Like any connective tissue injury, an inflammatory process will occur.

Though this is a natural and appropriate cellular response to commence a healing process, it can be quite painful, mostly because this injured tissue will continue to undergo mechanical strain with normal daily movement.

Close to the intervertebral disc (IVD) are a pair of nerves. The presence of inflammation nearby may cause these nerves to generate a pain signal along their path (like sciatica). This is known as neuropathic pain, or nerve pain.

A significant annular tear can cause a disc to bulge or herniate, leading to both chemical (inflammation) and mechanical (bulging) irritation of the exiting nerve roots.

We use various methods to assess and treat IVD-related pain.

Key signs of IVD-related pain include localised pain with spinal flexion, tenderness, muscle spasm and pain aggravation with activities like coughing and sneezing.

Neurodynamic tests - like the 'slump test' and 'straight leg raise test’ - help assess nervous system flexibility and may indicate disc pathology. If either of these are ‘positive’ then the likelihood of a symptomatic disc pathology increases.

If we suspect that the back pain is due to irritation of a nerve root, we will perform a quadrant or Kemp test. This test acts to position the patient's spine in a way that narrows the passageway through which these nerve roots exit the spine at each level.

If a nerve root is involved in a person’s pain, then it is very likely that when we move their spine into an extended and side-flexed position, that they will get a return of (or worsening of) the referred pain into the hip or leg.

The Kemps test is also quite sensitive for facet joint pain, so if there is pain in this position that remains localised to the spine, we suspect their pain is related to the spinal joints.

In a healthy state, we should be able to move into that position with only a sense of tightness in the back as you would feel with any other stretch.

Pharmaceutical interventions: these can play a key role in management of severe acute lumbar back pain with or without nerve pain (referred pain). We would work in collaboration with your GP on this.

Manual therapy techniques: which will be chosen after assessing a person’s ability to move into, and remain in, certain positions.

Dry needling and soft-tissue massage: provide a non-threatening first line option to reduce muscle spasm and begin calming the heightened pain state.

Joint mobilisation: applied directly to the symptomatic region or segments of the spine will begin reducing pain signals. The small gliding movements applied into the pain barrier will potentially allow your body to engage active movement without triggering a pain response as readily.

Joint manipulation: is known to have a positive impact on acute spinal pain. This will be applied with caution when an acute disc herniation is suspected.

MET (muscle energy technique): this will involve the patient in some active techniques where the practitioner will apply stretch to a joint or specific muscle and ask the patient to perform a muscle contraction to assist with the effectiveness of the stretch.

Exercise interventions: extension movements and core control exercises are often prescribed. This will likely be the most important ongoing protection against acute spinal pain.

Machine traction: may be used to temporarily decompress the spinal area involved.

At-home exercises can be helpful in your continued recovery from a disc injury. Click here to view and practice these helpful exercises between clinic visits.