Physical Therapy for Herniated and Bulging Discs
Get Help With Your Herniated Disc
Intervertebral Disc Herniations 101
The nomenclature around disorders of the intervertebral disc has evolved over time. In the medical field we most often refer to discs as “herniated” or occasionally, “bulging.” Still, you may hear someone say they have a “slipped disc” in a more colloquial conversation. While advanced imaging today makes us pretty certain that discs are not “slipping” in and out of place, disc herniations or bulging discs are certainly a very real cause of neck and back pain treated in a physical therapy clinic.
Symptoms of a herniated disc can include localized pain in the spine, radiating pain into the arms or legs, numbness or tingling in the extremities, pain in the area with coughing or sneezing, weakness in the arms or legs, pain with walking, difficulty sitting for long periods, difficulty standing up straight, pain with bending the spine and bowel/bladder function changes. While the pain and discomfort of a herniated intervertebral disc can be disconcerting, in most cases conservative treatment such as physical therapy can help improve your symptoms.
WHAT IS HAPPENING WHEN A DISC HERNIATES?
Intervertebral discs have an important role to play in the structure of the spine. An intervertebral disc sits between each of the vertebral bodies in the neck, mid back and lower back. They act as a cushion, spacer and shock absorber. The height of the intervertebral disc helps create space for the spinal nerves to pass unencumbered from the spinal cord to the skin, muscles, soft tissue and organs throughout the body. When the height or structure of the disc is altered it can place unwanted pressure on the spinal nerves causing alterations in sensation and muscle function.
If you were to extract an intervertebral disc and examine it you will see that it is fairly oval-shaped and made up of two distinct materials. In the center is the gelatinous nucleus pulposus. Surrounding this area is the strong, fibrous outer layer called the annulus fibrosus. The nucleus helps with shock absorption and cushioning while the annulus helps maintain the shape of the disc and resist the stress and strain applied to it through spinal movement.
In the case of a disc herniation, a tear in the fibrous outer layer allows the gelatinous center of the disc to extrude or protrude outside the confines of the disc. This is what is called a herniated or bulging disc because when seen on imaging, a bulge of nucleus pulposus is seen on the outside of the disc. In most cases disc herniations are a result of natural weakening of the disc as we age but sometimes it can be caused by a single episode of high stress across the back such as picking up something that is too heavy.
Central disc herniations occur when the disc herniates medially toward the spinal cord. This may result in bilateral symptoms depending on the size and location of the bulged disc. Lateral disc herniations can impinge on the spinal nerves as they exit the foramina and will typically cause symptoms localized to one side of the body along the distribution of the affected nerve. The location of symptoms can help your PT or physician determine which intervertebral disc may be involved. While technically a disc herniation can occur anywhere in the spine, they are most common in the cervical spine (neck) and lumbar spine (low back).
Pressure on the spinal nerves or spinal cord caused by the bulging disc material is the cause of the signs and symptoms we associate with a herniated disc. If a herniation occurs in the cervical spine then symptoms are usually experienced in the neck, arms or hands. Alternatively, when a lumbar disc herniates the symptoms may be felt in the lower back, buttock, hips, thighs, lower leg or foot. In severe cases, a large central disc herniation can injure the spinal cord which can lead to more widespread and severe symptoms.
If you are experiencing severe muscle weakness or pain that has not responded to conservative treatment, a surgical consult may be recommended. If you are experiencing sudden loss of bowel or bladder control, immediate surgery is often recommended to decompress the involved nerves.
PHYSICAL THERAPY IS AN EXCELLENT CHOICE TO TREAT A HERNIATED DISC
In all but the most extreme cases physical therapy is a more optimal treatment choice than surgery or opioid pain medication. While initially the pain or discomfort you are experiencing may make you feel like surgery or opioid pain medication are the best choice, a conservative approach like physical therapy can not only provide you with symptom relief but help you avoid the long recovery of a surgery and the potential side effects of pain medication. In most cases an intervertebral disc herniation will spontaneously improve over a period of months but physical therapy can help hasten symptom relief.
In the first couple of days after an acute disc herniation your physical therapist can advise you on strategies to help minimize pain and stiffness. Applying ice to the affected area for 15-20 minutes every couple of hours and making sure you continue to get up and walk throughout the day can help with these symptoms. Similarly, they may advise you on how to modify your sleeping position to find the most comfort or on using a firm chair versus a soft chair. Additionally, while they may recommend avoiding pain-provoking activities at first, it is also important to avoid bed rest because this can actually worsen the pain and stiffness you feel when you decide to get up and get moving again.
After the first couple of days your PT can guide you through an individualized physical therapy program aimed at restoring pain-free motion. They may perform gentle hands-on techniques to restore joint and soft tissue mobility and reduce pain early on. You will learn exercises to help centralize your symptoms so that they no longer radiate into your arms and legs. An individualized strength and flexibility program can help restore strength in any weakened muscles and promote good strength and control around the spine itself. If there are postural habits that may have contributed to the injury you will be instructed in postural exercises as well as training on optimal biomechanics for performing both everyday movements and ones that may place you at higher risk for injury like picking up heavy items.
Treatment for a herniated disc can begin right away. If you are experiencing symptoms of a herniated disc our team of physical therapists is ready to help. Get a jump start on your recovery and the confidence of knowing how to reduce the likelihood of this injury happening again in the future.
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Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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