First, let's review the anatomy of a disc. Think of it in terms of a jelly filled doughnut. The inner portion (nucleus pulposus) lies inside and is susceptible to pressure changes placed on the outer portion (annulus). Most of the pressure placed on the annulus is from the anterior aspect of the disc due to slouched sitting and bending over most of the time (spinal segments gap open in the back and close down in the front). This in turn forces the nucleus to move toward the back of the annulus.

Over time, this can create a disc bulge. A disc bulge simply means that some portion of the disc is extending beyond the normal space it occupies. Most bulges are posterior and lateral (off to one side). A bulge may or may not cause low back pain or associated radiating pain into the buttocks or down the leg. In some cases there may be faint signs of numbness and tingling. The most common areas affected are between L4 and L5 and between L5 and S1.

A disc herniation, on the other hand, means that a portion of the annulus has actually broken free and the boundary encasing the nucleus has been compromised. Sometimes this is a small crack or break, and at other times an actual piece of the annulus can break free and even rest on the nerve root.

With a herniation, you can get mechanical pain (dependent on position of the spine) or chemical pain. Mechanical pain may be classified as when a person can not straighten up completely or is even shifted to one side as to avoid pinching the nerve where the disc is herniated. Chemical pain occurs when nuclear material spills out and irritates the nerve root. This is often accompanied by persistent intense pain (often down the leg) as well as numbness/tingling that does not let up regardless of positional changes. The body will eventually reabsorb the chemical irritants, but it takes time.

The next form of disc pain I want to address is pure mechanical low back pain. I personally suffer from this. I have a history of right sciatica and even had to have prednisone last year as I was bent over and could not stand straight up. Better now. :) But, consequently, I have to be very careful about my posture and body mechanics due to an area of weakness I have at L5/S1. If I bend over frequently, lift the wrong way, or sit for prolonged periods of time (plane flights and long car trips) I often experience pain down my right thigh into the foot and some faint tingling on the outer portion of the foot as well. This is classic mechanical low back pain. Many of you may even feel some of these symptoms while driving and pushing down the gas pedal. This is a common complain from those suffering from mechanical back pain.

Lastly, I will briefly mention degenerative disc disease (DDD). This process actually begins in the 3rd decade of life. Basically, the disc loses its ability to take in water and essentially shrinks over time. This can be bad because the space between the vertebrae also diminishes and leaves less room for the nerve roots to exit out of the spine. In turn, you may experience mechanical back pain, bulges or even a pinched nerve. DDD affects some people more so than others, but is typically problematic for people between the ages of 35 and 60.

So, these are the most common disc injuries I see and deal with. Mechanical low back pain can turn into a herniated disc. However, mechanical low back pain does not always mean you have a bulging disc. Mechanical low back pain usually starts with poor posture and/or faulty body mechanics at work, on the job or at play. With that in mind, pay careful attention to your posture and positioning as it can have an impact on your back and ultimately your golf game.

The progression of such injuries can vary from person to person. Some individuals may experience an acute injury or herniation, while others may have a slow progressive onset of symptoms over months and years. Regardless, you will generally see the following symptoms:

• May or may not have diffuse ache/sharp pain in low back
• Pain is often worse with forward bending (bulges especially)
• Pain is worse with side bending, rotation or extension (especially herniations)
• Pain, numbness or tingling along the back of the leg (sciatic nerve) or front of the leg (femoral nerve)
• May have some weakness in the foot or lower leg with a pinched nerve
• Diminished reflexes with a pinched nerve
• Pain is often worse with prolonged sitting, bending, stooping or twisting
• Pain and stiffness is often worse in the morning or late at night

Keep in mind that you may have some or all of these symptoms at different points in time. Pain in the low back is much better than pain in the buttocks or thigh because referred pain means the nerve is being pinched or irritated. Numbness/tingling or weakness is indicative of even greater problems. Be sure to see your physician for a complete evaluation if you suspect a disc problem. In the next newsletter, I will address common exercises and forms of treatment to rehab and prevent such injuries form interfering with your golf game.

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