Q&A

Thanks…this is some great info. my main problem is that I’m also coupled with some type of chronic fatigue and 2 bulging discs in my lower back I’ve been battling for the last 13yrs or so which has limited my activity and everything only seems to be getting worse. I’m getting no help from doctors and I’m hopelessly at a loss of what to do. you are so right, the quality of my life has been on a downward
spiral for the last 7 yrs and I just turned 37, but I feel 67. my father will be 62 this yr and he’s more physically fit than I am!

Troy.

Hi Troy

I am sorry to hear that you are in the midst of the pain ‘vicious cycle’.  You state that you have been ‘battling two bulging discs  for the last 13 years’.

I would like to discuss what the diagnosis of  ’bulging discs’ means and then explore whether they are the most likely cause of your ongoing pain and increasing disability. [Disability is not the same as pain - it is a measure of how many activities you have stopped doing. This is really important because often you feel you have to stop the activities you most enjoy- which impacts hugely on your happiness and fulfilment in life].

The disc sits in-between each vertebra and acts as a shock absorber. It has a thick wall made of a protein called collagen with gel inside. The wall is a structural element and should  be able to carry the load above it without buckling at all. However often the wall is weakened either by an traumatic event  [it gets a tear] or by accumulated micro-trauma. The wall becomes weaker and bulges outwards – like an old tire.  If there was an obvious traumatic event, the tear in the wall [annular tear] will have inflammtion surrounding it and will cause a deep pain. The natural history for this is that over 1-2 years, the pain burns itself out in over 85 % of people.

If the bulge is from accumulated micro-trauma this is termed  ’wear & tear’ or spondylosis and is actually a natural consequence of growing older. It is a bit like getting laughter lines in your face- all it means is that you have had a full and active life. There is a lot of evidence in the literature that the vast majority of people with spondylosis do not have increased back pain.

I will quote one of many studies:

• In a review article, examining 56 articles Andersson has concluded that degenerative changes of the spinal column have long been and continue to be confused with the presence of spinal distress and pain. All parts of the spine undergo degenerative changes as we age & there is no increased incidence of pain associate with these changes. (Andersson, G  B(1998). What are the age-related changes in the spine?. Baillieres Clinical Rheumatology. 12(1):161-73, 1998 Feb).

So by 13 years, it is quite probable that the bulging discs are not significant contributors to your ongoing pain.  However your pain is real and distressing and ongoing. So the question is:

What is the most likely cause of this pain?

To answer this  first we need to understand how & where we actually feel pain.

If I asked you ‘ Troy where do you really feel your pain?’ You would probably answer ‘in my back’.

This is not correct.

The original message arises in your back [ it could be any combination of structures- the disc, facet joint, muscle, ligaments, tendons or nerves] and is picked up by nerve endings. These then transmit the pain via the spinal cord along a particular pathway. As the message moves along, it passes various ‘synapses’ where one nerve talks to another. At each of these synapses, the message can be altered- especially it can be amplified.

The message finally ends up in your brain where it is decoded and meaning is given to it. It is only here that your brain will decide that this is pain and you will then say ‘ouch’

If you damaged your two discs – they would transmit the pain  signal along this pathway and would continue for many months. Your brain knows that this is an important signal and therefore makes the decision to ‘turn up’ the synapses along this particular pathway. This can be useful in the short term so that your brain can keep an eye on this area. This amplification should switch off in time & does so in most people.

However sometimes [and definitely in your body] the amplification along the  pathway from your back to your brain stays switched on. This means that if someone gently presses on your back – the original message of gentle pressure will be amplified & by the time it reaches your brain – the message will be ‘this is really painful’. Your brain can only work on the final message it gets and has no idea of what is really happening in your back.

In other words – you can no longer trust that your nervous system is sending you accurate messages about your back. You may often feel pain in areas where there is no longer any active damage.

If, at this stage, you stop doing the things you enjoy- because the pain is still intense and because your doctor has said – ‘you have bulging discs’- you will actually intensify the malfunction in your pain system. As you stop moving, your attention will focus more on the area and the amplification will increase. The pain will start to obsess you and this will increase your attention etc … & the vicious cycle will worsen.

As you stop doing more things [further clipping your wings] – your mood will become affected. You often feel anxious and depressed. This further intensifies the attention on the area and the pathway is turned up more.

You now become increasingly unfit and deconditioned. Your sleep is often affected and you cannot restore properly. You then become increasingly fatigued….

Once you are in this cycle – the only way out is by understanding the actual process.

Your bulging discs are now a minor part of the problem. The primary cause of your pain is a mind/body malfunction- specifically in your Pain System. Up till now – you have given the highest priority to the pain messages from back. However now you realise that these are distorted and amplified messages and cannot be trusted.

Therefore downgrade their importance. If you feel a sharp pain or a deep ache- do not react with tension and fear. Continue with a smooth movement. What you will find is that the pain settles. If you make the same movement again in a smooth and natural way- there will be considerably less discomfort.

Become playful [I'll bet you can't remember the last time you moved this way] & explore little dancing movements – with the full expectation that they will be comfortable and easy.

Start a regular and incremental [increasing step by step] exercise program. Walking is a good – you could swim or cycle- what you love the most.  Start with a very small beginning – just to the corner and back and increase by a lamp post every few days. Do NOT let pain stop you doing this and concentrate on natural smooth movement. As time goes on – you will go [literally ] from strength to strength.

Please let me know how you go.

Regards

Jonathan

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