Our Magic Donuts - The Intervertebral Discs
Have you ever wondered what's nestled between your vertebrae, working tirelessly to support your every move? Picture this: a world of intervertebral discs, often compared to those beloved rings of deliciousness, donuts. These discs, however, are more than just fluffy treats – they're the guardians of your spine, the champions of mobility, stability, and shock absorption. They're the unsung heroes that let you bend, twist, squat, and lift, all without skipping a beat.
Imagine these discs as the heart of your spine's resilience. The center, akin to a delectable jelly filling, is known as the nucleus pulposus. This jelly-like substance, made of collagen and water-loving proteins, ensures that every force is evenly distributed, allowing you to move seamlessly in any direction. When you lean forward, it compresses; when you stretch back, it moves forward. This nucleus, generously hydrated, embodies springiness and vitality.
Now, let's not forget the annulus fibrosus – the robust exterior, your disc's powdered perfection. This fibrous wall surrounds the nucleus, lending crucial support. Comprising numerous overlapping collagenous sheets, it's a true multitasker, stretching every which way to cradle your spine in all its dynamic glory.
But what happens when things go awry? What's the story behind the infamous herniation? Gather 'round, as we dive into the mystery of back pain's nemesis.
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.
So, the question arises: to go under the knife, or not? The answer isn't as simple as it seems.
Now that you've got the lowdown on herniated discs, you might think surgery is your only option. But hold on! While surgery may be necessary in some cases, a less invasive approach is often the wisest choice. A study by Iwamoto et al. in 2010 compared surgical and non-surgical therapies for athletes with lumbar disc herniations. Surprisingly, both groups reported similar outcomes. This means that whether you opt for surgery or opt for a gentler, non-surgical path, you could end up with similar results.
Consider this: investing a few hours a week in physical therapy exercises and posture correction might be a smarter move than subjecting yourself to a traumatic surgical procedure. Surgery comes with its own set of challenges, from bed rest to immobilization. Not to mention the rare but present risks associated with anesthesia. Sometimes, the perceived "easy way out" isn't the best route.
Cool, I am scared of these feeble jelly donuts exploding. I feel frail…
Don’t feel too fearful though! The jelly donut theory is a major overdramatic twist to something
Enter the extension approach, a cornerstone of physical therapy. Imagine this as a strategic dance with your spine. If your nucleus wandered off in the wrong direction, the extension approach aims to coax it back where it belongs – inside the annulus. This simple yet ingenious strategy counteracts the very movements that led to the herniation in the first place.
Paired with exercises that bolster your core muscles and stabilize your vertebral column, this approach aligns your spine, creating more room for those precious nerves and reducing the chances of radiating pain.
But remember, there's more to the story. The extension approach is just one piece of the puzzle. If you suspect a herniated disc is behind your pain, I urge you to consult a physical therapist. These exercises are a stepping stone, a way to alleviate the symptoms and discomfort associated with herniated intervertebral discs. Think of them as your weapon against poor posture and other factors that might trigger lower back issues.
In conclusion, dear readers, I hope this article has shone a light on the enigmatic world of lumbar discs. They're not just discs – they're your partners in every twist, turn, and bend. Give these exercises a try, and let's keep those jelly donuts (ahem, discs) in their rightful place, ensuring a healthier, happier spine for all!
References Iwamoto, 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.
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.
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.