Updated: Aug 31, 2020
Have you been told that you have a herniated, ruptured, slipped, or bulging disc? Because of this have you ever been told to NEVER lift, squat, bend, or rotate again? Were you told that you would need surgery or maybe you even had surgery, but continue to have problems? If so, this blog is for you! I will outline what exactly it means to have a herniated, ruptured, slipped, or bulging disc, what to do about it, and how you can get back to enjoying your favorite activities. If Thor Bjornsson can deadlift 1104 lbs, your back is resilient enough to get back to lifting, running, golfing, etc.
What is a Herniated Disc?
The terms herniated, ruptured, slipped, or bulging disc are used interchangeably to describe the same pathology. However, the proper term, is herniated. As a point of clarification, your disc cannot "slip" out of place, so this term is very misleading when discussing disc injuries. To help you better understand what I mean when I say herniated disc, let's talk a little bit about anatomy of our spine. In between each vertebrae there is an intervertebral disc, which act as a cushion and shock absorber for our spine. The disc is made up of a tough, rubbery outer layer, the anulus fibrosus, and a gel like center, the nucleous pulposus (see the above picture).
So what happens when you have herniated disc? There is a weakening in the tough outer layer, which allows the gel like inner layer to push out into this weakened spot. This can happen to varying degrees: the nucleus can remain contained within the anulus or the nucleus may escape outside of the anulus. How far the herniation extends and the inflammatory process that can occur as a result of the herniation can impact the symptoms experienced. This most commonly occurs in the lower back, but can happen throughout the spine.
Common symptoms of a lumbar (lower back) disc herniation include:
Radiculopathy (pain that radiates down the leg)
Numbness/tingling in the leg
Weakness in the leg
Lower back pain
The mechanism of injury for a disc herniation can vary, but they most often result due to gradual, age-related wear and tear. As we age, our discs become less flexible and lose hydration, which puts the disc at risk for an injury. Yes, traumatic disc herniations can happen from lifting something heavy, a forceful rotation movement, or another type of traumatic injury, but these injuries are not the norm.
What are the Outcomes if You Have a Herniated Disc?
The terms "herniated", "ruptured", "slipped", and "bulging" are all scary sounding terms and sound like something very traumatic has happened to your spine, especially if these terms are being thrown around with words like "surgery" or "injection" by your physician. It makes our spine seem very fragile and sounds like the outcomes are poor. However, while disc herniations should be taken seriously, they are also not the end of the world, they often do NOT require surgery or invasive procedures, and you can most definitely lift, squat, run, or golf again.
Did you know??? Studies have shown that 40% of people have a bulging disc in their back but do NOT have any symptoms. Also, the time of day an MRI is performed can affect the results because on average our discs are 20% more swollen (have more fluid in them) in the morning than compared to the evening. So just because an MRI shows that you have a "bulging" disc, it may not actually be the source of your pain. However, as with any injury, a herniated disc can lead to bleeding and inflammation, which can lead to the common symptom of radiating pain due to irritation of the nearby nerve root. Good news is, this is all part of the normal healing process and discs have the ability to heal, just like any other part of body. MRI studies on a patient with a bulging disc who has a repeat MRI 2 months later, have shown on average that the bulge is 50% smaller and approximately 1 year later the bulge is completely gone. As our body absorbs the fluid, the disc can heal.
So you might be asking yourself, "If the disc can heal, then why was I told to never do X, Y, or Z again?" That is a great question and honestly, I wish I knew the answer. My hypothesis is that in a 5-10 min appointment with your physician, they do not have the time to teach you how to proper perform movements X, Y, or Z so it is safer and easier to just tell you never to do that movement again. Because it is true that if you do not perform movements with good technique or lack the underlying stability needed to perform that specific movement, you are at risk of injury or re-injury. However, our bodies are more than capable of getting back to the activities and movement you enjoy, they just need a little help along the way to get back to that level.
What Should You Do if You Have a Herniated Disc or Have Been Avoiding an Activity Because of One?
First, if you are currently experiencing the symptoms of a disc herniation it is important to get evaluated by a trusted medical provider. As mentioned before, disc herniations should not be taken lightly and early intervention is key in achieving good outcomes. A Doctor of Physical Therapy (DPT) can help you get to the root cause of your problem and start you on a recovery plan. They can guide you through treatment and also work with you to determine what activities are safe for you to continue and what if anything you need to modify or avoid in the short-term. If you are currently experiencing radiating pain into your leg check out the the following video for two exercises you can start implementing today to reduce the nerve irritation.
If you are someone who has a history of back pain or a herniated disc or you have been told that you should never do X,Y, or Z again then I would definitely recommend working with a DPT who is familiar with your sport. There are many other factors that can contribute to low back pain, such as: less than optimal movement patterns, repetitive movement, lack of skill in a specific movement, soft tissue irritation, decreased mobility or stability leading to compensation patterns, etc. Not every person or athlete is the same, and not all back pain is the same, which is why it is important to find out the root cause of your problem, instead of Googling for the “5 best exercises for a herniated disc”. Also, if you have been avoiding a certain activity because you were told to, it is very important to work with a DPT for thorough assessment and to develop a specific plan to help you get back to that movement safely.
Call us today at 515-985-9038 to set up a consultation with our Doctor of Physical Therapy to help you with your recovery and get you back to the activities that you love.