Disc Herniations: What are they and How to manage them.
What is a Herniated disc?
There are 33 vertebrae or spinal bones which make up your back. Between each of these bones is an intervertebral disc or shock absorber. A disc has a firm fibrous outside (annulus fibrosis) that is filled with a thick gel-like centre (nucleus pulposus). When a major force or repetitive minor forces are placed through this structure the gel like centre can bulge through the fibrous outer. If this bulge causes a crack in the outer layer it becomes a herniated disc. A herniated disc is also referred to as a “slipped disc”. Very important to remember: DISCS DON"T SLIP! They will not physically move out of place, contraire to popular belief.
The most common form of disc herniation or injury is the lumbar spine or low back. Some herniated discs are painless while others can cause severe pain. Pain can come from inflammation or the herniation placing pressure on a spinal nerve. However, useful to note many people have discal herniations to varying degrees and will never experience pain.
Causes of disc herniation:
Disc herniation injuries are most common in young to middle-aged adults. Common causes of disc herniation include:
Wear and tear with aging
Repetitive flexion motions (repetitive micro-trauma)
Strong flexion and rotation injury
Lifting injury (especially with poor technique)
In some cases, it is not possible to identify the exact moment a disc herniation occurs while in others it will be very clear.
Risk factors for disc herniation:
Some risk factors which may predict disc herniation include:
Age (especially between 35-50 years of age)
Physically demanding occupation (increased exposure to trauma and wear and tear)
Gender (males are 2x more likely than women)
Smoking (decreased blood flow to disc structures)
Hypolordosis (flat back)
Just because you fit in to some/most/all of these categories does not mean you are destined to suffer a disc herniation.
Signs of a Herniated Disc:
Typically, the pain and symptoms from a disc bulge will be on one side of the body. Larger disc bulges can effect both sides. Symptoms involving the legs/feet indicate a lumbar spine or low back disc bulge and symptoms involving the arms/hands indicate a cervical spine or neck disc bulge. You can have a disc bulge in your thoracic spine or mid back but this is relatively uncommon.
Common symptoms of a disc herniation may include:
Neck, back or buttock pain (ranging from mild to severe)
Referral of pain into arms/hands or legs/feet (depending on level of disc herniation) (sciatica)
Numbness, pins and/or needles
Restricted range of motion (especially when bending forward)
It is important to remember that not all disc herniation’s cause pain or symptoms. If you have an image which indicates you have a disc herniation and you have no symptoms it is not a reason for concern. Symptoms usually come on once the disc bulge places pressure on a nerve exiting the spine.
If you’re having the above symptoms and pain in both legs/arms, bowel or bladder changes or any difficulty breathing it is important to seek immediate medical attention.
What you can do right now for a herniated disc?
Common advice given for an acute disc herniation is avoid aggravating activities, apply ice, apply heat, gentle extension/rotation exercises, and reduce inflammation. More in depth information to follow.
If you are suffering from a disc lesion it is important to give the disc an opportunity to heal or re-absorb back to pre-injury state. To encourage this, we advise avoiding aggravating activities especially those in lumbar flexion (i.e. bending forward) or heavy lifting. Bed rest is generally not indicated for acute low back pain. Remain mobile with walking and low impact activity within pain limits.
If this is a recent injury (within the last 24-48hours) applying and ice pack or cold compress may be indicated. This can provide you with some pain relief and keep inflammation to minimum. I advise you not to apply icepacks directly to the skin; wrapping to ice in a towel and applying in 20 minute intervals. After this 48-hour period this should be transitioned to heat pack application. This encourages the flow of blood to the region and decreases muscular guarding.
Gentle rhythmic lumbar extensions and rotation exercises are recommended, they should not be painful. Once your pain levels improve you may be able to attempt neural glide exercises to help with any symptoms which effect the arms or legs. It is generally better the get a professional opinion about when it is okay to commence these exercises.
Osteo treatment for disc herniation:
The first step to forming a solid treatment and management plan is establishing exactly which structures are causing your symptoms. This will involve questions, range of motion testing, orthopedic testing and neurological assessment (Checking the strength, sensation and reflexes). This will be used to rule out other diagnosis and establish which level of your spine has a disc herniation (can be more than one). If there are any further concerns or queries your health professional may send you to get some imaging done (e.g. MRI).
Hands on therapy will not only focus on the areas of pain but also aim to address the underlying mechanisms responsible for your injury in the first place. This will mean techniques being applied to not only your low back (if a lumber disc herniation) or the neck (if a cervical disc herniation) but the surrounding areas too. Soft tissue massage, stretching, traction, muscle activation techniques, joint articulation and traction may be utilized in a session with a physiotherapist or osteopath.
To compliment hands on sessions you will be given some “homework”. This will initially involve remaining mobile, minimising flexion motions and heavy lifting and encouraging extension and rotation ranges of motion. This will then be tailored as you improve to include muscular strengthening exercises and some specific stretches.
How do you know if you have a herniated disc?
Your osteopath will be able able to tell you if you are suffering from a disc bulge. They will by ask you questions about your pain, assess the region and performing special orthopedic and neurological stress tests. In some cases you may be referred off for imaging like X-Ray, CT or MRI. If you are concerned you have a herniated disc it is best to consult a health professional.
How long until a herniated disc gets better?
A disc herniation will usually respond to conservative therapy within 6-12 weeks. Disc herniation’s usually respond will to conservative management with a physiotherapist or osteopath.
In extreme cases of disc herniation (some sequestration and always extruded disc) will require surgical intervention.