Physical Therapist's Guide to
Herniated Disk
It's estimated that as many as 75% of us will have some form of back or neck pain at some point in our lifetime.
The
good news is that most of us will recover without the need for
surgery—and conservative care such as physical therapy usually gets
better results than surgery. A herniated disk is one cause of neck and back pain.
What is a Herniated Disk?
Your spine is made up of 33 vertebrae (bones) that are stacked on
top of one another. Between each vertebra is a cushion-like piece of
cartilage called an "intervertebral disk." Imagine the disk as a tire,
with gelatin filling the hole in the tire. The rubbery outer part is
called the "annulus,” and the gelatin is called the "nucleus." When
we're young—under 30 years of age—the disk is made mostly of gelatin. As
we age, we start to lose some of that gelatin. The disk becomes flatter
and less flexible, making it easier to injure. In some cases, the
gelatin can push out through a crack in the rubbery exterior and lead to
a herniation (bulge) or rupture (tear).
Herniated disks are most common in the neck (cervical spine) and low
back (lumbar spine). In the low back, disks may become damaged by
excessive wear and tear or an injury.
Your risk for developing a herniated disk increases due to:
- Age – most herniated disks occur in people who are 30 to 50 years of
age as a result of age-related disk degeneration. Herniated disks are
less common after the age of 50, however, because with aging there is
less fluid to push out of the disk
- Obesity – increased weight results in increased pressure on the disks
- Occupation – jobs that are physically demanding and involve
repetitive tasks such as lifting, pushing, pulling, and twisting place
additional stress on the disks
- Low levels of physical activity – people who are not physically active are less able to handle physical demands
Signs and Symptoms
You might have mild to intense neck or back pain—or no pain at
all. Herniated disks sometimes show up on the diagnostic images of
people who have no symptoms.
When the disk ruptures ("herniates") and a portion of the disk pushes
outside its normal boundaries, it can "pinch" or press on spinal nerves
or the spinal cord. This condition is called "radiculopathy." The
pressure can lead to back pain or to pain, numbness, or weakness in the
legs.
The type and location of your symptoms depends on the location and the amount of pressure on the nerves:
- If you have a herniated disk in the cervical spine, you may have pain, tingling, numbness, weakness, or any combination of these symptoms in the arm, shoulder, or neck
- If you have a herniated disk in the lumbar spine, you may have pain, tingling, numbness, weakness, or any combination of these symptoms in the back, buttocks, or legs; most likely, your symptoms will be on only one side of your body
Often, symptoms from herniated disks are made worse by certain
activities or positions. If you have a herniated disk in the lumbar
spine:
- Pain may get worse with sitting, bending, and reaching
- Pain may be worst first thing in the morning and after staying in one position for a long time
- You may need to switch positions frequently
- You may prefer to stand rather than sit
If you have a herniated disk in the neck, symptoms are often worse with prolonged sitting and when lying down.
How Is It Diagnosed?
Your physical therapist will conduct a thorough evaluation that
includes a review of your medical history and will use screening tools
to determine the likelihood of a herniated disk. For example, the
therapist will:
- Ask you very specific questions about the location and behavior of your pain, weakness, and other symptoms
- Ask you to fill out a body diagram to indicate specific areas of pain, numbness, and tingling
- Perform tests of muscle strength and sensation to determine the severity of the pressure on your nerves
- Examine your posture and observe how you walk and perform other activities
- Measure the range of motion of your spine and your arms and legs
- Perform special tests, such as the straight leg raise test or the
crossover straight leg raise test, that help diagnose a herniated disk
- Use manual therapy to evaluate the mobility of the joints and muscles in your spine
- Test the strength of important muscle groups
If you have muscle weakness and loss of sensation or very severe
pain, special diagnostic tests, such as magnetic resonance imaging
(MRI), electromyography, or nerve conduction studies may be needed.
Physical therapists work closely with physicians and other health care
providers to make certain that you receive an accurate diagnosis and
appropriate treatment.
Research shows that in all but the most extreme cases (usually
involving muscle weakness or high levels of pain), conservative care,
such as physical therapy, has better results than surgery.
If your physical therapist’s evaluation indicates that there are no
signs of nerve compression and you don't have any signs of muscle
weakness or numbness, treatment can begin right away. If the evaluation
indicates that the herniated disk might be compressing the nerves, your
therapist will consult with a physician specialist.
How Can a Physical Therapist Help?
Your physical therapist's overall purpose is to help you continue
to participate in your daily activities and life roles. The therapist
will design a treatment program based on both the findings of the
evaluation and your personal goals. Your treatment program most likely
will include a combination of exercises.
Your therapist will design:
- Exercises that involve specific movements to relieve nerve pressure
and decrease pain and other symptoms, especially during the early stages
of treatment
- Stretching and flexibility exercises to improve mobility in the
joints and the muscles of your spine, arms, and legs—improving motion in
a joint can be key to pain relief
- Strengthening exercises—strong trunk muscles provide support for
your spinal joints, and strong arm and leg muscles help take some of the
workload off those joints
- Aerobic exercise, which has been proven to be helpful in relieving
pain, promoting a healthy body weight, and improving overall strength
and mobility—all important factors in managing a herniated disk
This might sound like a lot of exercise, but don't worry: research
shows that the more exercise you can handle, the quicker you'll get rid
of your pain and other symptoms.
Your physical therapist also might decide to use a combination of other treatments:
- Manual therapy to improve the mobility of stiff joints and tight muscles that may be contributing to your symptoms
- Posture and movement education to show you how to make small changes
in how you sit, stand, bend, and lift—even in how you sleep—to help
relieve your pain and help you manage your condition on your own
- Special pain treatments—such as ice, traction, and electrical
stimulation—to reduce pain that is severe and not relieved by exercise
or manual therapy
Once your pain is gone, it will be important for you to continue your new posture and movement habits to keep your back healthy.
Can this Injury or Condition be Prevented?
Herniated disks can occur as a result of aging, but there are lifestyle changes you can make to reduce your overall risk:
- Maintain a healthy weight may reduce the overall stress on your spine
- Use proper posture—improving your alignment may contribute to the health of your spine
- Use proper body mechanics—changing how you perform activities,
especially those that you do frequently, may help reduce your risk of a
herniated disk. Not sure what changes to make? Discuss your occupation
with your therapist, who will provide an analysis of your job tasks and
make suggestions on how you can reduce your risk of injury.
Many physical therapy clinics conduct regular educational seminars to
help people in the community learn to take care of their backs and
necks. These seminars often are free and provide demonstrations along
with written information about exercises for the back and neck,
instruction on proper lifting and sitting postures, and other tips to
keep your back healthy.
If you already have a herniated disk, your physical therapist can
help you develop a fitness program that takes into account your
herniated disk. There are some exercises that are better than others for
people with a herniated disk, and your therapist will educate you about
them. For instance:
- Exercising in water can be a great way to stay physically active when other forms of exercise are painful
- Exercises involving lots of twisting and bending are not good for everyone
- Weight-training exercises, though very important, need to be done with proper form to avoid stress to the back and neck
