Lower Back Pain with Sciatica - Is that disc bulge really the culprit?
Yes... No... Partially... Not really... Maybe...
The dredded 'slipped-disc'!
Lower back pain is one of the most common causes of disability across the western world. 80% of Australians will experience it at some stage in their life. If the first health professional that you seek care from is a GP then there is a good chance that you will end up getting a CT scan. Now, many studies have shown that disc herniation is very common, in fact 81.4% of people will have a lumbar disc problem - and NO PAIN. So does that mean that imaging is not relevant? No - it is still important information when working up a case. There is a possibility that there is a sequestration or floating fragment of disc material in your spine or some other disease process. Such a problem can be aggravated by certain chiropractic methods if there is underlying unknown pathology. In any case, instead of getting the CT, it is most often preferable to have an MRI as this will show the soft tissues much better than the CT scan. The reason that the GP will tend to order the lower quality, radiation intensive CT (1 lumbar CT is a similar amount of radiation as 100 normal xrays taken one after another) is cost. CT scans are bulk billed while MRIs generally are no and thus cost around $350 out of pocket. If your chiropractor thinks that an MRI is needed, we can refer you to the same radiology clinics and get the same MRI - minus the GP consultations. You are also more likely to be put on a path towards surgery rather than conservative management.
So why does one individual with a minor disc bulge have crippling pain whilst another with a severe bulge have no symptoms? Chiropractors with training in Advanced BioStructural Correction are particularly aware of the importance of the meningeal system to human function. The concept of adverse mechanical tension on the the nervous system was developed by Swedish neurosurgeon, Dr Alf Brieg. Basically, if there is tension within the dural system, then there is greater scope for a disc lesion to cause the individual pain. If there is slightly less tension within the dural system then the disc lesion causes no symptoms whatsoever - it is for this reason that ABC chiropractors will anecdotally report immediate pain relief from radiculopathies including sciatica (refered leg pain) and disc related lower back pain when meningeal releases are performed. These seemingly miraculous results are typically short lived, however long term results are typically achieved over a course of several weeks.
