Disc herniation diagnosis - What does that mean?

Disc herniations are a relatively common injury with a similar mechanism of injury as that of a disc bulge. They are a progression of disc injury, and therefore considered a more serious injury. There are four classifications of disc injury:

·      Disc bulge- protruding but still confined inside the outer layer.

·      Disc prolapse-protruding into the outer fibers of the outer layer of the disc

·      Disc extrusion- pushing out of the borders, part of the fluid filled disc starts moving into the epidural space

·      Disc sequestration- the disc has burst out of the inner casing and is free floating in the epidural space

This movement of disc fluid into the epidural space causes risk of pressure build up on or near the spinal cord, which can result in muscle weakness and/or numbness and tingling down the hips or legs. Just like with disc bulges, people’s symptoms can be different. Different postures, positions, and activities can affect the pressure on the disc.

Activities that increase pressure at the low lumbar disc and amount of pressure increase:

·      Coughing/Straining: 5-35% increased pressure

·      Laughing: 40-50% increased pressure

·      Walking: 15% increased pressure

·      Side Bending: 25% increased pressure

·      Small jumps: 40% increased pressure

·      Bending Forward: 150% increased pressure

·      Rotation: 20% increased pressure

·      Lifting a 20 kg weight with knees bent and back straight: 73% increased pressure

·      Lifting a 20 kg weight with knees straight and back bent (BAD!): 169% increased pressure

So as you can see, bending forward and lifting weight with poor mechanics loads your spine in a very unsafe way, risking an initial flair up, or a progression of disc injury. 

What if you or someone you know has a disc herniation already? You may be asking questions such as: 

What are my next steps? Do I need surgery? Am I always going to be in pain?

 Here are some “Favorable Factors” a physical therapist considers when assessing a patient's symptoms, and when a patient asks these questions. Knowing these factors gives us an idea of how you might improve, but is never a guarantee.

Favorable Factors include:

·      Spinal motion into extension that does not reproduce leg pain

·      Relief of more than 50% of leg pain symptoms within the first 6 weeks of onset

·      Positive response to corticosteroid treatment

·      Self employed

·      Motivated to recover and return to function

·      Educational level >12 years

·      Good prior fitness level

·      Progressive return for numbness and tingling symptoms within the first 12 weeks

Overall, disc injuries can be very frustrating, but many situations improve with conservative treatment including diligent adherence to your home exercise program and therapy plan. If you have questions related to a disc injury you or someone you know is dealing with, reach out to us to learn more about how Balanced Physical Therapy can help!