Many terms may be used to describe issues with a spinal disc and disc pain, and all may be used differently and, at times, interchangeably. Some commonly used terms include:
- Herniated disc
- Pinched nerve
- Ruptured/torn disc
- Bulging disc
- Disc protrusion
- Slipped disc
There is no main consensus on the use of these terms, and it can be frustrating to hear one diagnosis described in many different ways as a patient.
Two Causes of Pain: Pinched Nerve vs. Disc Pain
There are two main ways a spinal disc can cause pain:
- Pinched nerve. In most cases a herniated disc itself is not painful, but rather the material leaking out of the disc pinches, inflames, or irritates a nearby nerve, causing radicular pain. Radicular pain (also called nerve root pain), describes sharp, shooting pains that radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is commonly called sciatica.
- Disc pain. A spinal disc itself may be the source of pain if it dehydrates or degenerates to the point of causing pain and instability in the spinal segment (called degenerative disc disease). Degenerative disc pain tends to include a chronic, low-level pain around the disc and occasional episodes of more severe pain.
A herniated disc and degenerative disc disease typically occur in the cervical spine (neck) and lumbar spine (lower back). Disc pain tends to be most common in the lower back, where most of the movement and weight-bearing in the spine occurs. These conditions are uncommon in the mid-back (the thoracic spine).
Diagnosing Disc Problems
Review of Medical History and Specific Symptoms
The diagnostic process typically begins with a collected medical history and a review of current symptoms. A complete review of symptoms will include:
- The location of the pain, including whether it is confined to the neck or back, or whether it includes arm or leg pain
- A description of how the pain feels, such as searing, sharp, or stabbing vs. dull or achy
- Whether certain activities, positions, or treatments make the pain feel better or worse
Collecting a full medical background can rule out or identify other possible conditions that may cause pain. A medical history may include information on recurring health problems, previous diagnoses, and past treatments and their effectiveness. Information on sleep, dietary, and exercise habits is usually also collected. advertisement
Physical Examination
A physical exam for diagnosing disc pain may include one or more of the following tests:
- Palpation. Palpating (feeling by hand) certain structures can help identify the pain source. For example, worsened pain when pressure is applied to the spine may indicate sensitivity caused by a damaged disc.
- Movement tests. Tests that assess the spine’s range of motion may include bending the neck or torso forward, backward, or to the side. Additionally, if raising one leg in front of the body worsens leg pain, it can indicate a lumbar herniated disc (straight leg raise test).
- Muscle strength. A neurological exam may be conducted to assess muscle strength and determine if a nerve root is compressed by a herniated disc. A muscle strength test may include holding the arms or legs out to the side or front of the body to check for tremors, muscle atrophy, or other abnormal movements.
- Reflex test. Nerve root irritation can dampen reflexes in the arms or legs. A reflex test involves tapping specific areas with a reflex hammer. If there is little or no reaction, it may indicate a compressed nerve root in the spine.
Some physical exam tests may be used to rule out or confirm a diagnosis that coincides with symptoms reported in a medical history.
Diagnostic Tests
A diagnostic test may be ordered to confirm the disc problem and/or to gain additional information, such as the location of a herniated disc and impinged nerve roots. Diagnostic tests may include:
- CT scan/Myelogram. Computerized tomography (CT) scans consist of an X-ray taken of the body, with a computer reformatting the image into cross sections of the spine. Sometimes a myelogram is performed during a CT scan, in which radiographic dye is injected into the area to provide more detail on the spinal structures. See Computerized Tomography (CT Scan)
- MRI scan. Magnetic Resonance Imaging (MRI) provides a sensitive and accurate assessment of the spinal nerves and anatomy, including disc alignment, height, hydration, and configuration.See MRI Scan of the Spine
- Discogram. A discogram may be recommended to confirm which disc is painful if surgical treatment is considered. In this test, radiographic dye is injected into the disc to recreate disc pain from the dye’s added pressure.See Discogram
- X-rays . Although plain film x-ray is a poor imaging modality to visualise the actual disc, it can provide important feedback about what is causing the disc problem, and the state of the disc itself.
It is important to note that the test findings on an MRI scan or other diagnostic test are not in and of themselves a diagnosis. Physical exam findings and a review of symptoms need to match the MRI or other test findings to accurately identify the cause of pain.
Only then can an effective treatment plan be prescribed, whether that entails treating a pinched nerve from a herniated disc, disc pain from degenerative disc disease, or another condition.
At Absolute Health we have two clinics in the Sunshine Coast. We have a clinic in Mooloolaba and Nambour where we treat disc conditions all the time. If you are suffering from this condition, contact our office to see if we can help today.