Common Conditions
Lumbar disc problems (with or without leg pain)
See below for when you should seek immediate medical attention
Lumbar disc problems (which can cause low back and leg pain) can be concerning and painful, but are quite common and usually respond well to conservative care. The below aims to provide you with some information about this type of condition and importantly outlines those times when you must seek immediate medical attention.
Terms such as herniated disc, prolapsed disc, protruded disc, disc bulge or slipped disc are often used to describe disc problems. “Slipped disc” however, is a bit of a misleading term, as discs don’t actually slip.
Disc problems occur for many reasons and stress and strain on the back can play a part. These problems often occur in people who have a history of recurrent low back pain, but not always.
Symptoms
As the disc wears, the inner core can bulge or herniate into the spinal canal. This can then put pressure on the nerves that go down your leg causing symptoms such as back, buttock or leg pain. Sometimes weakness, numbness or pins and needles occur in the leg or foot. You do not need to have all of the symptoms to be diagnosed with a disc problem. People sometimes call these symptoms in the leg “sciatica” or a trapped nerve.
The term for leg pain coming from a nerve root in your spine is "radicular" pain. If you experience leg symptoms such as muscle weakness, changes in sensation or changes to the muscles reflexes, due to a problem with a nerve root in your low back, this is called "lumbar radiculopathy."
Below are some images which can help to understand this process:
Treatment
Chiropractic treatment can often help this type of problem and manual therapy is suggested in the NICE guidelines as part of a treatment package including exercise. These are evidence-based recommendations for health and care in England and Wales. They are developed by the National Institute for Health and Care Excellence (NICE).
Although treatment can help, it can take some weeks to improve the symptoms and may take several months to fully recover. It is important to follow advice given and allow your body time to heal. Pain relief medication can help recovery but this should only be taken if it is appropriate for you and this is something that may need to be discussed with your GP.
In some instances, where the problem is not settling, an MRI scan may be suggested. Some persistent or severe cases of disc herniation may require surgery. Symptoms are monitored carefully to guide these decisions.
When you need to seek immediate medical attention
In rare cases disc material can prolapse and compress nerves that supply the pelvic organs and legs, this is known as Cauda Equina Syndrome (CES).
CES is regarded as a medical emergency as it can lead to permanent damage or disability, therefore quick assessment is vital to optimise recovery. Immediate advice should be sought from your practitioner or if unavailable the A&E department of your local hospital.
Symptoms of cauda equina include:
Severe low back pain with sciatica down one or both legs
Bladder dysfunction. (A feeling of not fully emptying your bladder, becoming incontinent of urine or loss of sensation when you pass urine. Not knowing when your bladder is either full or empty)
Bowel dysfunction. (Not being able to retain faeces, a change in bowel function or a loss of sensation when you pass a bowel motion)
Numbness or altered sensation such as pins and needles, in the buttocks, back passage or between the legs, for instance the inner thighs or genitals. This may present as an altered feeling when using toilet paper to wipe yourself
Progressive weakness in the legs and/or feet
Changes in sexual function, or loss of sensation in the genitals during sexual intercourse
