In this video, you're going to learn how to tell if your back pain is coming from a disc injury
or from a spinal stenosis problem. People suffering from back problems often worry if
it's more of a disc injury or if it's more of a spinal stenosis problem, and especially if you've
had an MRI, and the MRI report says that you have both a disc herniation a disc injury of some sort,
as well as a lumbar spinal stenosis, then it can get really confusing on which one
is causing your back problem. Many of the symptoms from each
problem overlap and it is possible to get pain coming from each of those different problems.
But it's most common that even if both problems are showing up in the same MRI, that it's just
one of those conditions that's truly causing your back and leg pain coming up next year.
In this video, I'll explain the differences between the two how you can tell whether
your symptoms are more a disc herniation problem or a spinal stenosis problem.
And then I'll also tell you about what steps to take next to begin to fix these issues.
My name is Dr. David Middaugh, and I'm a specialist physical therapist at El Paso manual
physical therapy. And this channel is dedicated to helping people stay healthy, active and mobile,
while avoiding unnecessary surgery injections and pain medications. Please consider subscribing to
our channel so that you don't miss out on any of the helpful videos we post each and every week.
So first off, let's talk about disc herniation symptoms. What I'm talking about in the spine
is the discs that are right here between the vertebrae between the bones. If you get
a disc herniation that means a chunk of that disc, which is kind of a squishier substance
than the bone the vertebrae here, inside, it's actually a very durable structure. But if you've
had enough injury to the area over time, you can begin to get some of that disk sticking outwards
from where it's supposed to be. And if that happens, it can compress the nerve, you can
see the yellow thing right here on my spine. If it compresses that nerve, then it can cause
pain right in that area of the back wherever the disc herniation is. And these nerves,
they run down from there into the hip area, into the thigh into the buttock area, down into your
knee all the way down into the foot into the tips of the toes. So it is possible to get pain from
anywhere in that in that region of where the nerve travels if you've got a disc herniation.
Now the most common sites for herniation are going to be the very most bottom disc
and the one right above it. This is the L five s one disc and here's the L four l five disc for
disc herniation symptoms you typically see back pain in the area right here,
where the disc would be. And then you see symptoms just to one side,
that's the most common presentation is there may be central back pain right here in the area.
But then if you have the nerve compression, it'll go just into one leg and it often
mimics sciatica, like symptoms. In fact, it's possible to get sciatica, true sciatica,
along with a disc herniation problem. The symptoms the back pain, the leg pain
tends to be relieved when you stand up straight versus bending over tends to make it worse,
like reaching towards your feet that tends to aggravate the symptoms that people have from
disc injuries and getting upright tends to make it better although being upright for too long
does tend to bring on the symptoms because of the compression going through the discs.
Discs are designed to take compression but if they're injured, then it can begin to become
painful after a while. So people will often say that after they're standing for a bit, it varies
depending on your irritability, irritability level, they'll need to go lie down, they'll feel
like they need to go recline, go sit somewhere where they can lean back on the backrest or a
recliner is often the choice of people for relief. Or they just go lie down in their bed and they
tend to feel better from their disc herniation symptoms. Another name
for this that you might have been told you have is a lumbar radiculopathy. That's what
they call it when the nerve is pinched, although you can just have a dirt disc herniation that is
not pinching the nerve that is causing back pain. Now let me tell you about lumbar spinal stenosis.
All stenosis means that word is that there's a narrowing of a hole somewhere and there's a
bunch of holes in the spine where the nerves travel, they come out of the spine they go
through the spine in any one of those holes. If you get a narrowing in those holes, then you are
considered to have a lumbar spinal stenosis. We've got more videos talking about disc
herniations degenerative disc disease as well as lumbar spinal stenosis. They're
linked in the description below. So you can learn a lot more about it. But just
to give you a super quick overview. In stenosis, there's two types of stenosis.
You have what's called Central stenosis where the spinal cord in on the middle of the spine on
the inside of the spine that's been compressed somehow that this space is closing in there.
And then you have lateral stenosis, where these nerves come out on the outside.
Now, it this is why it overlaps because if you have a disc herniation pushing into that hole
right there where the nerve comes out, then technically that's a version of stenosis. So,
these two conditions are often seen together disc herniations with a nerve problem,
as well as lumbar spinal stenosis, but you might have stenosis for other reasons, like the bone
edges of the hole right here can be closing in, you could also have a positional stenosis,
like where your back arc is too great. A lot of people don't realize that even
healthcare providers don't realize that the arc of the curvature of the spine here should not be
very excessive, if it is very excessive, it closes those openings there and can cause stenosis
type symptoms where the nerve gets pinched. Typically, with central stenosis, where you have
the middle type, you may or may not have back pain, that's the big differentiating factor here.
If you have stenosis symptoms, you'll have leg pain, and it's typically both sides.
It might be stronger on one side versus the other. But there's usually symptoms on both sides,
you may have glute pain, five pain on the front on the back of the thigh, it may present as knee
pain or lower leg, foot, ankle and even toe pain. Because of the way the nerves run from the spine
here all the way down, all those body parts can be affected. But the big differentiating
factor between disc herniations and stenosis is that stenosis, you'll have symptoms both
legs usually versus a disc problem, it tends to be just one side. And then also with stenosis,
you may not have back pain. In fact, we often see,
probably about half of our lumbar stenosis patients don't really have any major back problems
and occasional ache or pain here or there. But it's more the leg symptoms that bother them. And
then of course, they've had an MRI that shows that they have stenosis, there are plenty of stenosis,
people that do have back problems. But with a disc herniation
patients that we see here in the clinic, they more consistently do have direct back
problems. And that's a priority for them to get fixed when they come in, in addition to
the pain running down just one side of the body. Now a key differentiating factor here is that MRI
so if you've got this kind of back problem, either a disc herniation or a stenosis problem, chances
are your back pain has become severe or your leg pain is could become severe at some point,
severe enough for you to go to the doctor and even get an MRI.
And if you're if you haven't had an MRI, and your symptoms are getting there,
I encourage you to go get once they can get an image a picture of the inside of your spine,
and determine if stenosis or disc problems are contributing to your back pain or leg pain.
Now on the MRI, you want to look for certain words if they'll have on the
report or the document share with you where they use the word severe or even moderate,
because if they say mild, in other words, like a mild disc herniation or mild stenosis, whether
it's lateral or sometimes use the word pyramidal. Instead of lateral, they're interchangeable in
the spine versus central stenosis, if they say mild, and I would not think that those
are going to be priorities to treat the ones that are going to be the moderate or severe
description like severe stenosis, severe disc herniation, those kinds of words,
those are going to be more telling of what your symptoms are like.
So you can rest on that a bit more that what to do for treatment for lumbar stenosis,
and a disc herniation problem. Most cases have the potential to improve without surgery. So in case
you're worried about possibly needing some sort of surgery, most cases that especially like what we
see here in the clinic, people that we treat with manual therapy and exercise programs, they get
tremendously better despite having had problems for years even doctors will offer you medications,
possibly injections to deal with the pain. And often they'll send you out to a physical
therapist to begin to do some of the exercises. But you do need to watch out that you visit
a physical therapy clinic or a therapist that specializes in helping people non surgically
because most clinics in your town are probably going to help out people after they've had
a back surgery or hip surgery of some sort. And they're not going to be as keen or as
knowledgeable about how to deal with this kind of problem before you have surgery.
So do your due diligence, do some research to make sure that you have the right kind of specialists
working on your back problem. And if getting to physical therapy isn't an option for you, you're
not looking to try it just yet. Go check out our videos here on our channel. In fact, I've linked
many playlists below here in the description where you can learn more about this these conditions and
even start to do exercises and treatments. We also have a program called the 28 Day
Back Health And Wellness Boost Program. It's a 100% online on demand program, you can access it
anywhere you have internet access and a screen. It's got videos of me teaching like
what I would teach patients here in the clinic for back problems to fix the root problem.
Oftentimes, there's like a abdominal weakness, glute weakness, and those problems need to be
addressed in order to take pressure off the spine and get pressure off the disk and get pressure
off the holes in the spine to open up the spaces to allow the nerves to flow freely. So wish you
the best of luck in treating your problem. And we'll catch you in the next video. Thanks bye