What is it a Herniated disk?
When people suffer from back pain or a back injury a common question is whether they have suffered from a Herniated disk. Unfortunately, back pain is all too common. In fact, there is an 80% chance of you experiencing low back pain in your lifetime. The good news is a most back pain can be treated conservatively without surgery or medications, including a herniated disc.
A herniation often called a slipped disc, is when the disc (cushion) between your vertebrae, bones within your spine, bulges or tears. They are caused by either a traumatic incident or years of wear and tear from repetitive heavy lifting, twisting, forward bending, and/or sitting. Other risk factors for disc herniation include being between the ages of 30-50 year’s old, competitive sports, obesity, smoking, poor posture, and men are at higher risk than women.
What causes disc herniation?
Your spine consists of 33 bones, known as vertebrae. Within the spine, your vertebrae are stacked upon each other forming an “S” shape which is by design to protect your spinal cord. In between each vertebra is a disc which provides cushioning and space between them. If space narrows, pressure adds to the disc, eventually either tearing it or causing a bulge where a part of the disc extends out beyond the vertebra’s normal space.
As we age, our discs become less hydrated and more brittle which can be a risk factor.; however, when exposed to higher risk factors such as obesity, labor intensive work, static sitting, and/or poor posture, there is a higher likelihood of a disc to tear or bulge causing a herniation.
In rare circumstance when the disc tears allowing for leakage, this can add pressure on a spinal nerve. Whether a tear or bulge, sometimes this pressure on the nerve causes pain or numbness and tingling. A herniation can happen at almost any level within the spine, but is most common in the cervical spine (neck) and lumbar spine (low back).
There are less common causes for herniation; however, they can be more serious in nature:
- Osteoporosis-vertebrae bones become brittle
- Osteoarthritis- breakdown of cartilage and discs of spine
- Scoliosis-abnormal curvature of the spine
- Spinal Stenosis-narrowing of the spine space
- Spondylolisthesis-when vertebrae slide forward and on top of one another
- Tumor of the spine
You find disc herniations most commonly in the neck and low back. In some cases, there is little to no symptoms with a mild to moderate disc herniation. The most common symptoms, however, include pain, numbness, weakness, and/or the inability to bend or rotate the neck or low back.
A herniation in the neck will likely cause intense shoulder and arm pain. A more severe herniation, or one that is not taken care properly, may cause numbness and tingling symptoms down the arm and into the hand. Often, associated with feeling weak in the arm as those muscles may be affected by the compressed nerves that intervene with them.
With a lumbar disc herniation, more often than not there is localized pain, and in some cases, there is severe pain in the buttocks and possibly down the leg. The most common symptoms may include:
- Tender to touch
- Sharp pain with activity
- Pain with standing or sitting
- Radiating pain (pain that moves down the buttock and leg (rarely below knee), around the groin or upper thigh area)
- Weakness, tingling, or numbness in leg or foot
- Change in bowel and/or bladder control
If you are experiencing the following symptoms, which are rare, we recommend you visit with your physician:
- Pain that travels to the mid back and possibly into the chest area
- Pain that worsens over time
- Constant low back that does not resolve with, or ease up with, rest or lying down
- Loss of sensation in part of, or the entire, hand or foot
- Change of bowel and/or bladder control
- Taking steroids for more than a few months without resolving symptoms
- Immediate severe pain with traumatic incident (like a car accident or fall)
How is a disc herniation diagnosed?
If you are experiencing neurological symptoms such as numbness, tingling, and muscle weakness down your arm or leg, we recommend you visit your primary care physician. An X-Ray or MRI (magnetic resonance imaging) may be used to rule out more serious conditions such as tumors and bone fractures; however, diagnosis of most herniated discs is without imaging.
A highly qualified medical provider, such as a physical therapist (PT), can determine if you are experiencing a disc herniation. Your PT will do his or her investigative work during the examination to determine not only the primary cause of your symptoms but also he or she will be able to provide you with a customized treatment plan to help reduce symptoms and improve function.
Physical therapists (PTs) are experts in the musculoskeletal system. PTs receive extensive training in differential diagnosis and treatment of conditions related to muscles, tendons, ligaments, bones, and nerves.
Whether you are visiting your PT or your physician, a complete physical exam, review of your medical history, questions around specific symptoms, and completing, a few special tests will most often determine if you have a disc herniation.
Commonly a PT will look to assess reflexes, joint stiffness, loss of movement, poor posture, and your movement patterns to assess if they are within normal range or not. Also, your health care provider will ask questions and look for movement patterns that cause increased symptoms, which will often direct him or her to where the herniation may be.
Within the first 24 to 48 hours of a disc herniation, the following is recommended:
- Ice the area for 15-20 mins every two hours
- Avoid bed rest
- Be active, but keep activity at low intensity to avoid flaring up your symptoms
- Avoid soft chairs
- Alternate positions frequently
- Avoid weighted out reaching
- Minimizing exposure of forward bending and rotation to pain level threshold (keep activity within range of managing symptoms)
- If symptoms do not improve, visit your PT or primary physician
Making an appointment with your PT at the early onset of symptoms will help alleviate symptoms sooner rather than later. In most cases, your PT can restore your daily functional activities with minimal to no pain, but also he or she can teach you how to manage your condition to avoid re-aggravation or reoccurrence. Your PT will help you restore and self-manage symptoms without surgery and in most cases without the use of major addictive medications like opioids.
Each of us is unique which is why there is no size fits all approach to care. A PT is trained to provide specific prescriptive exercises that are the key to recovery with a disc herniation. Generalizing exercises or stretches is not appropriate for each situation and person are unique and performing the wrong exercise, or the right exercise incorrectly, may do more damage than good.
As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
Take a conservative approach to your care. PT first is highly recommended; however, there are certain circumstances where medications, imaging, injections, or possibly surgery may be needed. Your PT will work with you and your physician to get you the best possible care you need to recover.
If your situation is significant enough where poor tolerance to conservative treatment occurs, then medications, injections or surgery may be needed. If this is the case, your physician will work with you on making an informed decision weighing the benefits and side effects of each treatment approach.
In rare cases when you need surgery, the surgeon will remove a portion of the disc that is protruding, which is called a discectomy. In rare circumstance the surgeon may remove the full disc and use an implant disc, or, the surgeon will fuse the area of the spine stabilize the bones.
Early intervention and treatment of a disc herniation are key. The goal is to provide conservative yet effective care in getting you back to doing the things you love. Remember, you have a choice in finding a health care provider that is right for you.
To find a highly qualified PT near you, please click on the following link (FOTO PT database link). Here you will find highly qualified PTs. There are many PTs to choose from, but we can help you find a local PT that has top national outcome rankings for spinal care.