A herniated disc is a rupture of the cushion-like cartilage (“the disc”) between the bones. Also, the disc’s gelatin-like center leaks. Sometimes mistakenly referred to as a slipped disc, a herniated disc can be caused either by severe trauma or long-term pressure on your spine. People between 30-50 years of age are most likely to experience this condition.
However, the incidence is twice that of women. A herniated distal disc is caused by repeated lifting, participation in weight-bearing exercises, obesity, smoking, and poor posture. Most herniated distal discs can be treated with physical therapy. A physical therapist can create a customized treatment program to help people with herniated distal discs regain normal mobility, reduce pain, get back to regular activities, and improve their quality of life.
Physical therapists can be movement experts. They enhance quality of life by providing patient education, hands-on treatment, and prescribed movement. A physical therapist can be reached directly to arrange for an assessment.
What is a Herniated Disc?
The spine is made of 33 vertebrae which are the bones that are stacked on each other. A cushion-like piece cartilage known as an “intervertebral disc” lies between each vertebra. Imagine the disc as an ice cream cone. The outer donut portion is made up of a rubbery substance, the “annulus fibrosus” or Af. A gelatin-like substance fills the “hole”in the donut (the ‘nucleus pulposus’ or NP).
People younger than 30 are able to use the disc because it is flexible, soft and absorbs shock exceptionally well. However, flexibility can decrease as individuals age. When the spine is stressed, the outer layer of the disc (AF), may tear. The gelatin-like core, NP, can leak through the tear. This bulging of the gelatin, also known as herniated disc, is called leakage. In some cases, the leaking NP can seep beyond the spinal cord.
Herniation may be caused by a variety of injuries. If someone lifts something in an unsafe position, it can cause a severe injury. This strains the spine and causes the outer disc to suddenly tear. A slow injury could result from sitting, standing, and stooping in poor posture for hours, weeks,, or even years. Slowly overstretching, or tearing the outer disc can lead to a slow injury. A herniated disc occurs most often in the low back, which is just below the waist. A herniated cervical disc can also occur in the neck.
How does it Feel?
A herniated or bulging disc can cause tightness, numbness or weakness in the neck or back, arms or legs. The bulging or leaky disc can cause muscle weakness or pain if it presses on nearby nerves. Pain or disability may not be caused by the bulging/leaking disc if it does not push on any nerves. Herniated discs can cause back or neck pain. However, there could be other causes. Your physical therapist can check for and rule out other conditions.
Surgery may be required if a herniated or bulging disc is pressing on a nerve or pressing on the spinal cord. Your surgeon and physician will collaborate closely with you to determine the best treatment.
Signs and Symptoms
The type and location your symptoms are will depend on their location and direction, as well on the pressure on nearby nerves.
The herniated disc can cause no pain. It may cause one or more of these symptoms:
- Pain in the neck, back and low back.
- Inability to bend or turn the neck and back.
- Numbness, tingling, or pain in the neck or shoulders, arms, hands and hips.
- Slackness in the arms or legs
- Walking with a limp.
- Increased pain during coughing, sneezing or reaching.
- Inability to stand upright; being stuck in a certain position, like. Supportive or passive posture that involves leaning to one side or bending forward.
- Difficulty in getting up from a sitting position.
- A condition that causes you to be unable to maintain a certain position for extended periods of time, such as sitting or standing, is called pain.
- Pain that is worse in the morning.
Over 50-year-olds may experience a dry, gelatinous core of their disc (NP). This can make it more likely to herniate or leak. This can lead to degenerative disc disease and degenerative joint diseases, which can both cause pain. Your physical therapist can work with other healthcare professionals to diagnose the exact condition.
How does Herniated Disc get diagnosed?
Your physical therapist will perform a comprehensive evaluation, including taking your health history. Your physical therapist might also ask questions about the injury.
- When did the pain get started?
- It is worse at what hour of the day?
- Which kind of discomfort are you feeling?
- What can you do to manage the pain in your day?
Your physical therapist may perform physical tests to identify physical problems such as:
- Difficulty in moving.
- Tightness or weakness in the muscles.
- Numbness or loss of skin sensation in certain areas
- The loss of reflexes.
- Joint stiffness
- Poor posture.
- Difficulty in walking.
If you have any of the above symptoms, your physical therapist might recommend physical therapy to get you back on track to recovery. If your testing reveals more severe issues, your physical therapist may work with a surgeon or doctor to conduct special diagnostic testing. Physical therapists can work with other health care providers, including physicians, to make sure you get the diagnosis you need and the treatment and care that you need.
Assessing a Herniated Disc
However, a disc herniation discovered on a magnetic radiation imaging (MRI)scan doesn’t necessarily mean that you will have pain. The issue could lead to many symptoms. A herniation at the lumbar spinal nerve can lead to low back pain. A herniation in the lumbar spine can cause pain in the back, legs or feet. A nerve compression, pinching, or pinching may cause weakness, pain, or tingling in your legs.
A herniated disc in the cervical spine could cause pain or spasms to the neck and shoulder blades (scapula). The herniation can pinch a nerve and cause severe pain. The symptoms of a thoracic (mid back disc) herniation are more common and less well-known. Most often, the herniation causes pain in the lower back, abdominal, or upper back. It can also cause weakness in the extremities, and may even spread to your legs.
Because symptoms can manifest in many different places, a physical therapist needs to start with a thorough assessment. A PT will also ask questions to help determine the root cause of your condition. To check if there have been any injuries to your arm or leg muscles, they may also examine them. Additionally, they will need to examine your sensation and reflexes as these may indicate a herniation. They can offer beneficial treatments to improve your pain once they have an understanding of your particular problem.
Pinched Nerves
In many cases, a disc injury can pinch or compress an adjacent spinal nerve. When this happens, the pain, numbness, or weakness that results will spread to the extremities (the legs or arms for a cervical herniation and the legs or lumbar herniation).
Your physical therapist will usually examine your pinched nervous system to see if it is moving in a particular direction that causes symptoms in your arms and legs to improve, or resolve completely. This is known as centralization.
This is known to be a directional preference. Your PT will recommend the types of exercises. Similar to the previous point, exercises that require you to move in particular directions may cause your pain to worsen in your extremity (called “perimeterization”). These types of movements should be avoided at the beginning of therapy.
Some cases of pinched nerves can be so severe that traditional treatments such as physical therapy or medication are not sufficient to ease the pain. In these cases, surgery may need to be performed to remove the herniated spinal disc and stabilize the affected segment.
Pinched nerves are a common reason for pain and tingling
After being diagnosed with a herniated spinal disc by your doctor, and treatment has been deemed appropriate for you, it’s important to find a PT skilled in treating this type condition. An orthopedic or a neurological physical therapist are usually well-versed in this area. The American Physical Therapy Association’s website allows you to find an orthopedic clinical specialist or neurologic clinical specialist in your region.
Physical therapy sessions have many goals once you are enrolled. First, you’ll be instructed in exercises to help relieve nerve pressure based upon your directional preferences. For stabilizing the spine, core stability exercises are recommended. Aerobic conditioning will help increase endurance. Additionally, the therapist will help you stretch and do manual work to improve your flexibility. It has been proven that physical therapy combined with pain medication and education is equally effective in treating lumbar disc herniation.
First 24-48 hours
The worst pain is usually felt within the first 24 hours to 48 after disc herniation. While it’s normal to be scared, your physical therapy will likely educate you on the importance and necessity of staying active.
Moving around, such as swimming, or walking, can help relieve muscle spasms. Mobility exercises and core strengthening are recommended for support of the spine. Also, lumbar traction can relieve the pressure on your spinal cords and help you get back to normal faster.
Ongoing Treatment
Your therapist will focus on the home portion of your treatment once you are done with the acute phase. In order to strengthen your core and ensure strength, you will need to do more difficult exercises. Your form will be monitored by your therapist to prevent any potentially dangerous compensations.
Furthermore, while early physical therapy may focus on movement that leads to symptom centralization and the latter phase of rehab often involves slowly reintroducing motions that were previously irritating. After your symptoms have subsided and you have successfully managed your condition, your PT will normally create an individualized treatment plan that you can follow after you’re discharged.
What Can a Physical Therapist Do to Help You?
In almost all cases, other than the most severe, conservative care (such physical therapy) is better than surgery or pain medication, such as opioids, in treating a herniated spine. Your physical therapist works with you to develop a personalized treatment plan. Physical therapy will allow you to return to your usual lifestyle and activities. Although the healing process can take a while, you will see results in 2 to 8 weeks. If you follow a correct posture, pain-reduction and stretching program, your condition will be resolved.
Your physical therapist could advise you to take these steps within the first 24 hours to 48 after your diagnosis.
- You can rest the area by avoiding activities that cause worsening symptoms in your arms or legs.
- Avoid bed rest.
- Do your best to stay active at home. Take short walks every day. You will feel more energetic and less stiff.
- Ice packs are applied to the affected areas for 15 to 20 mins every 2 hours.
- Recommendations: Sit on sturdy chairs. Easy chairs and soft couches can make your problems worse.
- To receive further services such medication or diagnostic tests, consult your physician.
Individuals with herniated distal discs may find some exercises more helpful. These are the things your physical therapist will teach you. Here are some examples:
- Swimming can be a great way for you to remain active even when other forms don’t work.
- Exercising that involves a lot more twisting and bending might not be beneficial to you. Your physical therapist may create a program specifically for you.
- To avoid injury to the neck or back, weight-training exercises should be performed with proper form.
Your physical therapist works with you to:
Reduce pain and other symptoms. Your physical therapist will guide you on how to prevent or modify the injuries, so that healing can start. Your physical therapy may employ different techniques and methods to reduce and control your pain.
Correct your posture. If your physical therapist determines that your poor posture contributed to your herniated distal disc, they will instruct you on how to improve your posture so that there is less pressure in the injured area and that healing can start as quickly as possible.
Enhance motion. Your physical therapist can recommend activities and treatments that will help you restore normal movement to any stiff joints. These could start with passive motions your physical therapist makes to move your spine. Then, you might be able to do the exercises and stretches yourself. These movements can be performed at your home or workplace to speed up healing and relieve pain.
You can improve your flexibility. Your physical therapist will evaluate your flexibility and start stretching you at home.
Strengthening your body. If you are diagnosed with weak or injured muscles, your physical therapy will help you to choose the best exercises to gradually restore your strength. “Core strengthening” is a common treatment for neck or back disc herniations. This helps to strengthen and coordinate the muscles around your spine, hips and pelvis.
Improve endurance. It is important to regain muscular endurance after an accident. Your physical therapist will create a program to help you regain your endurance and improve it.
You can learn a home-based program. A physical therapist will give you exercises for strengthening, stretching, or pain relief that you can use at home. These exercises will be customized for your needs. You can speed up your recovery if they are done as directed by your physical therapist.
You can resume your normal activities. Your physical therapist will review your activity levels with your and help to establish your work, sports, and personal recovery goals. Your treatment program will help achieve your goals in the fastest, most effective, and safest way. Your physical therapist may instruct you the correct “body mechanics” (correct ways to perform tasks, lift heavy objects) that can help protect your spine.
You should continue to practice the new posture and movement patterns you learned once your pain is gone. This will ensure that your back stays healthy and pain-free.
After Surgery
Sometimes surgery is required in order to prevent permanent damage of a nerve or the spinal cord. Your surgeon and your physical therapist can work together to help you recover motion and strength quicker than you would on your own. They will also help you return to your regular lifestyle as quickly and safely as possible.
Can the Injury or Condition be Prevented
The following tips can help prevent a herniated or bulging disc:
- You should use good body mechanics whenever you lift, push, pull, or do any other activity that puts additional stress on your spine.
- Maintain a healthy body weight. This will reduce the stress placed on your spine.
- Stop smoking.
- Discuss your job with a physical therapist. They will be able to provide a detailed analysis of your job and make recommendations for how to reduce injury.
- Keep your muscles flexible and strong. For a healthy body, keep fit and active by participating in regular exercise.
Many clinics offer “backschools,” which are classes that teach patients how to protect their backs and necks from injury. Ask your physical therapy therapist about programs offered in your region.
The following tips will help prevent a herniated disc recurrence:
- For your back to stay healthy, continue the good posture and movement habits you learned from your physical therapy.
- Keep up the home exercise program your physical therapist gave you to maintain your gains.
- Be active and fit.
What kind of Physical Therapist do I need?
All physical therapists can treat low back pain that is caused by a herniated spinal disc. Here are some other options you may be interested in:
- A physical therapist with experience treating people with musculoskeletal or orthopedic problems.
- A board-certified clinical specialist, or someone who completed a fellowship in orthopedic physical therapy. This therapist can apply his or her advanced knowledge and experience to your specific condition.
Some general tips for finding a physical therapy professional:
- Ask friends, family, or any other health care provider for their recommendations.
- If you are contacting a physical therapy clinic to make an appointment, be sure to ask about the experiences of physical therapists with people who have a herniated distal.
- Be ready to describe your symptoms in detail and tell what makes them worse.
Exercises for neck pain
Following a slipped disc, neck pain is common. Neck pain can result from pressure on the nerves of the neck. It can also cause pain shooting down the arm.
The following exercises can help relieve neck pain that is caused by a slip disc in the upper spine.
Neck stretches
You can relieve pain and pressure caused by a herniated disc in the neck area with the following exercise:
- Straighten your neck by sitting upright in a comfortable chair.
- Move the left arm toward the left shoulder. Then move the right arm toward the right shoulder.
- Repeat this process several times.
Hamstring exercises
A strengthening of the hamstring muscles can be beneficial for those suffering from a slipped disc in the lower spine. This will allow them to support their core, back and core. Here are some hamstring stretches to try:
- Stretching a seated chair
Do a gentle, seated stretch of the hamstrings:
- With one foot on the floor, place your other on the table.
- Straighten your spine and stretch your upper thigh by leaning forward.
- You can keep this position for between 15-30 seconds.
- Switch legs and do this several more times.
- Towel hamstring stretch
This is a great way to deepen your hamstring stretch.
- One leg should be lifted up into the air while you lie on your back on a yoga pad.
- Wrap a towel around one leg and hold it up in the air.
- While holding the towel, move the leg towards your body by pulling the towel toward you.
- You can hold it for between 15-30 second.
- Repeat several times with the other leg.
Exercises for low back pain
These exercises can be used to ease lower back pain and build back muscles. This will help you avoid future injuries by providing more support.
Back flexion stretch
Back flexion exercises help stretch the spine. These exercises should only be performed after a back injury. To perform a back flexion stretch:
- Keep your legs straight and erect.
- You can also move your head forward to create a comfortable stretch at the mid- and low back.
- Repeat the process several times.
Knee stretch to the chest
The knee to chest stretch will help you stretch the muscles on each side for a gentler stretch. Try these:
- Lay on your back, knees bent, and both heels on to the ground.
- Place both your hands behind one knee, and pull the other toward the chest.
- Switch legs, and do it again several times.
Piriformis muscle stretch
The piriformis muscle is a small buttock muscle. This muscle can also be stretched.
- Lay on your back with your knees bent and your heels on the floor.
- Cross one leg over another, and place your ankle on the bent side.
- Gently pull the crossed knee towards your chest until the buttock is stretched.
- Repeat the process on both ends.
How can exercises be of help?
Recovery from a herniated or bulging disc can be helped by physical therapy and exercises. A doctor will typically recommend that you take a break for several days after suffering from a herniated or bulging disc.
Light activities and exercises that strengthen the spine will reduce pressure on it. They may also improve flexibility of the spine and help to prevent a herniated distal from recurring. The doctor may suggest that you start small and gradually increase the intensity of your activity. You will be given specific instructions on what to do and what not to do during your recovery.
There are gentle exercises that can help a herniated disc:
- Yoga
- Swimming
- Walking
- Cycling
You should perform all exercises slowly and controllably, especially when you’re bending or lifting. The exercises should not cause pain. If anyone feels pain from the exercises, they should quit and see their doctor.
Avoid these activities
A herniated disc can be caused by heavy lifting, sudden pressure on one’s back, repetitive strenuous exercise, or lifting too much weight. During recovery, people with a herniated spine should avoid strenuous activities.
It is important to avoid any exercises that can cause pain or make the pain worse. Sciatica should be treated with caution. It is possible to steer clear of high-impact activities, like jogging or martial arts. These can cause severe injury to the spine. Start small and work your way up to more intense exercise. This is the best way to reduce symptoms. However, it’s possible to improve your outcome by beginning exercises and stretches earlier. Discuss your needs with your doctor before you start any exercise regimen.
Prevention
You can’t guarantee that you won’t experience a spinal disc herniation. However, there are many steps you can take to avoid one. Regularly performing a strengthening program that targets your spine-supporting core, and posture muscles is one of the best ways. This, together with regular aerobic exercise helps to stabilize the spine.
Also, maintaining a healthy body weight can help reduce the strain on spinal discs. This will also decrease the risk of herniation. When lifting heavier objects, it is also important to practice good body mechanics (using your legs and keeping the spine straight) Avoiding high-heeled shoes as well as smoking can help reduce your risk of developing this spinal condition.
Summary
It is possible to ease the pressure and pain of a herniated/slipped disc by gentle exercises and stretching. For pain prevention and recurrence, strengthening your back and hamstrings muscles can help reduce pressure on your spinal column.
Talk to your doctor before performing any exercises. This will ensure that you don’t cause injury to the back or cause additional pain. A doctor will be able to recommend the most effective exercises depending on the location of the herniated disc.
