Back to Basics – Getting Relief from Disc Herniation
What is a Herniated Disc?
There is a total of twenty-three vertebral discs in the spinal column that sit between the vertebrae. These circular discs have a tough fibrous exterior which encases a soft mucoprotein gel. They are often explained as being like a jelly doughnut.
Disc herniation occurs when the jelly in the inner core pushes through a crack in the fibrous collagen exterior. Contrary to popular belief you can have a herniated disc and not even know about it because there isn’t always symptoms. However, given the right circumstances, disc herniation can irritate the nerves when it becomes compressed which results in pain, numbness and weakness in your appendages (arms or legs).
Disc herniation can happen anywhere in the spine including the cervical spine (neck), but it occurs most frequently in the lumbar spine (lower back).
What Symptoms Are Common?
You will find in any situation that symptoms will be slightly different depending on a person’s structure, where the herniation occurs and how severe the damage.
The most common symptoms with the lower back are moderate to intense pain that begins in the buttocks and can travel down the thigh and into the calf. Occasionally the pain will also include portions of the foot. When the herniation involves the cervical spine, the pain will radiate into the shoulders and down the arms. In either case, the pain will intensify when you cough, sneeze or change the spinal position. Many people also experience numbness or tingling in the outer extremities, as well as muscle weakness that is served by the impinged nerves.
The Common Causes of Disc Herniation – Can It Be Avoided?
Disc herniation can be created by any number of activities and most of the time people cannot identify the exact cause. Sometimes it can be as simple as lifting a heavy object using your back in the incorrect position instead of legs, especially if you are twisting at the same time. Damage can also occur to the discs due to a traumatic event such as an accident or even during pregnancy and delivery.
Disc herniation is most frequently the result of gradual wear and tear related to aging. During the aging process, the discs lose their water content, especially in the sedentary population. When they become drier, they are more susceptible to tear or rupture due to the decrease in flexibility.
Other factors that increase the risk of herniation are obesity which causes stress on the lower back from extra load, physically demanding jobs that have elements of repetitive lifting, pushing or pulling and the age old case of pure genetics.
When to Seek Medical Attention
Seek medical attention if you are experiencing pain in your back or neck that is travelling down your arm or leg and is accompanied by numbness, tingling and muscle weakness.
See your doctor immediately if your symptoms increase to the point that it is affecting daily activities. Also, consult your physician if you are experiencing bladder or bowel dysfunction, or progressive loss of sensation in the inner thighs, back of the legs or areas surrounding the rectum.
What to Expect from Your Doctor
Initially, the doctor will perform a physical exam that will include testing the reflexes, muscle strength, gait and ability to feel sensations such as touch, pinpricks and vibrations. The exam is usually enough to make a diagnosis. However, if the doctor suspects other extenuating circumstances they may also order a CT scan, MRI, Myelogram or Electromyograms (nerve conduction).
Moderate treatment plans begin with avoiding positions that create pain and incorporate an exercise prescription from an appropriate health professional such as a physiotherapist or clinical exercise specialist.
Physicians will usually also include some over the counter pain medications such as ibuprofen or naproxen. However, you should check with your doctor before beginning any medication to establish that it is appropriate for you. Should over the counter medications not relieve your pain, then your doctor will reassess your pain levels and add in either muscle relaxants, prescription nerve pain medications, cortisone injections and if all else fails, then they will prescribe narcotics. Exercise plans, coupled with over the counter medications, will relieve pain in 9 out of 10 people.
Physiotherapists may also recommend that you apply heat or cold to the affected area. They may also suggest ultrasound, traction, bio-electrical stimulation or short-term immobilization of the area through a brace.
During therapy, although it may seem counterintuitive, you should avoid too much bed rest. An overabundance of bed rest can cause muscle weakness and stiff joints. Every 30 minutes it is recommended to get up and go for a short walk. During acute phases avoid any activity that increases the pain.
Exercise Plans to Help Strengthen the Trunk and Posture
Once you have been given the green light by your physiotherapist and physician, hire a personal trainer that has experience with rehabilitation. They will develop an exercise prescription in conjunction with your physiotherapist that incorporates core stability and postural realignment. They will also develop an appropriate cardiovascular plan to help you lose any excess weight. Decreasing your girth will reduce pressure on the spine and discs which in turn makes them less vulnerable to another herniation.
Once given the green light to begin working out again, begin with a basic program of simple body weight exercises, stretching and cardiovascular exercise. Most people find that restorative yoga or Pilates is an excellent starting point to help stabilize the back and can offer relief from any residual pain.
Cardiovascular activity should be moderate; it can include walking, biking and swimming. Initially, begin with low intensity, continuous activities. Avoid any high-intensity workouts or heavy weight lifting, as this will aggravate the injury and could set you back.
Remember to start slow when you begin activity again. Start with 10 minutes the first day and slowly increase the time each day until you can complete 40 minutes of continuous activity 5 days a week. Hire a personal trainer to keep you on track and to modify your activity as your injury allows!
Stretching is also imperative during your rehabilitation, watch this YouTube video as Andre Noel Potvin (M.Sc., CSCS) demonstrates 3 stretches for Disc Herniation that help to relieve the pain.
Listen to your body and follow the advice of health professionals and you will be up and doing all of your normal activities in no time!
Cathie Glennon – BCRPA(SFL), Rehabilitation Specialist, Pharm Tech(Level 3)
Presented by Andre Noel Potvin, M.Sc. Cardiac Rehabilitation, ACE, BCRPA-TFL, ACSM, and Recognized by the British Columbia Recreation and Parks Association (BCRPA) for providing Continuing Education Credits (CEC), the Clinical Exercise & Rehabilitation Workshop Series (CES) are a select group of courses specifically designed for the Fitness Trainer that has interest in expanding their knowledge in clinical exercise and rehabilitation. Students will learn foundation knowledge in exercise rehabilitation, training special population groups, and advanced knowledge in fitness testing and assessments.