Disc Herniation: Understanding Symptoms, Causes and Treatments

Back pain is a widespread symptom, with approximately 80% of the population experiencing it at least once in their lifetime. Among the many causes of low back pain, the most frequent is intervertebral degeneration, which leads to lumbar disc herniation and degenerative disc disease. (Mustafa I. Al Qaraghli; Orlando De Jesus, NIH, August 23, 2023)

Disc herniation is a common condition affecting any part of the spine. It often occurs in the lumbar or cervical region, causing pain ranging from mild to severe. The approach to understanding this condition encompasses biological mechanisms, risk factors, and available therapeutic alternatives.

Figure 1: Normal disc versus herniated disc

Source: commons.wikimedia

What is a Herniated Disc?

A herniated disc occurs when an intervertebral disc, which serves as a cushion between two vertebrae, develops a crack or displacement of the inner material. This displacement puts pressure on adjacent nerves, leading to painful symptoms. The body can usually adapt to this displacement of disc material, but in about 20% of cases, the displacement compresses the adjacent nerve and can cause symptoms of pain, loss of sensation, or weakness in the leg.

It’s important to note that most disc herniations are located in the lower back, mainly because these regions are subjected to significant pressure during daily movements such as lifting heavy objects or simply walking. Additionally, the ligamentous structures covering the back of the spine are thinner at the lumbar level, which means the disc has more possibility to deform backward. Disc herniation can also appear at the cervical or thoracic level, causing pain in the arms and shoulders for cervical herniation and the trunk for thoracic herniation.

Mechanism and Potential Causes of Disc Herniation

The intervertebral disc comprises a tough, fibrous outer layer and a gelatinous inner substance. Over time or under prolonged forces, the outer wall can weaken, deform, and tear, allowing the central nucleus to move. This protrusion then compresses the surrounding nerve structures.

Common causes include repetitive movements, sudden trauma to the spine, or a general decrease in muscle strength due to age. Physically demanding occupations and poor posture while sitting more than standing are also frequent causes of this condition.

Associated Symptoms

Symptoms vary depending on the location and severity of the herniation. The most common sensations are shooting or continuous pain in the affected area, sometimes accompanied by muscle weakness or numbness along the affected limbs.

While a herniation may be present without causing apparent pain, the symptoms become markedly more intense when it irritates or compresses a nerve. For example, a lumbar herniation could generate sciatic pain, radiating down the leg and even to the sole of the foot.

How to Diagnose a Herniated Disc

Identifying a herniated disc generally begins with a clinical examination based on the patient’s symptoms and specific tests by the physiotherapist or doctor. However, to specify the extent and exact location of the herniation, imaging techniques such as magnetic resonance imaging (MRI) are used to confirm clinical signs. This examination allows detailed visualization of the soft and bony structures of the spine.

Title: MRI with a double disc herniation

Source: https://upload.wikimedia.org/wikipedia/commons/8/84/Hernie_discale_L4_L5.png

Electrodiagnostic tests, such as electromyography or nerve conduction studies, help evaluate the degree of involvement and the state of compressed nerves, thus determining the extent to which the nerve is compressed and, more precisely, the necessary treatment.

Herniated Disc: Therapeutic Approaches

Management of a herniated disc depends on the severity of the symptoms and their impact on the patient’s daily life. For many people, physiotherapy treatment, which initially aims primarily to relieve pain, reduce inflammation, and restore mobility, is effective. Physiotherapy treatment will then aim to strengthen muscle groups surrounding the lumbar region, address the causes of sciatica to prevent recurrence, and develop a home exercise program.

Here are things to do during the acute phase of your sciatica or lower back pain:

Rest: Avoid activities that worsen the pain, but don’t stay bedridden for too long.

Medications: painkillers, anti-inflammatory drugs, and muscle relaxants can help reduce pain and inflammation.

Application of heat or cold: These methods can help relieve pain and reduce inflammation.

Physiotherapy: specific exercises to try to reduce pain and restore mobility:

1- Try lying on your stomach and supporting yourself on your forearms for 30 to 60 seconds; if you feel relief or a reduction in your back symptoms, try doing this 3-4 times every 2 hours.

2- If you feel better after the previous exercise, you can progress to the next exercise; 12 repetitions every 2 hours should be sufficient.

3-Stretch your back in a 4-point kneeling position; if you feel relief or a reduction in your back symptoms, try doing this 3-4 times every 2 hours.

 

Alternative approaches: Some people find relief through alternative therapies such as acupuncture

Surgery: In severe or persistent cases, surgical intervention, such as a discectomy, may be necessary to remove the herniated portion of the disc.

Although surgery has a high satisfaction rate, like any invasive procedure, it carries risks and subsequently requires a period of vigorous rehabilitation.

How to Prevent a Herniated Disc?

Minimizing the risks of disc herniation inevitably involves a set of good postural practices. Maintaining proper posture, especially in prolonged sitting positions, regularly engaging in gentle but consistent physical activity, and being mindful of one’s weight are all essential preventive measures. Recommended activities include:

• Walking: a simple and accessible activity that strengthens back muscles and improves blood circulation. Regular walking for 30 minutes a day can make a big difference.
• Swimming: Water supports the body, particularly reducing pressure on the spine. Swimming strengthens back, shoulder, and abdominal muscles without impact.
• Yoga: Certain yoga poses can strengthen back muscles and improve flexibility. Poses such as cat-cow, cobra, and bridge are particularly beneficial. It’s essential to practice yoga with a qualified instructor to avoid injuries.
• Pilates: Pilates focuses on strengthening core muscles, which helps stabilize the spine. Pilates exercises also improve posture and flexibility.
• Tai Chi: Tai Chi combines slow, fluid movements with deep breathing. It improves balance, coordination, and flexibility while particularly reducing stress.
• Gentle stretching: Regular stretching of back muscles, hamstrings, and hips can help maintain flexibility and reduce tension on the spine. It’s essential to consult a physiotherapist to ensure you’re doing the right exercises adapted to your condition.
• Cycling: Cycling, especially on flat terrain, can be a gentle activity to strengthen back and leg muscles. Make sure you have good posture and a well-adjusted bike. It’s essential to consult a physiotherapist to determine if an exercise in a seated position suits you; this may be problematic if you have a prolonged sitting job.

For those whose work involves repetitive movements or lifting heavy loads, it is recommended that they select ergonomic equipment and strictly adhere to safety principles when handling such material.

Summary

What are the differences between disc herniation and disc protrusion?

Disc herniation is a term that encompasses four different stages or phases. Disc protrusion, also called disc bulging, is one of the possible types of disc herniation.

Here are the different types of disc herniation:

1- Disc degeneration: a slight intervertebral disc deformation, where the nucleus pulposus remains well contained within the annulus fibrosus. Disc degeneration is generally less severe than the following stages of herniation. It is often asymptomatic or may cause mild to moderate lower back pain. Treated with physiotherapy.

2- Disc protrusion or disc bulging: a intervertebral disc deformation where the nucleus pulposus remains within the annulus fibrosus. Disc protrusion is generally less severe than the following stages of herniation. It can be asymptomatic or cause mild to moderate pain, depending on the pressure exerted on surrounding nerve structures. Treated with physiotherapy.

3- Disc extrusion: a significant deformation of the intervertebral disc where the nucleus pulposus is at the limit of the annulus fibrosus but still inside it. Treated with physiotherapy.

4- Disc sequestration: the annulus fibrosus is cracked or ruptured, allowing the nucleus pulposus to exit from its normal position. This condition is the most severe disc herniation and most likely requires surgical intervention. It is difficult to treat with physiotherapy, but a treatment attempt by a physiotherapist specialized in the McKenzie Method should be undertaken in parallel with orthopedic surgery consultations.

In the case of a disc herniation, the annulus fibrosus is cracked or ruptured, allowing the nucleus pulposus to exit from its normal position. On the other hand, disc protrusion is a deformation of the intervertebral disc, where the nucleus pulposus remains contained within the annulus fibrosus.

However, the annulus fibrosus is weakened or bulging, causing a slight disc protrusion. This condition is often considered an early stage of disc degeneration. Disc protrusion can remain stable but can also evolve into a disc herniation if the annulus fibrosus cracks.

Disc protrusion is generally less severe than disc herniation. It can be asymptomatic or cause mild to moderate pain, depending on the pressure exerted on surrounding nerve structures.

Conclusion: Although disc herniation is common, it is not inevitable. Physiotherapy and musculoskeletal medicine can effectively manage most cases, thus offering quality of life and autonomy to affected individuals. Thanks to a team of experienced specialists and advanced training, the AMS Clinic provides personalized solutions to each patient. If you suffer from a herniated disc, don’t hesitate to consult our physiotherapy service to regain comfort and mobility.