Back pain with nerve root irritation

Up to 85% of people will, at some point in their life, experience back pain. Almost all of these will recover within three months, but around half will experience a relapse. Back pain with nerve root irritation only accounts for 5-10% of all cases of back pain. It is most common in those between 20-50 years of age. Men are more often affected than women.

Cause

The spine consists of, amongst other things, strong intervertebral discs. These discs are made up of a thick, liquid gel surrounded by strong fibrous rings. Discs are important shock absorbers, and during one's life, it is common for changes to occur in the fibrous rings.

With time, the disc can bulge out, or in some cases the liquid gel can leak out. This is known as a bulging- or herniated disc. They can occur anywhere along the spine but are most common in the lower back. Why some people get them and others do not is not known, but age and genetics probably play a major role.

Signs and symptoms

The pain can arise suddenly, almost without warning. The event may seem acute, but is often the result of a long-term process. The disc bulge or herniation can put pressure directly on a nerve or create an inflammatory process that may irritate one or more nerves in the spine. This condition can cause radiating pain, reduced sensation, and tingling and numbness. Occasionally it can also cause paralysis of certain muscle groups. It must be emphasised that it is normal to have up to several bulges and herniations without any symptoms.

Diagnosis

The diagnosis is made with a systematic clinical examination by a doctor or physiotherapist. Medical imaging is usually not necessary, but it should be used if there is suspicion of a serious illness. Only 1-2% of back pain cases have a serious underlying cause.

Findings on MRI or X-ray images should be interpreted with caution. Research on people without any back pain show that age-related changes in the back are very common. Around 52% have bulging discs, 90% have degenerative discs and 28% have a herniation.

With time, the disc can bulge out or in some cases the liquid gel can leak out. This is known as a bulging- or herniated disc. They can occur anywhere along the spine, but are most common in the lower back. Why some people get them and others don’t is not known, but age and genetics probably play an important role.

Treatment

Believe it or not, this condition gets better with time. It may, however, take up to three months until the pain is gone. In some cases, it may take even longer. Nerve pain is unpredictable, and it is normal for the symptoms to vary a lot over time. Treatments, such as massage, mobilisations and manipulations can give temporary pain relief, but seldom have any long-term effect.

It is completely normal to experience a small amount of pain during activity in the beginning, but the pain should not spread down into the legs or increase in intensity once the activity has stopped. Contact your physiotherapist if you are in any doubt as to how much activity you can tolerate. 

Research has shown that there are no specific exercises or types of exercise that are ‘the best’ when it comes to treatment of this condition. But training in itself can provide pain relief as exercise causes the body to release hormones that act as painkillers. Choose an activity you enjoy and which doesn’t significantly aggravate the pain. Start slowly and gradually increase. Activities can be running, cycling, swimming or general strength training. It might be an idea to plan training in consultation with a physiotherapist.

This condition rarely requires surgery

Surgery is only performed in certain cases. Conservative treatment (i.e. without surgery) is the recommended course of action. Pain relief medication can help with an acute onset of pain but may have negative long-term side-effects. The use of pain relief medication should be discussed with your doctor.