Often inaccurately referred to as a “slipped disc,” disc herniations, also called bulging discs, can happen anywhere in the spine but most commonly occur in the neck (cervical spine) and lower back (lumbar spine). These intervertebral discs lie between each of the vertebrae in the neck, mid back and lower back and act as a cushion, spacer and shock absorber. Running through the center of the vertebral column is the spinal canal that houses the spinal cord. Holes, or foramina, between adjacent vertebrae act as portals through which spinal nerves exit from the spinal canal and travel out to the skin, bones, joints, muscles and organs.

Intervertebral discs are made up of a gelatinous center called the nucleus pulposus surrounded by a strong, fibrous outer layer called the annulus fibrosus. When excess pressure or strain is applied to the spine the annulus fibrosus can tear which allows the central nucleus pulposus to extrude out the opening. This is called a disc herniation. The bulging disc can then place pressure on the delicate nerves. Disc herniations sometimes occur acutely as a result of a sudden force applied to the spine such as lifting something heavy with poor body mechanics. It can also occur as a result of slow degeneration or tearing of the annulus over time such as can happen after years of standing or sitting with poor posture.

WHAT ARE THE SIGNS AND SYMPTOMS OF A HERNIATED DISC?

Symptoms of a disc herniation can vary based on the location of the affected disc. If the herniation is on one side of the disc affecting a spinal nerve as it exits the spinal canal then symptoms will be felt along the distribution of the nerve. The location of symptoms can help your therapist identify the likely site of involvement. If the disc herniates centrally toward the spinal canal it can cause symptoms in any areas supplied by the spinal cord below the herniation and on one or both sides. If the herniation occurs in the neck then symptoms will typically involve the upper extremities (and below if the spinal cord itself is compressed) whereas a herniation in lower areas of the spine will affect the lower extremities, the ribcage or lower back and possibly even bowel and bladder function.

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. In general, if you are experiencing any of these symptoms, you may be dealing with a herniated intervertebral disc:

• Pain in the neck, back, low back, arms, or legs.
• Inability to remain in one position for a long period of time, such as sitting or standing, due to pain.
• Pain that is worse in the morning.
• Inability to bend or rotate the neck or back.
• Numbness or tingling in the neck, shoulders, arms, hands, hips, legs, or feet.
• Weakness in the arms or legs.
• Limping when walking.
• Increased pain when coughing, reaching, sneezing, or sitting.
• Difficulty standing up straight; feeling like you need to be stooped forward or leaning to the side.
• Difficulty getting up from a chair.

If you decide to work with a physical therapist to help correct your herniated disc issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized back pain physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your back pain PT sessions yet in the comfort of your own home.

WHAT PHYSICAL THERAPY TECHNIQUES ARE USED TO ADDRESS DISC HERNIATION?

The goal of physical therapy treatment for disc herniation is to relieve the pressure and irritation on the nerve roots to provide symptoms improvement and to address any underlying or contributing factors that may predispose you to recurrence or progression of this problem. As mentioned above, my team and I will create an individualized treatment plan based on your unique presentation and the findings of our exam but here are some treatments commonly used to manage a disc herniation:

Manual therapy: Manual therapy is a hands-on manipulative type of physical therapy that your physical therapist can use to address joint hypomobility and soft tissue impairments and to provide some pain relief. Joint mobilizations, soft tissue mobilization, and myofascial release are some examples of manual therapy techniques.

Postural re-education and body mechanics training: learning to move well can be an important step to reducing symptoms of a disc herniation and to prevent their recurrence. By learning to adjust your posture and move in an efficient and safe way you can perform more activities with less pain and less irritation on the spinal nerves.

Strength and flexibility training: Graded exercises to improve muscle strength and overall flexibility will be prescribed. Having adequate strength and flexibility around joints, muscles and other tissues in the back, hips and legs can help reduce symptoms of pain, help you feel more capable of moving and performing daily tasks and create more resiliency in your spine in the future.

Education: education is an important part of the physical therapy program for a herniated disc. Education may include things like avoiding bed rest and using ice to manage pain and swelling during the acute phase, instruction on proper lifting biomechanics and how to modify your workspace or work duties to help reduce the likelihood of reinjury.

If you are dealing with a disc herniation and are ready to find a long-lasting solution to your pain call us today to learn more about our services and schedule an evaluation