A Disc Herniation is a painful spinal condition that can have debilitating consequences if left untreated. It occurs when the soft jelly-like center of one or more of your vertebrae ruptures and presses outwards through the disc’s outer covering. That’s not to say that you should avoid heavy lifting, as this activity is an inevitable part of almost any job! It is a matter of making sure that you take precautions beforehand to reduce your risk as much as possible. In this article, we will explore what a herniated disc is and its common symptoms, treatments, and risks associated with it.
Most People Have Disc Herniations
Let’s face it, a lot of people have disc herniations. The chances are good you have one. Here is some research that highlights this:
- Thirty-six percent of the 98 asymptomatic subjects had regular disks at all levels.
- With the results of the two readings averaged, 52 percent of the subjects had a bulge at least one level, 27 percent had a protrusion, and 1 percent had an extrusion.
- Thirty-eight percent had an abnormality of more than one intervertebral disk.
- The prevalence of bulges, but not protrusions, increased with age. The most common non-intervertebral disk abnormalities were Schmorl’s nodes (herniation of the disk into the vertebral-body endplate), found in 19 percent of the subjects; annular defects (disruption of the outer fibrous ring of the disk) in 14 percent; and facet arthropathy (degenerative disease of the posterior articular processes of the vertebrae), in 8 percent.
- The findings were similar in men and women.
A little more research:
- One-third of the subjects were found to have a substantial abnormality.
- Of those less than sixty, 20 percent had a herniated nucleus pulposus, and one had spinal stenosis.
- In the sixty-year-old or older group, the findings were abnormal on about 57 percent of the scans: 36 percent of the subjects had a herniated nucleus pulposus, and 21 percent had spinal stenosis.
- There was degeneration or bulging of a disc at least one lumbar level in 35 percent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old issues.
I know you are thinking, “Man, my back must be messed up.”
Let’s talk about your neck now:
- Abnormality in 19 percent of the asymptomatic subjects
- Of the 19 percent, 14 percent of those who were less than forty years old and 28 percent of those who were older than forty
- Of the less than forty subjects, 10 percent had a herniated nucleus pulposus, and 4 percent had foraminal stenosis.
- Of the subjects older than forty, 5 percent had a herniated nucleus pulposus, 3 percent bulging of the disc, and 20 percent foraminal stenosis.
- Narrowing of disc space, degeneration of a disc, spurs, or cord compression were also recorded.
- The disc was degenerated or narrowed at one level or more in 25 percent of the subjects who were less than forty years old and in almost 60 percent of those older than forty.
- VERY IMPORTANT, AND THIS APPLIES AS WELL TO EXERCISE PRESCRIPTION – The prevalence of abnormal magnetic-resonance images of the cervical spine-related to age in asymptomatic individuals emphasizes the dangers of predicting operative decisions on diagnostic tests without precisely matching those findings with clinical signs and symptoms.
If 52% of People Have a Disc Herniation, What Are We Doing to Keep Them Out of Lumbar Flexion?
My life in lumbar flexion:
- When I go to my family doctor, I sit on my bicycle and bike there. Sitting on my bike puts me into lumbar flexion.
- When I go to the Chiropractor, I drive there. My truck seat puts me into lumbar flexion.
- When I go to the physical therapist, I sit on the edge of the treatment bed, which puts me into lumbar flexion.
- When I go to the massage therapist, I sit in the waiting room on a firm hard chair, which puts me into lumbar flexion.
- If you do what Dr. Stu McGill calls the “Midnight Mambo,” this puts you into lumbar flexion.
It is nearly impossible to avoid lumbar flexion, and a lot of what we do daily puts us into it.
It is probably more important to look at duration, frequency, and load compared to the act of lumbar flexion.
Plus, it is tough to think all of the above is okay, but doing 30 seconds to 60 seconds of exercise will be the thing that slips your disc or causes a disc herniation.
What Kind of Client do You See?
The setting I work in will affect the type of disc herniation client that I would see.
When I worked in a Medical Rehabilitation Program (MRP), I would see the worst of the worst. The disc herniation clients I would see had all kinds of symptoms and limitations. The ones that tried Physical Therapy, chiropractic, Massage Therapy, etc. but did not get better.
The MRP worked because the sports medicine doctor would see each client; he would let me know the medical findings and then provide direction for the exercise program. Then I would design, implement, supervise and progress the exercise program.
Looking at all the settings I have worked in, the type of disc herniation client varied. The client differed depending on if they were in a Work Hardening Program, Occupational Rehabilitation Program, Chronic Pain Program, Physical Therapy Clinic, Community Based Rehab, Personal Training Studio, Gym, or Recreation Centre.
We see or hear something and think of the typical client that we see or that we come across in our work environment.
Now I see clients that have finished their medical care and have been cleared to start an exercise program. They have an injury, limitations, and an area I need to focus on. Based on their injury, function, and goals, I need to know which exercises will help or make things worse.
We Like to Focus on What Not to Do
When I go to the doctor, my list of what I should not be doing is longer than my list of what I should be doing.
I often leave with the fear that if I do anything, I will make it worse.
I feel I should lie on the floor and not move.
I wonder if I breathe too hard that will make things worse.
I felt this way after my car accident or after seeing my physical therapist when I flared up my back and had all kinds of neurological signs.
Now my guidelines are simple.
- Movement is good for you.
- Focus on the movements you can do.
- Workaround the movements you can’t do.
- Do what you can with the movement you have.
- Work on constantly improving your movements.
Have We Drunk Too Much of the McGill Cool-Aide?
I remember when Paul Hodges came out with his research on transverse abdominis activation and how this was now going to save the world from back pain.
I remember when Paul Chek came out with his concept of core training and how this was going to save the world from back pain.
I remember when Juan Carlos Santana did all kinds of core exercises with the stability ball, and now this was going to save the world from back pain.
Now everyone is quoting Dr. Stu McGill on bits and pieces of his research and how this will save the world from back pain.
I wonder what will be next.
Hodges, Chek, and Santana were in the very 1990s. McGill was very 2000; let’s see what comes up in the rest of this decade.
Stu McGill’s Research Says…
I have two of Stu’s books.
I have organized a conference and brought him to Vancouver. I have attended his course.
I have heard him talk at another conference. I have read a few of his research articles of his 147 that are on PubMed.
I use his information as a piece of my core exercise continuum.
I can’t say that I have read and know all of his research.
He has probably forgotten more about the back and his research than I know about the back.
Corrective Exercise is Not For Acute Clients
Corrective exercise has a lot of misconceptions around it.
One of them is what an acute client should be doing it.
When I worked with acute clients, I never did any corrective exercise.
I use corrective exercise for healthy individuals who need to have specific movements restored.
- Stage of Recovery – This will play a role in deciding the exercise. Whether they are acute, sub-acute, or chronic will play a role in the activities they need to do.
- Guest Blog Posts – I like to let guests speak their minds. I wouldn’t say I like censoring them. I want to hear their perspective because their education, learning, and experience differ from mine. Many times this leads to discussion, which is excellent.
- McKenzie Protocol – I like this system and have hosted them in Vancouver before. I find it very effective for SI Joint pain.
.Just a reminder that this month’s Injury of the Month is ready to go. It is Piriformis Syndrome.
Rick Kaselj, MS