Our SHIFT physical therapists continue the injury spotlight series on common ailments and exercises to aid in pain relief. For more information about common injuries and physical therapy solutions, please visit our blog.
What is a lumbar disc herniation?
A disc herniation, also known as a protruded or ruptured disc, is a condition commonly diagnosed in the low back. The injury occurs when the jelly-like center (nucleus pulposus) of an intervertebral disc protrudes through the outer fibrous ring (annulus fibrosus). The intervertebral discs between spinal vertebrae are important for shock absorption during walking, running, or other physical activities. The protrusion of the nucleus pulposus material, beyond the annular ring of the intervertebral disc, puts pressure on the nerves that exit the spinal column and releases chemical irritants that contribute to nerve inflammation (see graphic below). The pressure on the nerves can cause pain, numbness, and weakness in the lower back and legs. When the symptoms travel down your leg, the condition is called “sciatica.” While an acute disc herniation feels painful and debilitating, most people feel better after a few weeks of conservative treatment (treatment that aims to relieve symptoms while the body dissolves and reabsorbs disc herniation on its own).
*Image adapted from American Academy of Orthopedic Surgeons (https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/)
Causes
This injury is typically a result of normal age-related wear and tear (i.e., disc degeneration). We lose water content as we age, so the discs become more compressed, less flexible, and more narrowed between each vertebra. A traumatic incident, such as a fall, accident, or a heavy lift without correct body mechanics can also cause a disc herniation.
Common Symptoms
- Sciatica, or sharp, shooting pain that extends from the low back into the buttock and back of one leg
- Pain with forward flexion (i.e., bending forward)
- Numbness, tingling, loss of sensation, or pressure in the leg or foot
- Weakness of the leg or foot
- Cauda equina syndrome (this is the loss of bladder or bowel control and is a rare condition that requires immediate medical attention, as this is caused by compression of the nerve roots in the end of the spinal column)
Risk Factors
- Males between the ages of 20-50 years
- Improper lifting techniques, such as twisting or not bracing through the core to lift a heavy item
- Excess body weight
- Occupation or sport with repetitive bending, twisting, lifting, or pulling
- Long periods of sitting (e.g., long driving commute to work)
- Sedentary lifestyle
- Smoking
Solutions
Conservative Solutions
- Rest to relieve acute, high-level pain
- Physical therapy exercises to relieve pain, relieve other symptoms, and build strength to surrounding muscles
- Avoid sitting for long periods
- Minimize bending forward or lifting (move slowly if you need to bend or lift)
- NSAID’s or corticosteroids (as recommended by your physician)
- TENS (transcutaneous electrical nerve stimulation) device to block nerve impulses for pain-relief
- Epidural steroid injection if the pain persists after 4-6 weeks of physical therapy
Surgical Solution
- Microdiscectomy surgery is a last option if physical therapy and/or conservative efforts fail to improve pain and symptoms after at least 6-8 weeks
Physical Therapy Exercises
- Prone On Elbows: Lay on your stomach with your legs extended. Prop up onto your elbows, hinging through your low back. Keep the glutes relaxed and hold this position for 2-3 minutes, or as long as tolerated. (Complete 2 sets for 2-3 minutes)
- Prone Press-ups: While lying on your stomach, place your hands on the ground directly underneath your shoulders. Straighten your arms by extending your elbows to create a greater hinge in the low back. Press up slowly to as high as your back will tolerate while keeping the glutes relaxed. (Slowly complete 2 sets of 10 reps)
- Low-back Windshield Wipers: Lay on your back with your knees bent and your feet on the ground. Slowly let your knees twist left until a gentle stretch is felt in the low back, and then slowly return to center and twist to the right. (Complete 20 repetitions total)
- Sciatic Nerve Glides: Laying on your back, lift one leg and clasp both hands behind your thigh. Slowly extend the lower leg until you feel a gentle stretch in the hamstring or back of the knee. Then, gently pump the foot like a gas pedal and return the leg back down. (Complete 20 reps of 5-second holds)
- Modified Piriformis Stretch: Lay on your back and bring one knee up toward your chest. Pull your knee toward the opposite shoulder until you feel a stretch in the glute/buttock. (Complete 3 sets of 30-second holds per side)
If following these recommendations does not result in pain relief, please contact physicaltherapy@shiftlife.com or Schedule Physical Therapy Appointment for an in-person assessment of symptoms and to create a more individualized plan of care.
In Real Health,
Avis Jason, PT, DPT & Scott Robin, PT, DPT
SHIFT Physical Therapists