Understanding The Back: Disc Herniation

Let’s start with the basics

Our spine is composed of vertebrae, and between each level are intervertebral discs. These discs are comprised of an outer ring of cartilage called the annulus fibrosus, and contained within it is the gel-like nucleus pulposus. Intervertebral discs function to cushion the vertebrae and absorb force through the spine. 

What is a disc herniation?

When there is excessive strain placed on the disc (notably with trunk flexion and rotational stress), the ring of cartilage can be damaged. Depending on the severity of the damage, the disc itself may be painful, however if the nucleus of the disc displaces due to the forces, it becomes a herniation. 


Who could have it?

Many studies have shown that degeneration of the discs is present in 40% of individuals under 30 years of age, and present in over 90% in individuals between the ages of 50-55 (Cheung KM et al. 2009).

Degeneration of the intervertebral discs occurs with normal aging as early as 20 years of age. However, damage to the discs is often asymptomatic, meaning that while changes may be detectable in imaging, there is no limitation or pain in the patient. 


What does it look like ?

In some cases, the injured disc may bring about pain in a localized area of the back or neck. Depending on the severity of the injury, there can be compression of the nerve roots that leave the spinal cord. In these situations, the irritation of the nerve root may bring about pain, numbness, or weakness of the legs or arms.

With herniations of the disc, there is typically pain maintaining prolonged seated postures and forward bending of the trunk. Changing positions may be difficult and overall range of movement may be significantly limited.


How can physiotherapy help? 

A comprehensive approach in physiotherapy will allow you to: 

  • Move adequately during the healing process while regaining optimal mobility; 
  • Find optimal movement strategies to perform your activities of daily living while decreasing symptoms; 
  • Strengthen the appropriate musculature to support your trunk or neck; 
  • Correct poor posture and movement patterns (ex.: walking, work posture, etc.) to optimize function and avoid relapses

How to avoid this type of injury? 

  • Avoid performing activities that require a lot of effort, especially while bending forward and rotating; 
  • If lifting a heavy object, bring yourself closer to the object and bend at the knees
  • Move often and exercise regularly!

Certain muscle weaknesses, especially of the glute, and limitations in lumbar mobility are often implicated in these types of injuries. If you work in a sitting position most of the day, remind yourself to get up and stand often. 

Finally, remember that this condition is reversible! Many studies have actually found that disc herniations can actually resorb on their own, with conservative intervention.