The simplest and most utilitarian way to categorize disc-issues is with provocative/relieving motion tests and a detailed history. I deduce that there are generally (3) disc types:
- Herniation g. derangement of the nucleus pressurizing & distorting the outer annulus, either contained or ‘broken-thru’ and either constrained by the PLL or not. This is your “young man/woman’s’ disc” typically with a DP (when contained: pain to-the-knee) or full blown Sciatic issues (pain thru foot with neurologic issues). Back pain for sure but lots of leg/hip/butt/foot issues as well…mitigated with key-motions and traction.
- Discogenic/degenerative/Internal-disc-disruption: The standard finding in the “recalcitrant” class of cLBP, the “persnickety” back and the long-standing “bad backers’”. Typically no discernible DP and predominate back-pain issues.
- “Other” disc issues:g. one-off or recurrent low back “sprains”, motion disorders or peripheral structure-involvements. Form-closure/repositioning motions help in the case of “disorders” NOT primarily from a ligament tear or contusion.
The bending & distraction tests remain the gold-standard determining whether the “bulge” is a protrusion, extrusion or circumferential/degenerative/flat-tire bulge.
Number (1) allows us potential “draw-in” and re-arrangement with traction and facilitated motions (typically extension or lateral).
Number (2) is to the greatest degree a palliative, nutrition and ergonomic/education responder.
Sprains are luckily VERY disconcerting but typically fully healed within the 12 week time frame (often with or without treatment) and palliative, “hope-full” treatments, that “first DO NO harm” are most beneficial while innate does her job.