What Is Herniated disc

The vertebral column, or backbone, is made up of 33 vertebrae that are separated by spongy discs.

The spine is divided into 4 areas:

The cervical spine has 7 vertebrae forming the neck.

The thoracic spine has 12 vertebrae forming the chest area.

The lumbar spine has 5 vertebrae that form the lower back.

The sacral spine has 5 vertebrae below the waist and 4 vertebrae that comprise the tailbone (coccyx).

In the whole spine, there are 23 intervertebral discs, which are made of a gelatinous substance called the nucleus pulposus, surrounded by a fibrocartilaginous ring called the annulus fibrosus. The discs also have cartilaginous endplates that attach them to the vertebrae.

Components of a vertebral disc

1. Nucleus pulposus:

It is the gel-like center of the disc is made of water, collagen fibers, and proteoglycans. The water content decreases with age.

2. Annulus fibrosus:

It is the thick, fibrous outer ring of the disc, is made of layers of collagen and proteins called lamellae. The lamellae are arranged in a radial-ply pattern that makes the disc strong and flexible.

3. Cartilaginous endplates:

It anchors the disc to the vertebrae.

Functions of vertebral discs:

To provide shock absorption to the spine,
To allow the spine to flex, and
To prevent the vertebrae from grinding together.

What is a herniated bulge?

A herniated disc bulge is a condition where a soft tissue cushion between the spine’s vertebrae bulges outward or ruptures. It’s also known as a slipped or ruptured disc.

Other names: slipped disc/ruptured disc/prolapsed disc.

This disc bulge can feel like pain, numbness, tingling, or weakness in your neck, back, arms, hands, legs, or feet.

Types of Disc lesion:

Disc bulge,
Herniation,
Protrusion,
Extrusion,
Sequestration.

Disc Bulge is a circumferential extension of disc tissue beyond the apophysis or (extension for about 25-100% of disc circumference)

Disc Herniation is the localized extension of the disc beyond the limits of disc space (extension limited to <25% of disc circumference)

The protrusion is the extension of the disc where the base of herniated disc tissue is thicker or wider than the tip.

Extrusion is the extension of the disc where the base of herniated disc tissue is narrower than the tip/head part.

Sequestration is the detachment of herniated disc tissue from the entire disc.

What does a bulging disc feel like?

The symptoms of a disc bulge can vary depending on the severity of the bulge. It can range from mild pain and muscle guarding to severe radiating pain with motor and sensory loss.

What are the symptoms of a herniated disc in your lower back?

It can cause pain, numbness, tingling, and weakness in the lower back, buttocks, thighs, and calves.

Symptoms:

Pain that’s sharp or burning
Pain that’s intermittent or continuous
Pain that worsens with movement, coughing, sneezing, or standing for long periods
Pain that travels down one or both legs
Numbness or tingling in one or both legs
Muscle weakness in one or both legs
Decreased reflexes in one or both legs
Changes in bladder or bowel function (cautioned one)

What are the symptoms of a herniated disc in your neck?

It can cause pain, numbness, or weakness in the neck, shoulders, arms, and hands. The pain can be sharp or burning and may increase when you move your neck. You may also experience headaches.

Symptoms

Pain in the neck, especially in the back and on the sides
Pain that moves into the upper arm, forearm, and fingers
Numbness or tingling in the arms, shoulder, elbow, forearm, and fingers
Headaches, especially if the upper nerve roots are compressed
Pain that shoots into your arm or leg when you cough, sneeze, or move into certain positions.

What causes a herniated disc bulge?

1. Aging

As we age, the disc can dry out and lose fluid, leading to compression and bulging out of the disc. Disc herniation is most often the result of gradual, age-related wear and tear called disc degeneration. As people age, the discs become less flexible and more prone to tearing or rupturing with even a minor strain or twist

2. Trauma – Direct or indirect injury

An injury or heavy lifting can strain the disc and wear it down

Exercising in an improper position or improper loading can contribute to a bulging disc
Sedentary lifestyle
Smoking: It’s thought that smoking lessens the oxygen supply to discs, causing them to break down more quickly.

Is the herniated disc serious??

Most of the time it’s no!!! But sometimes yes!!

When a herniated disc compresses the nerve roots very much, it causes major problems like bowel and bladder dysfunction. And also, weakness in the upper or lower extremities depending on the level of lesion.

But in the majority of cases, it’s curable!!! with proper rehabilitation protocol.

Is herniated disc cure on its own?

Is L4-L5 disc bulge curable?

Yes, most herniated discs heal on their own within about 24-36 months in 80% of patients. Most disc herniations are age-related. The body’s immune system and enzymes help clear away the herniated material and relieve pressure on nerves with the help of proper load management strategies and rehab protocol.

While each case is different and recovery times can vary from person to person, most herniated discs can heal naturally. The body has an incredible ability to repair and regenerate damaged tissues.

Factors like age, general health, weight control, physical activity, and maintaining good posture can influence the healing process. Additionally, your diet plays a role in supporting the body’s natural recovery.

Risk Factors of Intervertebral Disc Pathology:

Obesity: Being overweight or obese puts extra stress on the discs in your lower back.
Smoking: Smoking reduces blood flow to the discs, which can cause them to break down faster.
Sedentary lifestyle: A lack of regular exercise weakens the muscles that support your spine.
Repetitive motions: Repeated lifting, pushing, pulling, bending, or twisting can strain your spine without proper load management.
Genetics: Some people may be more likely to develop a herniated disc due to their genes.
Traumatic injuries: Falls and other traumatic injuries can increase your risk.
Gender: Men are twice as likely to get a herniated disc as women.
Diabetes: Having diabetes can increase your risk of a herniated disc

How to diagnose a herniated disc

Physical examinations, including SLR, crossed SLR, Slump tests, muscular and sensory testing, and reflex tests, are advised in the guidelines for the diagnosis of lumbar radicular pain. Patients with Lumbar radiculopathy have demonstrated high diagnostic accuracy on the SLR and slump tests.

MRI

Taking an MRI is not always necessary for diagnosing low back pain until it presents with neurological symptoms. MRI uses radio waves and magnets to create detailed images of the spine and soft tissues. This is the most common test for diagnosing a bulging disc.

CT scan

Uses X-rays to create cross-sectional images of the spine

How our team treats the herniated disc :

At Exercise Prescriptor clinic, we approach a person with low back pain with a proper assessment which includes:

Patient history – about any previous injury, physical activity status,
Psychosocial factors,
Palpation,
Pain history,
Movement assessment-mobility & stability screening,
Neurological assessment- Motor and sensory assessment,
Physical examination: SLR, CSLR, slump test, motor and sensory testing, reflex assessment.

After analyzing all the evaluations, we set a differential diagnosis.

Initially starting with movement therapy, introducing the patient to mobility and mild strengthening activities for the upper and lower extremities according to the patient’s tolerance and need.

If a patient is psychosocially affected, we should educate the patient about the condition, eliminate fear, and provide support and motivation to enhance physical activity.

Is wearing a belt really effective for lower back pain??

No. Wearing a belt provides a negative psychological perspective that there is still structural damage in the back.

Instead, we must train our natural belt formed by the core muscles.

Exercise suggestions:

Improving flexibility

Glute stretches
Hamstring stretch
Calf stretch
Quads Stretch
Groin stretch

Improving joint mobility

Hip 90 – 90 mobility (internal and external rotation)
Lumbar mobility

Strength training

Glute Pelvic bridge
Hams pelvic bridge
Calf raise
Back extensors workout
Jefferson curl

Do I need surgery for a disc bulge?

No… Surgery is not needed unless the patient develops motor or sensory loss. A proper personalized rehabilitation protocol is crucial here.

Most of the disc herniations are age-related and not always problematic. Also, there is a difference in the severity level of disc herniation. Most of the disc herniations resolve within 24 to 36 months in 80% of the people. So surgery is required only when the symptoms are severe causing adverse effects like motor or sensory loss.

How I can avoid disc bulge??

Stay hydrated: The disc needs water to retain its properties and be flexible. So, get enough water intake throughout the day.
Sleep well: Sleeping is important for unloading the spine and allowing the disc to rehydrate and absorb nutrients.
Take good nutritious food: This is essential for tissue healing and reducing inflammation.
Exercise regularly: Avoid a sedentary lifestyle, and do some exercise for your back and lower limb muscles to improve the load tolerance capacity. There is a common misunderstanding that doing exercises like deadlifts will cause disc bulges. But, if such exercises are performed with optimal loading and training, they are excellent for strengthening the back and are not dangerous.