and compensatory movements that need to be corrected. 

Manual Therapy Techniques: Helping patient with lateral flexion, deep tissue release or dry needling to help ease pain and open up opportunity for exercise interventions pain free. like 

Education on long term management strategies: Learning about the best desk set up, lifting techniques and pain management tools to help increase capacity and minimize triggering events. 

Long term pain free living is always the goal for low back pain. Patients will benefits from adaptable exercise programs they can integrate into regular schedule. 

Discogenic LBP requires a comprehensive approach that includes thorough assessment and targeted management strategies. By understanding the unique characteristics of this condition and applying appropriate treatments, patients can achieve significant relief and return to their daily activities with improved confidence and comfort.

Conclusion

Discogenic LBP requires a comprehensive approach that includes thorough assessment and targeted management strategies. By understanding the unique characteristics of this condition and applying appropriate treatments, patients can achieve significant relief and return to their daily activities with improved confidence and comfort.