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Herniated Disc (Bulging Disc or Slipped Disc)

The basics of herniated disc

  • A herniated disc is a condition that occurs when the soft center of one of the 23 discs in the spine protrudes out through a weak spot in the tougher outer layer of the disc.
  • Many nerves travel through the spine to get to other parts of the body, but when a disc is herniated, that can cause increased pressure on a nearby nerve, resulting in pain and difficulty with daily activities.
  • Herniated discs can occur in one of three sections of the spine: the cervical (neck), thoracic (mid-upper back) and lumbar (lower back), but are most common in the lumbar spine.
  • Physical therapy is a primary treatment for this condition that offers pain relief, improved function and education to prevent additional injury.

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What is a herniated disc?

Circular discs of gel-like fibrocartilage act as cushions between the vertebrae that form the spinal column. Discs have a soft nucleus surrounded by a tough outer layer (the annulus). When a disc’s nucleus pushes out through a weak spot in this outer layer, either by normal wear or injury, it becomes a herniated disc.

This herniation may begin to press against a nerve or nerves as they exit the spinal column and can result in pain. Depending on the location and size of the herniation, it also can cause pain, weakness and numbness to radiate into the shoulders, arms or legs. However, not everyone experiences symptoms with this condition.

Disc herniations occur most often in the lumbar spine but can also occur in the cervical spine, and rarely the thoracic spine (the vertebrae in the thoracic spine are securely anchored to the ribs and breastbone so the spine has less movement and herniation is much less likely to occur).

About 2% of the population in the United States experience a slipped disc each year, affecting men about twice as much as women. The condition most often occurs in those who are 30-60 years old.

Who can treat herniated disc problems?

Patients can self-treat a protruded (herniated) disc if the pain is mild. Sometimes a herniated disc may resolve itself on its own with no treatment from a medical professional.

Physical therapists can treat the condition with a variety of exercises, manual techniques and other modalities to control pain. Patients do not need a doctor’s referral to begin physical therapy at Spine & Sport. Our occupational therapists can also provide treatments that instruct the patient on maintaining proper posture to keep the back aligned correctly, which can be particularly helpful when there is an injury to the cervical spine.

Physicians can also treat a herniated disc and may order imaging (X-ray, MRI, CT scan) to identify the extent and location of the injury. Doctors often refer their patients with a slipped disc to physical therapists for treatment. Sometimes patients are given a steroid injection in combination with physical therapy. Surgery is a treatment option for severe cases of herniated discs when conservative management does not improve the symptoms, or the symptoms worsen. Most cases do not require surgery and are resolved with proper treatment.

Causes of herniated discs

A herniated disc is commonly caused by disc degradation that accumulates with age. Discs tend to grow more rigid and less flexible with age, and the ligaments attached to them also weaken over time. When the discs in the spine become more rigid, they are more prone to injury, which often occurs from lifting, straining or twisting of the spine.

Sometimes a single event of added stress can cause disc injury. This can happen from lifting heavy objects with the back instead of the leg muscles or turning the back while lifting. A traumatic event can also rupture a disc.

Risk factors for slipped disc

  • Being overweight.
  • Smoking.
  • Workplace demands that require heavy exertion or repetitive actions like lifting, pulling and twisting.
  • Weight-bearing sports participation.

Herniated disc symptoms

Symptoms vary greatly in individuals depending on the position of the herniation and its size. Many people have no symptoms from a herniated disc, while others experience severe pain and restricted movement.

When the protruding nucleus is not pressing against a nerve in the spinal cord, the person may have a low-grade backache or no pain at all. When the disc material does press on a nerve, it can cause tingling, weakness or numbness in the area of the body that nerve is connected to.

  • A disc herniation in the lumbar spine usually causes pain in the legs, buttocks or groin. It can also cause sciatica, a sharp leg pain caused by pressure on the sciatic nerve. This can cause pain, tingling and numbness that radiates from the buttocks through the legs. Pain may feel like an electrical shock and generally affects only one side of the body. The pain may be greater with certain movements, or after prolonged standing or sitting.
  • If the herniated disc is in the cervical spine, the pain is most often felt in the neck, between the shoulder blades, and radiating down the arms to the hands and fingers. Numbness, tingling and a feeling of weakness may also be experienced. These sensations may become worse when moving the neck.

Other symptoms can include difficulty walking, trouble getting out of a chair, difficulty standing up straight, and difficulty staying in one position for too long.

Risks of not treating disc problems

If left untreated, an injured disc can continually degrade, and the pressure on nerves can worsen. Nerve damage can worsen and become permanent without treatment. Herniated discs that seem to have resolved can also re-occur if not properly treated. It is important to strengthen the core and back or neck muscles in order to prevent re-injury from occurring.

Physical therapy herniated disc treatment

Our physical therapy team will discuss the condition with the patient and conduct a series of tests to examine the affected areas. The physical therapist will evaluate the patient’s arm and leg strength, reflexes and sensation. Therapists may also determine that diagnostic imaging or other tests by a physician are appropriate before beginning treatment. We work closely with physicians on treatment plans.

The goals of therapy are to get the patient back to performing normal activities, reduce pain and prevent additional injury. Treatments are designed for each individual to improve strength, flexibility, posture, movement and endurance.

If the injury is acute, treatment will focus on managing the pain. Treatment in the acute phase may include:

  • Deep tissue massage to relieve tension in the affected muscles.
  • Hot and cold therapy to reduce pain. Heat serves to increase blood flow to promote healing in the injured area and promote muscle relaxation. Applying cold reduces inflammation.
  • Traction techniques elongate the spine to reduce pressure on a pinched nerve and the protrusion of nucleus material from the disc.
  • Transcutaneous electrical nerve stimulation (e-stim) sends mild electrical currents from electrodes on the skin to stimulate nerves and relax pain.
  • Education on how to manage pain at home including ice/heat, activities to avoid and a gentle exercise program.

After the acute phase of injury,  physical therapy will be more active and focus on getting patients back to the activities they love doing. Treatments our therapists may employ include:

  • Flexibility exercises that can help improve mobility in the spine. Therapy typically focuses on improving loss of motion before progressing to more active muscle strengthening and aerobic exercises. These techniques prevent stiffness and make movement easier.
  • Core strengthening is very important for improving spinal issues, as the core muscles help to provide stability to the spine. If core weakness in not addressed, the injury is more likely to recur.
  • General muscle strengthening is beneficial in supporting back muscles.
  • Aqua therapy may be appropriate for some patients especially if the pain is chronic.

Physical therapy includes educating the patient on ways to continue strengthening and conditioning his or her back to prevent pain and further injury. To accomplish this, the team will prescribe exercises to do at home specifically selected for the individual patient’s condition.

We will make sure the patient has full understanding of how to properly complete these exercises before assigning the home program. Patient knowledge is key to maintaining life-long optimal health for the back.

When to see a doctor for a herniated disc

In general, a person should see a doctor for a herniated disc if pain is disrupting normal activities, conservative self-treatment isn’t working or if the physical therapist recommends a referral. Some symptoms of herniated discs may indicate a more serious medical condition that requires fast attention, including:

  • Loss of feeling in the legs and feet.
  • Loss of bladder control and/or loss of bowel control.
  • Loss of sensation in the saddle region.
  • Having difficulty with fine motor skills (coordination of small muscles in the hands or fingers with eye movement).
  • Unexplained widespread muscle weakness.
  • Changes in vision.

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