What is Disc Herniation?
Between each vertebrae of the spine are intervertebral discs, or cushions for support and mobility of the spine. The intervertebral discs act as shock absorbers for the spine.
The center of the disc, which is a liquid like substance, is called the nucleus pulposus. The annulus fibrosus is a fibrous tissue that surrounds the nucleus pulposus. Disc herniation is a bulging of the nucleus pulposus into the annulus fibrosus of the intervertebral disc.
When the disc herniation pinches the spinal nerve you may experience pain down your leg if the disc herniation is in the lower back, or pain down your arm if the disc herniation is in the neck.
Disc herniation can occur at any spinal level, although it is most common in the lumbar spine, followed by the cervical spine.
The incidence of a herniated disc is about 5 to 20 cases per 1000 adults annually (Dydyk, Massa, & Mesfin, 2020). Lumbar disc herniation is one of the most common causes of low back pain (Kerr, Zhao, & Lurie, 2015).
The most common levels of disc herniation of the lumbar spine are L4-L5 and L5-S1. The most common levels of disc herniation of the cervical spine are C5-C6 and C6-C7.
90% of people who experience back pain due to a disc herniation will have a decline in symptoms within 6 weeks. Herniated discs are more common in people over the age of 30, and are about twice as common in men as they are in women (Institute for Quality and Efficiency in Healthcare, 2020).
Symptoms of Disc Herniation
It is possible to be asymptomatic. Some people don’t realize they have a disc herniation until symptoms begin or it is identified on specialized imaging. The symptoms experienced are dependent on where the disc herniation is located, whether it is in the neck or the lower back.
- Neck pain: if the disc herniation is in your neck it can cause neck pain with stiffness, tightness, and decreased range of motion
- Low back pain: if the disc herniation is in your lower back it can cause back pain with stiffness, tightness, and decreased range of motion
- Shooting pain: pain can shoot down your arm or leg. The pain may feel “electric” and go from your neck down your arm or from your back down your leg
- “Pins and Needles”: you may have abnormal sensation such as the feeling of “pins and needles” or numbness in your arm or leg
How Can Disc Herniation Impact Your Health?
If left untreated, disc herniation may continue to affect the sensory and/or motor function of your upper or lower extremity.
- Motor Weakness: you may have weakness in your arm or leg that can lead to clumsiness, difficulty preforming certain tasks with your upper extremity, or difficulty walking in advanced cases. Decreased motor function can be associated with poor balance and an increased risk of falls.
- Abnormal Sensation: you may have abnormal sensation such as “pins and needles” or numbness in your arm or leg that can get progressively worse. Numbness may impact proprioception and balance.
Risk Factors for Disc Herniation
Disc herniation is caused by “wear and tear” and dehydration of the discs. “Wear and tear” can be caused by occupational demands such as repetitive lifting, twisting, pushing, pulling, and bending, especially with heavy loads. The discs may lose their pliability and become dehydrated from smoking and weight gain.
- Occupational Demands: Persons who perform repetitive lifting, twisting, pushing, pulling, and bending, especially with heavy loads are predisposed to disc herniation
- Weight Gain: Obese and overweight persons are more prone to disc herniation due to increased weight on the discs
- Smoking: Persons who smoke may experience “drying” of the disc due to less oxygenation of the intervertebral disc
Potential Complications of Disc Herniation
In rare cases, disc herniation can be an emergency. If the disc protrudes into the spinal canal restricting the nerves of the cauda equina, the patient may experience bilateral weaknesses, loss of sensation in a saddle anesthesia presentation of the inner thighs and around the rectum, and deficits of function of their bowel and bladder control.
Prevention Strategies
To prevent disc herniation it is important to consider lifestyle factors such as staying active, preventing weight gain, and avoiding smoking.
Also consider the importance of proper posture and ergonomics in the workplace. Sit with proper posture and perform occupational tasks such as lifting with proper posture.
Avoid compromised postures, such as sitting for prolonged periods of time with slumped forward posture. While seated your head should be retracted back so your ears are over your shoulders, your shoulders are pulled back and not slouched forward, your hips are underneath your shoulders, your knees are at a 90 degree angle with your knees over your ankles, and your feet flat on the ground facing forward. Avoid crossing your legs, slouching your spine, looking down for prolonged periods of time, and shifting your hips forward in your chair.
Avoid lifting heavy objects by bending forward at the waist. For proper lifting posture, stand close to the item you are lifting, bend with your legs not from your hips, keep your back straight, and make sure you have proper balance. Lift the item up straight and do not twist your spine while lifting. Hold the item close to your body so it is easier to lift.
Treatment Options
Conservative treatments for the management of pain associated with disc herniation may include:
- Postural correction
- Ergonomics
- Chiropractic
- Physical therapy
- Acupuncture
- Yoga
These treatment options are not considered medical advice. Please consult your physician if you think you are having an emergency and for information regarding medication and surgery.
How We Can Help
We recommend considering conservative treatment options. To determine if you are a good candidate for conservative care, we recommend a consultation and a complete posture analysis for specialized patient centered care options.
References:
Burns, K. (2020) Disc Herniation and Posture, American Posture Institute Blog
Dydyk, A. M., Massa, R. N., & Mesfin, F. B. (2020). Disc Herniation. StatPearls [Internet].
Kerr, Dana, Wenyan Zhao, and Jon D. Lurie. “What are long-term predictors of outcomes for lumbar disc herniation? A randomized and observational study.” Clinical Orthopaedics and Related Research® 473.6 (2015): 1920-1930.
Slipped Disk: Overview, National Library of Medicine, PubMed Health. 2020.
Institute for Quality and Efficiency in Healthcare.
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