Did you know that between each and every one of your vertebrae there are donuts? These donuts are more anatomically referred to as
intervertebral discs. Each one of these discs provide mobility, support, stability and shock absorption to the spinal column. The combination of these properties allow us to perform tasks that require great amounts of mobility like bending and twisting, but also tasks that involve tons of compressive force like squatting and lifting.
Our intervertebral discs aren’t just any old donut either. They’re the really good jelly ones (I actually hate those ones, but for the purposes of this article we’ll pretend that I like them). The jelly filling is analogous to the nucleus pulposis, a jello-like material that allows for even distribution of all forces and in any direction of movement. If you bend forward the disc tends to squish back and if you extend your back, the disc will tend to move forward. The nucleus is highly hydrated and full of collagen and water loving proteins which absorb as much water as possible, allowing for the disc to be full and springy.
he outer ring, or powdered exterior, of our intervertebral donut is known as the annulus fibrosis, a thick fibrous surrounding wall which provides support to the interior, jelly nucleus. The annulus is composed of up to 25 sheets of thick collagenous overlapping sheets that stretch in all different directions to provide support in all planes of movement that it can possibly be stressed.
A single vertebra. The pokey part on the bottom of the image are those dinosaur bumps that go down the middle of your back, otherwise know as the spinous processes. A herniation typically occurs in the posterior direction.
So what is a herniation?
Now that you have an understanding of what those discs between your vertebrae do, what exactly happens to make us feel so much pain when the jelly blasts outside of the donut?
When a physician or physical therapist informs you that you have a herniated disc, what they are actually saying is that the nucleus of your disc has escaped the confines of the annulus’s protective outer sheath. In other words, the jelly like interior of the disc popped through the annulus enough to cause your symptoms.
The bulge created by the nucleus pushing out can press into nerves exiting the spine (nerve roots) and cause radiating pain, numbness, weakness and general dysfunction to the muscles of the legs and back. Depending on how bad the herniation of the disc, parts of the nucleus can leak out of the annulus and your body will react to the stimulus by sending all sorts of inflammatory mediators to the affected area and take up even more space. This only exacerbates the problem, compressing the nerve root to an even greater extent.
The most common type of herniation is of a posterior-lateral variety. Luckily, this spares our spinal cord and instead can hit an exiting nerve root. This is what causes the pain, numbness and tingling you may experience in a severe enough disc herniation.
To get cut open, or not. The answer should be simple…
Now that you know about what a herniated disc is, you may be thinking: “Boy, I should probably get operated on if my physician tells me I have one…” WRONG! Although at times, surgery may be the only suitable option for some, the non-invasive technique may be the best option for most. In a literature review by Iwamoto et al (2010), it was discovered that when comparing non-surgical therapy vs. microdisectomy (the most common surgical treatment for lumbar disc herniations) in athletes, both procedures shared satisfactory outcomes. In other words, both those that had surgery and those that received a conservative, non-surgical management technique felt the same post-intervention.
Would you rather devote two to three hours a week to taking control of your own back pain in the form of physical therapy or preventative maintenance exercises and postural correction, or undergo a physically traumatic procedure: which includes the negative effects of bed rest, immobilization and inactivity associated with post-operative protocols. The typical post-surgical rehab following a microdisectomy includes six weeks of no bending, lifting, or twisting in any way. Let’s not forget the very rare but needless risk of being anesthetized for a surgery. Too often, we look at surgery as a completely harmless procedure and absolutely necessary step that we should seriously consider over the much less traumatic, non-invasive technique of physical therapy and other non-traumatic interventions, but that is not always the case.
Physical therapy rehab of a herniated disc
The most commonly applied strategy that physical therapists tend to use involves using spinal extension to affect change in the structures of the low back. This "extension approach" is meant to take that jelly that has squeezed back into your nerve roots exiting your vertebral column and squish it forward into the donut where it belongs.
The idea behind the extension approach is basically performing the reverse of what caused your nucleus (jelly) to herniate (come out) in the first place. It’s actually a pretty simple strategy, when you think about it. If it is compression and faulty flexed posture mechanics (sitting with a rounded back, lifting things repetitively with poor posture, etc.) that pushed your nucleus backwards initially, then a properly performed compression of the nucleus in the opposite direction via extension of your back, would tend to push it the other way.
This approach combined with exercises aiming to provide stability to the vertebral column via the strengthening the core muscles, can assist with aligning the spine in a manner that creates more space for your nerves and avoids the vertebrae from flaring up your radiating symptoms.
But first, I must say:
The extension approach is only a single facet of a well-rounded treatment. If you have been diagnosed with or suspect that you may have a musculoskeletal pathology, such as a herniated disc in your lower back, I strongly recommend seeing a physical therapist first. The following exercises are general and intended to help your low back from the pain and symptoms commonly associate with the nerve pressure caused from herniated intervertebral discs. In no way are these exercises intended replace skilled conservative management from a physical therapist. Consider these exercises as a way to reverse the deleterious effects of poor posture and other factors that can be risk factors for symptomatic disc herniations in the lower back.
I hope this blog post has informed you about what exactly the discs in your low back are and how they can contribute to low back pain. Try out these exercises to gain low back mobility, stability and help keep your jelly donuts intact!
References
wamoto, J., Sato, Y., Takeda, T., & Matsumoto, H. (2010, December). The Return to Sports Activity After Conservative or Surgical Treatment in Athletes with Lumbar Disc Herniation. American Journal of Physical Medicine & Rehabilitation, 89(12), 1030-1035. doi:10.1097/phm.0b013e3181f71044
Kolata, Gina. "Why ‘Useless’ Surgery Is Still Popular." The New York Times. The New York Times, 03 Aug. 2016. Web. 01 Aug. 2016.