15 november 20185 min reading time

The low back hernia is so often misdiagnosed, and we don’t seem to understand its nature and treatment. It can be subtle and present in different ways and therefore easily confused to have a different cause.

It is always possible for different causes to present in a similar fashion

I often come across these in patients already diagnosed with mostly either Piriformis-syndrome or an SI-joint dysfunction and who are told it is the cause of their radiating pain. It is always possible for different causes to present in a similar fashion, but it remains the responsibility of the specialist to reach a diagnosis through careful examination. When a therapist wrongly diagnoses this disorder, he or she leaves the patient to experience unnecessary prolonged pain, uncertainty, and a loss of trust.

The low back hernia often makes its appearance unexpectedly because we don’t necessarily perform poor movements (at least, so we think). There are many reasons why it happens, so let us look briefly at the process. Firstly, you need a form of stress on a low back disc, often the fourth or fifth, which can vary from sitting/driving too much to over training or not enough recovery time and/or being deficient in nutrients necessary to heal.

Secondly, the disc is special in that it does not have any blood flow, which means the healing process is very slow, different to a muscle which is constantly fed nutrients through ample blood capillary networks. This means once the disc tissue has been damaged, you need to drastically create the right environment for it to draw up nutrients and heal. If you fail to do this, you might heal sub-optimally and regret having ongoing pain or an easily triggered recurring low back problem.

Our bodies are different and so are our movements

Another important aspect, very often overlooked, is the built of your body. We innately compare ourselves with others and therefore assume we should be able to do the same physical tasks as another person. Wanting to be able to do the same as another can be a very good stimulating factor to increase our physical abilities but can also cause serious harm. Every centimetre taller you are or any joint angle difference in a part of your body means a different movement strategy. The question is, can your body type cope with it and/or do you need to build more strength in that part of your body in order to do so?

Problems with diagnosing a hernia

Diagnosing a herniated disc can sometimes be difficult in the sense that it presents differently in every person. This is what often leads to confusion among practitioners who rely on stereotypical presentations. They compare the patient’s symptoms with either a textbook scenario or previous presentations and for this reason I often hear how disc hernias were only diagnosed months later through further investigation after chronic pain persisted. In my experience, when receiving patients with a diagnosis of something other than a herniated disc or discal fibre disruption, it seems like the practitioner is often hesitant to diagnose a disc problem and will go with some other diagnosis first. In most cases, the he or she wants to see strong evidence through further investigation. The practitioner wants to see the presence of a protruding disc or impinging nerve root. The problem with this is that the disc sometimes changes shape significantly from standing upright, bending over and lying down (as when the MRI is made). For this reason the researchers suggest that the practitioner make a diagnosis through orthopaedic-, neurological- and functional testing first and then use imaging to confirm it as just another tool, and not the other way around.

When in doubt, seek a professional to rule out the possibility of a herniated disc and, if it is present, find out what the best process is to make a good recovery. Being told to take painkillers and come back two weeks later or having tight spots massaged is a very incomplete strategy. While in the process of finding such an expert, you can start with creating an environment for tissue healing by taking the pressure off your back, doing light tolerable core stabilisation exercises, and going for regular, short, tolerable walks. Walking pumps the swelling away and turns on the small muscles in the lower back responsible for stabilising the spine, speeding up recovery.