What is a herniated or slipped disc?

A herniated disc refers to a problem with one of the cushions (discs) between the individual bones (vertebrae) that stack up to make your spine.   A spinal disc is like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disc or a ruptured disk, a herniated disc occurs when some of the softer "jelly" pushes out through a crack in the tougher exterior.   A herniated disc can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg. Interestingly, many people experience no back symptoms from a herniated disc and that makes this condition difficult to manage. Most people who have a herniated disc don't need surgery to correct the problem, they do need an immediate lifestyle change and this is often one of the greatest challenges for the physiotherapist. It is difficult to convince some of our new patients, the urgency and importance of avoiding sitting. There are also some very important exercises and lifestyle changes that you need to know about and these involve eliminating extension patterns and spending more time in patterns of extension like walking, running, standing, etc.

   

What are the common signs and symptoms of a herniated disc?

  • Arm or leg pain. If your herniated disc is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh, and leg below the knee. Your pain may also refer as far as into your foot. If your herniated disc is in your neck, the pain will typically be most intense in the shoulder and arm and may also refer into the hand. This distal pain may shoot into your arm or leg when you cough, sneeze, and do something that increases your abdominal pressure. Most typically the pain will intensify when you bend your head forward or bend your trunk forward, when you sit at a computer or drive. In general flexion (bending forward) increases pain and extension (arching backwards or looking upwards) reduces pain.
  • Numbness or tingling. People who have a herniated disc often experience numbness or tingling in the body part served by the affected nerves.
  • Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.
 

What is the cause of a herniated disc?

Disc herniation is most often the result of a gradual, positional and postural wear and later in life leads to disc degeneration where a number of structures become involved including the disc and the facet joints. As you age, your spinal discs lose some of their water content and that makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. Your physiotherapist can help you prevent this process by teaching you how to care for you spine and by keeping spinal mobility and stability.

   

What is the typically history of someone who has a disc herniation?

Most people can't pinpoint the exact cause of their herniated disc because it is often a cumulative process of excessive bending, lifting, twisting, bad posture, and or repetitive and untreated back injuries. Often the history of someone who has a significant herniation is several infrequent episodes of either bending or lifting injuries, then over the years, an increase in frequency and severity. Often the causes are preventable however, many only seek care when they are in severe pain and very late in the history. Your physiotherapist can help you develop the stabilizers needed to protect the spine. Sometimes, it’s a matter of learning proper lifting and sitting mechanics and the avoidance of lifting heavy objects that can lead to a herniated disc. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disc, often it occurs with the combination of bending and twisting.

   

What factors increase your risk of a herniated disc?

  • Age. Herniated disks are most common in middle age, especially between 35 - 45, due to aging-related degeneration of the discs.
  • Weight. Excess body weight causes extra stress on the discs in your lower back.
  • Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disc.
  • Sitting. The act of sitting is the worse position for your spine and prolonged sitting can significantly increase the risk of disc herniation.
   

What is the prognosis of a herniated disc?

Most mild herniated discs do well with conservative treatment and by changing the lifestyle that lead to the condition. Some people, after sustaining a disc hernation, may not ever be able to perform some activity, or lift a load above a certain weight following an injury and your physiotherapist can help you with these decisions.

  The treatment for an acute herniation requires a commitment to some very important concepts and some simple exercise. Consult your doctor to determine a proper diagnosis and then seek a physiotherapist. Imaging studies (MRI) show that the protruding or displaced portion of the disc shrinks over time, corresponding to the improvement in symptoms.

  Many people, if they follow a committed extension routine, get better with conservative treatment. Avoiding painful positions and following a planned and progressive extension program and return to flexion protocol is absolutely essential. The key and greatest challenge is to avoid flexion, sitting, bending, lifting, and with this in mind, avoiding sit ups, hamstring stretches, buttock and glutes stretch, meditation positions, activities such as rowing, yoga bends, and basically anything that flexes your knees to your chest and/or your chest to your knees. Your physiotherapist and massage therapist can show you positions and exercises designed to minimize the pain of a herniated disc.

  If pain persists and or becomes constant with accompanying neurologic signs, medical attention is required.  Immediately seek emergency medical attention if you experience:  

  • Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.
  • Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
  • Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.
   

How can physiotherapy and massage therapy help with a herniated disc?

Manual Physiotherapy

An acute disc bulge or herniation can occur traumatically or insidiously from repetitive bending/lifting and poor sitting postures that stress the tissue. The outer fibres (annulus) of the disc become strained, which causes the disc to "bulge" out of position. In some cases, this leads to low back and/or leg pain if the nerve is being compressed. Young and middle-aged adults are most commonly affected. The typical complaints of this injury are low back pain with sitting and forward bending, morning stiffness/pain, and possible leg pain, tingling, or numbness.

  The most important first aid treatment for a herniated disc is to avoid flexion, sitting, bending, lifting and all functional movements that flex the hips and or the trunk. Exercise therapy becomes the first measure to treat a herniated disc, and avoidance of flexion is critical. Manual therapy treatment focuses on: local traction/decompression of the disc for pain relief in acute stages, joint mobilization in the unaffected joints of the lower thoracic and lumbar spine to gain range of motion, and soft tissue release around the hip joint to prevent over-stressing the lumbar spine. As will be discussed further, it is imperative for you physiotheapist to prescribe a home exercise program for this injury to address core stability and hip flexibility.

   

Massage Therapy

Massage Therapy is an effective treatment for an acute herniation and one of the major reasons is the prone and extended position the client is in during the treatment. Avoiding sitting and bending during the recovery is essential in maintaining the benefits from massage. By evaluating where the tone and restrictions are, massage therapy can help release and store soft tissues. Depending on the level of the herniated disc specific muscles will be focused on using gentle-moderate Swedish massage and myofascial techniques.  

How can exercise and physical development help with herniated discs?

Urgent Care and Rehabilitation after a Herniated Disc

An acute herniated disc is a concern and requires urgent care by your physiotherapist. This condition may progress into a serious problem often compressing the nervous tissue and becoming chronic if the patient does not understand that they must change their lifestyle. The bulge is caused by extreme pressures on the disc from lumbar flexion (repetitive forward bending, sustained sitting postures, and often traveling). It is rarely caused by one incident in activities of daily living. We cannot stress enough the importance of prevention when it comes to a bulging disc. Even prior to seeing your physiotherapist, it is essential to avoid sitting and bending at the waist as much as possible. Rest in bed not in a chair.

  Once assessment by a medial practitioner, has confirmed a flexion disorder (as in a herniated disc), a routine where flexion is avoided and extension is encouraged begins. Typically, positions of prevention and healing include laying on your back with feet supported or laying on your stomach with 1 or no pillows under your abdomen. We call these "rescue positions" and you should be in these positions as much as possible when pain levels are high and/or leg pain is present. Lumbar extension exercises create an arch or lordosis in your back, and providing that pain reduces, helps to alleviate pressure as the disc and reduce the size of the bulge. The basis of positioning for disc healing is that positions should alleviate leg and/or back pain. If your leg pain is receding (i.e. started in calf, but now only in thigh) this is a very good thing for healing and these positions should help do that. Once you see your physiotherapist, we will progress you through the proper exercises that reduce the size of your disc bulge, as well as train you in core stability exercises to protect the long term health of your spine.

   

Rehabilitation after a Herniated Disc

As the pain improves, physiotherapists can educate you about the things do and to avoid doing. They can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury. Lumbar extension exercises create an arch or lordosis in your back, which helps to alleviate pressure as the disc and reduce the size of the bulge. Walking is an excellent for this condition once the pain reduces. Many are able to resume to their previous running activity as it is an activity that maintains the spine in good alignment. The activity that will never be good for this condition is rowing, deadlifts, deep squats, and excessive amounts of sitting, bending, lifting, sit ups, gardening, and any movements which bend the hips toward your chest and or bend your trunk to your legs. Your physiotherapist can help you decide which activity is best for you at which stage in your rehab. The most important thing is to avoid or minimize these risk activities. Don’t sit longer than 30 minutes without taking a break. Don’t sit all day at work and then come home and sit all evening. Part of living a healthy lifestyle is to take care of your back.

  A preventative program of manual therapy that is focused on maintaining spinal mobility and spinal health, and this, along with good postural habits and a balance of flexion and extension movements will also greatly reduce reoccurrence. Lifestyle change is the most critical factor in reducing the risk of re injury. Herniated discs occur in the fittest athletes, Olympians suffer from this problem even though they are very fit. Why? Because even fit individuals can have a weak trunk and core and can spend too much time sitting, bending, lifting and basically overusing their backs.

   

Physiotherapy and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:

 

  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home
   

How can low intensity laser therapy help herniated discs?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.

  The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.

  Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.

  The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.

   

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated.

  The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.

 

What life style and self-care measures can you do for yourself after recovering from a herniated disc?

Back pain is often associated with poor posture during the years where age-related wear and tear occurs. To help prevent back pain, in standing keep your head centered over your spine, in a neutral position. In sitting, keep your feet on the ground, your hips tilted forward creating an arch in your low back, keep your head in neutral such that your ear is in line with your shoulder and centered. Some simple changes in your daily routine may help. Consider the following:  
  • See your physiotherapist or massage therapist and be proactive in your physical development and your personal improvement plan. Learn about proper lifting and working mechanics. Some people, after sustaining a disc herniation, may not ever be able to perform some activity, or lift a load above a certain weight following an injury and your physiotherapist can help you with these decisions.
  • Avoid sitting for prolonged periods. Sitting is one of the worst things that you can do to your back and as much as you can avoid sitting in your life you should. The most common injury of overuse sitting is disc herniation. Prevention is the best treatment.
  • Take frequent breaks when you must sit for long periods. if you drive long distances or work long hours at your computer. Keep your back supported into lordosis and your spine in a neutral position such that your chin is tucked into your throat, your ears in line with your spine, and this will reduce back strain.
  • Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests, and your shoulders pull back and down in a position of scapular retraction. This keeps the spine in a neutral position.
  • Avoid sitting in lounge positions.  Avoid sitting crossed legged and sitting with legs up at the same time as your trunk is raised as it is stressful on our back. Instead sit with your feet on the floor when reading and watching TV.
  • Stretch frequently if you work at a desk. Every few minutes adjust your position and pull your shoulder blades back and down such that your head comes back into line with your neutral spine. Stand up and arch your back into extension several times. This simply reverses the flexion posture and protects you from prolonged creeping, which occurs with prolonged sustained tissue stretch.
  • Balance your muscles. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced your muscles.
  • Lift with proper movement skill and to avoid excessive stresses. If you have to lift or bend, use the large muscles called the gluteus Maximus rather than bending and hinging from the waist, sit back into a squat position and keep your spine in a neutral position. This movement skill, the squat, is fundamental to lifting. Also, avoid repetitive lifting and twisting light loads. Bring the weight close to you and learn how to lift with the lifting muscles by training the functional squat movement so that you do not bend and hinge from the waist when you lift.

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