What are spinal discs?
Your spine is made up of bones called vertebrae that surround and protect your spinal cord. In between each vertebra is a disc, these discs are made up of a tough fibrous outer layer and a soft gelatinous inner layer. The gel-like substance inside the disc allows for shock absorption and to maintain space between vertebrae for the free passage of nerves. These nerves come out from the spinal cord to send signals out to your body which help with sensation and movement.
If your disc starts to wear down, it may bulge out into the space where your spinal cord sits, or it may herniate. Herniation means that the disc’s outer layer has torn, allowing the inner layer to leak out into that same space. As a result, it may start pressing on a spinal nerve which can cause pain as well as muscular or sensory impairments elsewhere in your body.
How is a disc bulge or herniation diagnosed?
A disc bulge or herniation will often present as pain in the lower back that can extend to your hips, buttocks, thighs and even calves. Symptoms can often increase with coughing, bracing, sneezing, and sitting or standing in sustained positions. Symptoms will usually improve with short periods of rest or gentle movement.
It is also common to experience numbness and tingling in your back and continuing as far down as the arches of your feet due to the nerve’s pathways. You may feel that your back and/or hip muscles are very weak if the nerve’s signal is being compromised by the pressure of the disc. In addition to these symptoms, your reflexes at the knee and ankle may be altered, along with your lower body strength.
Finally, your sensation and ability to feel light touch along your lower body may be impacted. All of these factors will be thoroughly examined by your physiotherapist to determine if any neural compromise is present.
What causes disc injuries?
Disc herniation can occur from a traumatic event such as, excessive lifting (especially with load) or a fall, however it is more commonly caused from cumulative trauma. Some examples that can lead to disc degeneration and subsequent herniation are:
● increased pressure on the spine (weight gain/heavy backpacks),
● increased age,
● poor/sustained postures,
● excessive lordotic curve,
● and even smoking, as it lessens oxygen supply to the disc.
Do you always need surgery with disc herniations?
No! In fact, 9 out of 10 people will not need surgery for disc herniation. Surgery may be
considered if after an extended period of physiotherapy treatment, you are still not improving.
Other complaints that will be considered include: if you have trouble standing or walking, if you can’t control your bladder or bowels, if your pain is constant and interfering with your quality of life, and if symptoms are progressively worsening. Surgery is not the first course of treatment as there are other ways in which a disc can heal on its own and physiotherapy can help to promote this natural healing process.
How can Physiotherapy help?
At your first appointment with a physiotherapist, they will provide a thorough assessment and prescribe a variety of mobility exercises tailored to you, such as, but not limited to, those written below. Particularly, your physiotherapist may focus on exercises that move your spine in a way that gently promotes disc movement inwards and away from your spinal nerves.
Your physiotherapist may also provide a gentle pull or traction treatment through your spine to take pressure off the disc in an attempt to offload and encourage a decrease in inflammation and irritation. Additionally, your physiotherapist may use different modalities such as IFC (interferential current) or heat which can help to alleviate pain and encourage blood flow, oxygen, and nutrients to the injured disc. Finally, your physiotherapist may help to improve your core stability if needed.
Three Key Exercises to promote good disc health and prevent injury
1. Pelvic Tilt
Purpose: To strengthen your lower abdominal muscles and add flexibility to your low back.
How to perform a pelvic tilt:
Lie on your back with your feet flat on the floor.
As you exhale, squeeze your abdominal muscles, push your belly button toward the floor, and try to round your low back.
Hold for 5 seconds. Relax.
Repeat 10 times, holding for 5 seconds each time.
How to tell if you're doing the pelvic tilt right:
Using the same hand, place your pinky finger on your hip bone and thumb on your lowest rib.
As you squeeze your abdominals, your pinky and thumb should move closer together.
2. Lower trunk rotation
Purpose: to increase spine mobility and flexibility
How to perform lower trunk rotation:
Lie on your back with your feet planted on the floor and arms out to the sides at 90 degrees
Lift your feet off the ground until your legs are in a tabletop position
Slowly lower both your legs down to one side.
Hold for 30 seconds to 1 minute and then rotate to the other side
Repeat 5 times on each side.
3. Cat-Camel Stretch
Purpose: to increase blood flow to the spinal discs by encouraging healthy movement between vertebrae
How to perform cat and camel stretch:
Get on all fours with your knees stacked under your hips, your wrists under your shoulders and your back straight.
Slowly inhale and arch your back as you let your belly fall towards the floor while extending the head at the same time, hold for 10-30 seconds.
Slowly exhale, round your back and tuck your chin to your chest, hold for 10-30 seconds.
Slowly alternate between these two positions 10 times.
Evidence has shown that various exercises like those listed above can help to prevent the occurrence of disc injuries and improve spinal health. However, if you are experiencing any pain or difficulty with these exercises or with daily activities, please book an appointment at one of our clinics. One of our highly trained physiotherapists will be happy to help get you on the path to recovery.
Looking for more ways to improve your spinal health? Here is an extra resource just for you!
Written by: Erin Gorchinsky, Queen’s Physiotherapy Student
Title Image: https://www.medicinenet.com/script/main/art.asp?articlekey=250384
Exercise photos from Physiotech
Härtl, R. (2016, June 7). Surgery for lumbar herniated disc. Spine. Retrieved February 6, 2022, from https://www.spine-health.com/conditions/herniated-disc/surgery-lumbar-herniated-disc
Highsmith, J. M., & Brusie, C. (2022, January 14). Should I see a physical therapist for herniated disc pain? Degenerative Disc Disease Symptoms, Causes, Treatments and More. Retrieved February 6, 2022, from https://kaizenseattle.com/should-i-see-a-physical-therapist-for-herniated-disc-pain/
Magee, D. J. (2014). Orthopedic physical assessment. 6th. Elsevier Saunders.