Physical Therapy

Vertebral Disc Herniations: What It Means and What To Do

By: Caitlin Scheib

There are many terms used when describing a vertebral disc herniation… common ones include “bulging disc”, “ruptured disc” , “degenerating disc”, “slipped disc”, or something as vague as “I threw my back out”. These terms are relatively synonymous, however, there are different types of herniations that ultimately refer to the severity of the injury. Let’s start off with some brief anatomy of the spine.

Spine Anatomy

There are four segments within the spine: the sacral spine or the “tailbone”, the lumbar spine which refers to the low back, the thoracic spine which is considered the mid back, and the cervical spine which is the neck. All four segments are comprised of the same anatomy with some differences such as the size of the vertebrae and shaping. The sacral spine has 5 vertebrae, the lumbar spine has 5 vertebrae, the thoracic spine has 12 vertebrae, and the cervical spine has 7 vertebrae. Between each vertebrae sits an intervertebral disc. The disc is a “cushion” in between each bone to help with shock absorption. The inner most portion of the disc is called the nucleus pulposes. This portion is a more gelatinous material and can shift from inside of the disc to the outside of the disc. The outer most portion is called is annulus fibrosus and is a much less moveable material. As the inner disc material pushes towards the outer rim, it can potentially “spill out” of the disc if there is a tear or rupture to the annulus fibrosus. A bulging of the disc material towards the outer rim can cause a compression on the nerve root that sits just lateral to the disc. Furthermore, if the disc material does spill out, it can then compress and irritate not only the nerve root, but can go into the spinal canal. The further the disc material moves from the inside of the disc, the more pain a person will experience. If a nerve root is compromised, pain will then refer into the hip and down the leg. The further down the leg the pain is from the low back, typically indicates the severity of the herniation. Most disc herniations occur in the lumbar spine, specifically at the L4-L5 or L5-S1 level. So let’s discuss the types of herniations that can occur.

anatomy of the spine.jpg

Spine anatomy.jpg
Types of Disc Herniations

  • Disc Degeneration


As people age, an intervertebral disc will degenerate and become less hydrated and “flatten out” over time. This is a normal process that will occur, however, dependent on a person’s activity level and what they choose to do in their lives, this process can occur more quickly.

  • Prolapse


The nucleus pulposes of an intervertebral disc will shift towards the annulus fibrosus but, will still be contained within the disc meaning there is no tear or rupture to the disc. This type of herniation is the most common and is what classically is referred to as a “bulging disc”. This means, the disc is bulging towards the nerve root causing minor compression.

  • Extrusion


The nucleus pulposes of an intervertebral disc has shifted towards the annulus fibrosus and is no longer contained within the disc due to a tear in the annulus fibrosus. The disc material is now exposed to the nerve root.

  • Sequestration


This is the most severe injury to an intervertebral disc. The annulus fibrosus has been ruptured and the disc material is spilling over into the spinal column. This type of disc herniation can result in surgical intervention.

Types of herniations.jpg
Causes of a Disc Herniation

  • Aging and type of activity

  • Sudden twisting and/or bending movements typically involving lifting a heavy object

  • Overweight or obesity


Symptoms of a Disc Herniation

The symptoms of a disc herniation can vary depending on the severity of the injury and which vertebral segment is affected. The most common symptoms include:

  • Sudden “sharp” or “electric” type pain

  • Radiating pain either down the arm or down the leg

  • Shifting or siding (unable to lean to one side, therefore, the natural position becomes shifted over to the unaffected side)

  • History of recurrent back pain

  • Pain that worsens with coughing, sneezing, laughing, or standing for long periods of time

  • Muscle spasm

  • Numbness and/or tingling

  • Muscle weakness


Treatment

Most disc herniations can be treated with physical therapy and anti-inflammatory medications. Depending on injury severity, it will take a few days or around a week to decrease pain. This will include a lot of resting to allow the disc material to shift back to the center of the disc. Heavy lifting should be avoided until pain has completely decreased. After the initial healing, one can expect about 2 weeks – a few months of physical therapy with activity and exercise modifications before feeling 100% better. Physical therapy will include core and hip stability and strengthening to help provide more structural integrity for the disc. The key to a disc herniation is understanding what movements or positions will increase pain and which are “safer”. Most movements involving bending forward will increase pain and create a longer time for healing. It is best to work with a healthcare professional that can determine which vertebral segment and level the disc herniation has occurred at and which nerve roots may be involved. Once this diagnosis has been made, proper education and corrective therapy can be provided to improve overall function of the spine.

Long Term Outcomes

Once an individual has experienced a disc herniation, the likelihood of having a subsequent herniation is higher. Maintaining stability and strength in the core and hips will be an ongoing process for any individual with a disc herniation. Listening to the body’s pain response, understanding which positions and exercises are beneficial, and making smart decisions in regards to movement and workouts are the true key in successful outcomes after a disc herniation.

If you would like more information or would like to be evaluated for back pain, please reach out to us at Kinect Health! We want to help you understand why you are having pain and work towards making the necessary corrections so you can continue with life without pain! We believe in treating the cause of an injury, not just treating the symptoms of the injury. You can reach us at:

702-540-1869

kinecthealthnc@gmail.com

www.kinecthealthnc.com

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