We have all been there – one minute you’re picking up clothes from the floor and, before you know it, your back twinges with an unfamiliar pain.
Back pain, specifically low back pain, is one of the most common problems that cause people to seek medical attention. And, while there are many reasons to experience low back pain, one of the most frequent back diagnoses is a disc herniation.
But are disc herniations really that common?
We will answer this question, and more, in this article. First, let’s start with the basics by explaining the components of the disc itself.
The disc is made of three strong rings that surround a thick, gel-like center. It is sandwiched between two vertebral bodies that act as one unit to hold the disc in place and produce movement. Additionally, this entire structure acts as a shock absorber for any type of movement that occurs at each spinal level.
The problem usually occurs when this relationship between the disc and the vertebrae is disrupted. Issues that affect the disc itself are commonly referred to as a disc bulge or disc herniation.
What is a disc bulge or disc herniation?
A disc bulge or disc herniation is a general term that is used to describe changes in the disc in relationship to the surrounding structures.
It can be classified as one of four types of disc herniations:
To help you visualize each type of disc herniation, imagine a standard donut with a jelly-filled center on the inside of the donut hole. In this scenario, the jelly-filled center is the middle of the disc.
The least severe type of a disc herniation is known as a disc bulge. In a typical bulging disc, the jelly-filled center is beginning to migrate towards one side of the donut and work its way through the donut. The structure of the donut itself is intact and unaffected.
In a disc protrusion, the jelly-filled center is moving closer towards the outside of the donut.
Deemed as a more serious type of disc herniation, an extrusion occurs when the jelly has reached the outer rim of the donut and spills through the side.
Lastly, the most severe type of disc herniation occurs when the outside of the donut has split open with the jelly-filled center spilling over the ends. This is known as a sequestered disc (disc sequestration).
Aside from the different types of disc herniations, the most important part of this anatomy lesson is to understand where the disc is in relationship to the nerves that connect to the brain. This important connection, which is found on the outermost portion of the donut, allows the disc to message the brain, notifying it of potential problems.
Like all nerves, spinal nerves are highly sensitive to changes in their environment. Therefore, any migration of the disc (“jelly”) that encroaches on the nerve will trigger inflammation, pain, and potentially alter connectivity to the brain.
While many disc herniations have been known to cause pain, it is possible to have changes in the disc without obvious signs or symptoms. Such changes are considered to be normal and may be attributed to age.
In addition to varying degrees of severity, disc herniations can be named by the direction in which they are displaced. The disc can herniate anteriorly, posteriorly, or laterally. In other words, the jelly-filled center of the donut can migrate towards different points on the outer rim of the donut.
Although rare, an anterior disc herniation can happen after pregnancy. It results from the disc moving forward, towards the front of the body.
In a posterior disc herniation, symptoms may be felt on one or both sides of the body.
Lastly, lateral disc herniations may cause someone to shift away from midline, also known as the center of the body.
Who is most at risk for a disc herniation?
According to a recent study, the likelihood of disc herniations increases with age and seems to be generation-dependent. However, disc bulges or herniations tend to be slightly more prevalent in people between ages of 20 and 50 years old.
But here’s the interesting thing about disc herniations: they’re extremely common. In fact, many go undetected because they do not produce any obvious disc herniation symptoms, like pain or numbness.
What does a disc herniation feel like?
Common disc herniation symptoms include:
- Pain with sitting and relief in standing or walking
- Morning pain and/or stiffness
- Pain with coughing/sneezing
- Pain in the leg
- Muscle weakness
A common disc herniation symptom is pain that is felt first thing in the morning. Usually, this type of pain will subside after moving around, but the initial 15-20 minutes after getting out of bed can be tough.
In an acute disc herniation, pain with coughing and/or sneezing is a frequent complaint. Additionally, transitional movements, like moving from sitting to standing or rolling over in bed, can produce a sharp painful moment.
Admittedly, there are a lot of different pain patterns that can happen with disc herniations. For example, you may experience numbness, tingling, or burning sensations that can be felt in your back, buttock, or leg. These types of pain can be provoked with the simplest of tasks, like bending over to tie your shoes.
On the other hand, some may wonder why they have leg pain without any obvious back problems. This is most likely due to disc irritation in the low back.
Why is it common to experience pain with very simple tasks?
Remember, the disc and surrounding areas are highly sensitive and vulnerable to change. Thus, any change to the structure of the disc, nerve, or vertebrae can result in irritation and pain, either at rest or with movement.
Unfortunately, after an injury, the spine is extremely difficult to protect. Unlike a shoulder problem that can be protected by a sling, there is not much to be done to prevent the spine from moving. Even a back brace cannot control all movement at the spine.
Studies have looked at the spine’s ability to maintain a neutral position during movement. Sophisticated motion sensors that can detect movement better than the human eye were used to measure spinal movement in various directions, and the results were eye-opening. Apparently, researchers found that there is absolutely no way to produce movement without using your spine.
Bottom line: it’s impossible to prevent your back from moving even in cases where the spine seems to be in a neutral position, which is why you experience pain with simple tasks when you have a disc herniation.
How do we know it’s a disc problem?
Once you decide to see a healthcare provider about a potential disc herniation, don’t be surprised if he or she asks you several questions about your pain, lifestyle, daily activities, and work responsibilities. These questions are actually really helpful in establishing a disc herniation diagnosis.
It’s very important that your provider establishes the right diagnosis in order to find the best treatment approach. Sometimes, your disc herniation symptoms can masquerade as spinal stenosis, muscle strain, instability, or a different type of back pain. Asking questions to determine the source of your problem can narrow down this list of possibilities.
You should also be aware that imaging studies, like an MRI, do not always match how you feel or where your pain is located. Basically, imaging is only one piece of the puzzle that is used to determine if you have a disc herniation.
After speaking with you, your provider will conduct a thorough examination based upon the answers that you gave. Essentially, he or she is trying to determine the direction of movement that causes the least amount of pain for your body. This is also known as a directional-specific examination.
This type of examination has been linked with better outcomes, especially if there is a particular direction that your body prefers. Therefore, your provider may ask you to do several movements over and over again, because it could be valuable to improve the disc herniation symptoms that you’re experiencing.
Then, all of this information is put together so that your provider can make sense of the problem. Basically, he or she will analyze your imaging results + your history questions + findings from the exam to arrive at the conclusion that you are (or are not) suffering from a disc herniation.
You should be aware that the size of your disc herniation or the amount that can be absorbed back into the body (remember the jelly donut example) does not necessarily predict your overall outcome. So, just because your MRI results reflect a “mild disc bulge at L4/L5” does not necessarily mean that your back pain is coming from that particular finding.
Could that “mild disc bulge at L4/L5” be the reason for your pain? Absolutely.
Could that “mild disc bulge at L4/L5” result from age and be unrelated to your current problems? Absolutely.
As you can see, deciphering imaging results is only part of the overall picture in a disc herniation diagnosis. Altogether, this information is needed to reduce your pain and improve function as quickly as possible.
Herniated disc treatment
Physical therapy is considered to be a conservative herniated disc treatment to: (1) reduce pain related to disc problems, (2) improve your movement, and (3) increase your tolerance to certain positions. This is an important step in your recovery, and the ultimate goal is always to avoid back surgery for a herniated disc.
Upon meeting your physical therapist at Peak Physiotherapy and Performance, he or she will search for the direction of movement that causes the least amount of discomfort. From there, you will build upon those movements to reduce pain and other herniated disc symptoms.
Most likely, your PT will avoid performing mobilizations/manipulations on your first visit since that may aggravate your symptoms. Instead, those types of treatments, as well as dry needling, may be saved for the second or third visits, depending on how you progress.
One of the most crucial components of herniated disc treatment is learning how to modify activities that cause pain. Your PT may show you alternative positions for sitting, sleeping, or standing as well as modifications for any of your daily activities. This also applies when you are beginning to resume activities once your pain is under control.
Together, activity modification, dry needling, mobilizations/manipulations, workout modifications and repeated movements can be extremely effective in treating herniated discs.
As mentioned above, the ultimate goal for herniated disc treatment is to avoid surgery.
Admittedly, you probably have heard of someone or know a friend who had a bad experience after back surgery, and it has most likely scared you. But, rest assured, surgery is very rare for disc herniations. Although there was a point in time when it was more commonplace, many experts now agree that back surgery is not the best treatment for most herniated discs.
Get Help for Your Disc Herniation in Columbus, Ohio
Keep in mind that almost everyone will experience a disc herniation in their lifetime. This does not necessarily mean that you will need surgery because, luckily, most disc herniations can be managed conservatively through physical therapy.
You should also know that pain levels are not always an accurate reflection of what may be happening in your spine. To put it simply, pain does not always equal a disc herniation and vis versa.
Expectations for recovery can vary anywhere from four weeks to six months, depending on your disc herniation symptoms and presentation. Your healthcare provider and therapist should be able to provide more information that is specific to you. However, a complete recovery is possible as long as you receive early treatment.
Like with so many other health conditions, seeing a provider who has the proper training to be able to take care of you and get you going is crucial to your recovery. No one is more qualified to assist you with this than Dr. Andrew Junak of Peak Physiotherapy and Performance in Columbus, Ohio. With several years of experience and a specialty in orthopedic physical therapy, Dr. Junak has the knowledge and expertise to help you get back on your feet. If you think you’re suffering from a disc problem and want help now, don’t hesitate to contact him for a free phone consultation. We look forward to hearing from you and assisting you through your recovery.
About the Author
Dr. Andrew Junak is a Doctor of Physical Therapy and Board-Certified Orthopedic Specialist. Dr. Junak received his Doctorate of Physical Therapy from Walsh University and completed his Orthopedic Specialist training at the Cleveland Clinic Orthopaedic Residency Program. He is the owner of Peak Physiotherapy and Performance, a physical therapy clinic in Canal Winchester, Ohio where he serves the local communities of Lancaster, Reynoldsburg, Grove City, Pickerington and Columbus. In his practice, Dr. Junak helps clients with jaw pain, neck pain, and headaches find relief without resorting to medications, injections, or surgery.