Physical Therapy Guide To Herniated Disk
A herniated disk occurs when the cushion-like cartilage between the bones of the spine is torn, and the gelatin-like core of the disk leaks. Often mistakenly called a slipped disk, a herniated disk can be caused by sudden trauma or by long-term pressure on the spine. This condition most often affects people aged 30 to 50 years men are twice as likely to be diagnosed as women. Repeated lifting, participating in weight-bearing sports, obesity, smoking, and poor posture are all risk factors for a herniated disk. The majority of herniated disks do not require surgery, and respond best to physical therapy. Physical therapists design personalized treatment programs to help people with herniated disks regain normal movement, reduce pain, and get back to their regular activities.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Are The Symptoms Of A Slipped Disc
You can have a slipped disc in any part of your spine, from your neck to your lower back. The lower back is one of the more common areas for slipped discs. Your spinal column is an intricate network of nerves and blood vessels. A slipped disc can place extra pressure on the nerves and muscles around it.
Symptoms of a slipped disc include:
- pain and numbness, most commonly on one side of the body
- pain that extends to your arms or legs
- pain that worsens at night or with certain movements
- pain that worsens after standing or sitting
- pain when walking short distances
- unexplained muscle weakness
- tingling, aching, or burning sensations in the affected area
The types of pain can vary from person to person. See your doctor if your pain results in numbness or tingling that affects your ability to control your muscles.
What Are The Symptoms Of Lumbar Disk Disease
The symptoms of lumbar disk disease vary depending on where the disk has herniated, and what nerve root it is pushing on. These are the most common symptoms of lumbar disk disease:
Intermittent or continuous back pain. This may be made worse by movement, coughing, sneezing, or standing for long periods of time
Spasm of the back muscles
Sciatica pain that starts near the back or buttock and travels down the leg to the calf or into the foot
Muscle weakness in the legs
Numbness in the leg or foot
Changes in bladder or bowel function
The symptoms of lumbar disc disease may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
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When & How To Seek Medical Care
Fortunately, the majority of herniated discs do not require surgery. With time, the symptoms of sciatica/radiculopathy improve in approximately 9 out of 10 people. The time to improve varies, ranging from a few days to a few weeks.
- Limit activities for 2 to 3 days. Walking as tolerated is encouraged, along with an anti-inflammatory, such as ibuprofen, if not contraindicated for the patient. Bedrest is not recommended.
- Primary care evaluation during this time may lead to considering other non-surgical treatments noted below, such as physical therapy.
- Radiographic imaging, such as an MRI, is not recommended by the American College of Radiology, unless symptoms have been present for six weeks.
- Referral to a spine specialist, such as a neurosurgeon, is also recommended if symptoms persist for greater than four weeks. A specialist will often want advanced imaging, such as the MRI, completed prior to the appointment.
- Urgent evaluation and imaging is recommended if there are symptoms of significant leg/arm weakness, loss of feeling in the genital/rectal region, no control of urine or stool, a history of metastatic cancer, significant recent infection or fever AND radiculopathy or a fall/injury that caused the pain. Imaging should also be considered earlier for findings of progressive neurologic deficit on exam.
Moderate Physical Activity Releases Endorphins
While it may seem counterintuitive, staying active can provide pain relief if you have a lumbar herniated disc. When you exercise the body releases endorphins, which can naturally improve your mood3 and reduce the perception of pain.
Most people with lumbar herniated discs are able to tolerate low-impact activities such as:
- Walking outside or on a treadmill
- Using an elliptical trainer
Read more about Low-Impact Aerobic Exercise
If your pain is more severe, you may want to try a water-based activity, such as hydrotherapy. Water-based activities are often recommended because the buoyancy of water counteracts gravity and decreases the load bearing placed on your spinal discs. Your health care provider may suggest a dedicated water physical therapy program or swimming.
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Surgery For A Slipped Disc Is An Option
During surgery for a herniated disc, the surgeon removes the herniated fragment thats near the nerve. This can be done with an open surgery or minimally invasively.
I do a minimally invasive procedure called a tubular microdiscectomy, Dr. Dowdell says. Afterward, you have about two weeks where your back is sore from the surgery itself, and for the first six weeks your mobility is limited. You want to avoid things like bending or twisting at the waist or lifting anything that weighs more than 10 pounds. Some lingering symptoms like leg pain may remain for up to three months after the surgery, but once youre completely healed, the pain should be gone.
The risk of reinjuring the same disc is very low, though people who have had one herniated disc have a slightly increased chance of having another one.
When To Speak With A Doctor
Practicing good posture, exercising regularly, and healthful eating can often improve back pain without speaking with a doctor.
A person should consult with a healthcare professional if they have back pain that worsens over time or accompanies other symptoms, such as bowel or bladder control issues.
People experiencing severe back pain following trauma or physical exertion may also need to speak with a doctor.
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How Is Lumbar Disk Disease Treated
Typically, conservative therapy is the first line of treatment to manage lumbar disk disease. This may include a mix of the following:
Education on proper body mechanics
Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
Use of a lumbosacral back support
Medicine to control pain and relax muscles
If these measures fail, you may need surgery to remove the herniated disc. Surgery is done under general anesthesia. Your surgeon will make an incision in your lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the disc. Your surgeon will remove the herniated part of the disc and any extra loose pieces from the disc space.
After surgery, you may be restricted from activity for several weeks while you heal to prevent another disc herniation. Your surgeon will discuss any restrictions with you.
What Kind Of Physical Therapist Do I Need
All physical therapists are prepared through education and experience to treat people who have low back pain as a result of a herniated disk. You may want to consider:
- A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal, problems.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when youâre looking for a physical therapist:
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapistsâ experience in helping people with a herniated disk.
- Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
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Treating A Herniated Disc
Could I Have A Herniated Disk
Back pain can sneak up on you when you least expect it. One minute you’re sitting comfortably in front of the TV, and the next you try to stand up, and — ouch! — a sharp pain radiates through your lower back.
Could you have a slipped or herniated disk? You might.
The adult spine is made up of 24 bones called vertebrae. Some of the vertebrae are cushioned by soft disks made of a jellylike substance. These disks allow you to move your spine around and bend over.
But if a disk between two vertebrae starts slipping out of place, it can irritate the surrounding nerves and cause extreme pain. The condition is called a slipped, ruptured, or herniated disk.
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How Do You Know If Back Pain Is Pinched Nerve
Signs and Symptoms of Nerves Being Compressed
When Should I See A Doctor
Initially, you can treat herniated disk pain at home. But you should see your doctor if:
- Pain interferes with daily life, like going to work.
- Symptoms arent better after four to six weeks.
- Symptoms get worse.
- You develop loss of bladder or bowel control.
- You notice tingling, numbness or loss of strength in your arms, hands, legs or feet.
- You have trouble standing or walking.
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Symptoms Of Herniated Lumbar Disc:
Lower back pain Leg pain Leg numbness or tingling Pain is worse from sitting Restricted trunk flexionSciatica pain
Please note, a herniated disc DOESNT always cause pain, so you must get a proper diagnosis.
Lower back pain is typically the first symptom of a lumbar disc herniation. Often this pain will last for a few days and then subside, but leg pain, numbness or tingling, and/or weakness of the lower extremity often follows.
Typically the leg pain eventually travels below the knee and can even affect the ankle and foot.
How long does the pain last?
Most patients with a lumbar disc herniation will improve gradually over a period of days to weeks, with most patients being symptom free within 3 to 4 months.
Patients that actively participate in an exercise program often report a significant reduction of pain and improved ability to perform their activities of daily living.
When Is Surgery Needed To Fix A Herniated Disc
“For patients whose symptoms do not subside with other treatments, surgery may be necessary,” Dr. Vega-Lelkes says.
Your doctor may recommend surgery if:
- Symptoms haven’t improved after six weeks of nonsurgical treatment
- A disc fragment lodges in your spinal canal and presses on a nerve, causing progressive weakness
- You have difficulty performing basic activities, such as standing or walking
In most cases, the surgeon removes the protruding section of the disc. Rarely, the entire disc must be removed and the vertebrae fused with metal hardware to stabilize the spine. Your surgeon could also suggest implanting an artificial disc.
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How Is A Herniated Disk Diagnosed
Your healthcare provider will do a thorough exam. During the physical, your provider will assess your pain, muscle reflexes, sensation and muscle strength. Your provider may also order tests such as:
- Magnetic resonance imaging : The most common and accurate imaging test for a suspected herniated disk is an MRI.
- X-rays: Getting X-rays helps rule out other causes of back or neck pain.
- Computed tomography : A CT scan show the bones of your spine. Herniated disks can move into the space around your spinal cord and nerves and press on them.
- Myelogram: A myelogram involves an injection of dye into your spine using X-ray guidance for a CT scan. The dye can reveal a narrowing of the spinal canal and location of your herniated disk.
- Electromyogram : This test involves placing small needles into various muscles and evaluate the function of your nerves. An EMG helps determine which nerve a herniated disk affects.
Treatment For A Herniated Disk
Dr. Pelle says there are some treatment options that can bestarted right:
- Ice and rest.
- Medication .
- A dose pack of steroids.
Surgery is an option for some people who fit the criteriafor it.
I always tell people that there are three prerequisites forsurgery, says Dr. Pelle. You have to have had the pain for at least six weeks.You have to fit the requirements from the physical examination and medical history.And we need to have a serious conversation about how bad the pain is botheringyou and affecting your quality of life.
Surgery on the spine is serious and should be weighed accordingly.
If you think youre dealing with a severe herniated disk orthe pain just wont go away, schedule an appointment with your doctor.
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What Is A Herniated Lumbar Disc
A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall .The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if low back and/or leg pain is going to resolve it will do so in about 6 weeks.
Different terms may be used to describe a herniated disc. A bulging disc occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal.
Most herniated discs occur in the lumbar spine, where spinal nerves exit between the lumbar vertebrae, and then join together again to form the sciatic nerve, which runs down your leg.
What To Do If You Have A Bulging Disc In Your Lower Back
by Dr. Don DuffAug 8, 2018
Bulging discs in the lower back are a common cause of back pain. By definition, this condition is a weakening of the outer lining of the disc that allows the inner layers to push out and bulge the outer rim of the disc. There are varying levels of severityfor instance, a herniated disc is when the nucleus of the disc is actually protruding. The more severe the case, the more advanced treatment youll need. But most bulging disc pain can be treated with natural remedies, in many cases giving the abnormal disc the time it needs to repair itself.
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Who Is At Risk For Lumbar Disk Disease
Although age is the most common risk, physical inactivity can cause weak back and abdominal muscles, which may not support the spine properly. Back injuries also increase when people who are normally not physically active participate in overly strenuous activities. Jobs that require heavy lifting and twisting of the spine can also cause back injuries.
Video: Lumbar Herniated Disc
Symptoms of a lumbar herniated disc can include pain along the nerves of the leg.Watch Now
In the vast majority of cases, the pain eases within six weeks. But despite its short duration, the pain can be excruciating and make it difficult to participate in everyday activities and responsibilities. For some, the pain can become chronic and/or debilitating.
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