PT and Herniated Disc

DEFINITION:

A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patient’s who experience pain related to a herniated disc often remember an inciting event that caused their pain. Unlike mechanical back pain, herniated disc pain is often burning or stinging, and may radiate into the lower extremity. Furthermore, in more severe cases, there can be associated with weakness or sensation changes. In some instances, a herniated disc injury may compress the nerve or the spinal cord causing pain consistent with nerve compression or spinal cord dysfunction, also known as myelopathy.

ARE HERNIATED DISKS COMMON?

Every year, up to 2% of people get a herniated disk. Herniated disks are a leading cause of neck and/or arm, and back and/or leg pain (sciatica). They can happen anywhere along the spine, but herniated disks most often occur in the lower back or the neck. It’s rare for a herniated disk to be in the mid-back.

Herniated Disc’s:

  • Can be very painful.
  • Within a few weeks, most cases of painful disc herniation heal.
  • In many instances, the herniation of the disc does not cause that patient any pain.
  • Herniated discs are often seen on MRI of asymptomatic patients (MRI is the imaging modality of choice).
  • The management of disc herniation requires an interprofessional team. The initial treatment should be conservative, unless a patient has severe neurological compromise.
  • Surgery is usually the last resort as it does not always result in predictable results.
  • Physical therapy is the key for most patients. The outcomes depend on many factors but those who participate in regular exercise and maintain a healthy body weight have better outcomes than people who are sedentary

WHO GETS HERNIATED DISKS?

People ages 30 to 50 are most likely to get a herniated disk. The problem affects men twice as often as women. Other risk factors include:
  • Sitting for long periods in the same position.
  • Being overweight.
  • Lifting heavy objects.
  • Repetitive bending or twisting motions for work, sports or hobbies.
  • Smoking.

HERNIATED OR SLIPPED DISK IN THE BACK (HERNIATED LUMBAR DISK)

It’s common for a herniated disk in the lower back to cause “sciatic nerve” pain. This sharp pain usually shoots down one side of your buttocks into your leg and sometimes the foot. Other symptoms of a herniated disk in your lower back include:
  • Back pain.
  • Tingling or numbness in the legs and/or feet.
  • Muscle weakness.

HERNIATED OR DISK IN THE NECK (HERNIATED CERVICAL DISK)

Symptoms of a herniated disk in your neck include:
  • Pain near or between your shoulder blades.
  • Pain that travels to your shoulder, arm and sometimes your hand and fingers.
  • Neck pain, especially in the back and on the sides of your neck.
  • Pain that increases when bending or turning your neck.
  • Numbness or tingling in your arms.

COMPLICATIONS

Just above your waist, your spinal cord ends. What continues through the spinal canal is a group of long nerve roots that resemble a horse’s tail (cauda equina). Rarely, disk herniation can compress the entire spinal canal, including all the nerves of the cauda equina. In rare instances, emergency surgery might be required to avoid permanent weakness or paralysis. Seek emergency medical attention if you have:
  • Worsening symptoms. Pain, numbness or weakness can increase to the point that they hamper your daily activities.
  • Bladder or bowel dysfunction. Cauda equina syndrome can cause incontinence or difficulty urinating even with a full bladder.
  • Saddle anaesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of the legs and the area around the rectum

PREVENTION

How can I avoid getting a herniated disk? It’s not always possible to prevent a herniated disk. But you can reduce your risk by:
  • Using proper lifting techniques. Don’t bend at the waist. Bend your knees while keeping your back straight. Use your strong leg muscles to help support the load.
  • Maintaining a healthy weight. Excess weight puts pressure on the lower back.
  • Practicing good posture. Learn how to improve your posture when you walk, sit, stand and sleep. Good posture reduces strain on your spine.
  • Stretching. It’s especially important to take stretching breaks if you often sit for long periods.
  • Avoiding wearing high-heeled shoes. This type of shoe throws your spine out of alignment.
  • Exercising regularly. Focus on workouts that strengthen your back and abdomen muscles to support your spine.