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I started having low back pain two years ago from what I was told was a disc problem. So I set myself up on a walking program (twice a day, 20-minutes each). It hasn't really helped my back pain even though I've lost 20 pounds. Do you really think it's a disc gone bad?

When it comes to low back pain, it can be very difficult to tell what is the problem and where the pain is coming from. Disc disease as a cause of low back pain can be especially challenging to diagnose accurately. The diagnosis may require more than one single test. MRIs, pain provocation on discography, and pain relief by discoblock are three key diagnostic tools. You are probably familiar with MRIs (magnetic resonance imaging). MRIs use radio and magnetic waves to show details of internal structures like discs and ligaments. Discography and discoblock may be more unfamiliar terms. Discography is the use of a radioactive dye injected directly into the disc. Your response to the injection is telling. An increase in or reproduction of your pain suggests the pain is coming from the disc. CT scans of the area also show areas where the dye has gone where it shouldn't indicating tears, fissures, holes, or other damage to the disc and/or its outer covering. Discography isn't always reliable and even if it's positive, that's not a sure sign that the chronic back pain you are experiencing is caused by the damaged disc. That's why discoblock may be helpful. With discoblock, an injection of a numbing agent like bupivacaine (similar to novacaine) is used. Immediate pain relief signals the disc is the problem. The test is accurate and reliable. The surgeon uses a special real-time X-ray called fluoroscopy to make sure the injection gets to the exact right place (inside the disc). Studies show that patients who have a discoblock and then go on to have disc surgery have improved results from the operation when compared to patients who had a discography instead. All that is just to diagnose the problem as accurately as possible. Now for the treatment. Walking is a great way to exercise and may be a helpful treatment approach when there is a mechanical problem (e.g., weakness, muscle imbalance, postural alignment). But for disc involvement, you may need some specific type of exercises that will address your particular problem or you may need surgery to remove the disc. If you haven't been back to the physician who diagnosed you two years ago, it may be a good time to make a follow-up appointment. With this added piece of information (walking program with weight loss), it may be easier to sort out what are the various factors and where the pain is coming from.

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