Discogenic or Herniated Disc

Your spinal discs play an important role when it comes to keeping your body upright, supporting a wide array of movement in different directions, and acts as a shock absorber. Your spinal column has rubbery cushions or disks that help to cushion the individual vertebrae and they can become ruptured or slip and irritate nearby nerves.

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Causes of Lumbar Disc Herniation

Causes may include injury trauma, chronic poor sitting posture, improper lifting and bending, and poor mechanics of other areas of the spine and/or hips. These factors lead to micro-tearing of the ligament-like material of the disc, allowing the disc to bulge. Although an acute episode of pain may occurfor no apparent reason, the underlying cause is usually repetitive damage to the disc stemming from weakness, muscle imbalance, or stiffness.

  • Injury/Trauma
  • Chronic Poor Sitting Posture
  • Improper Lifting and Bending
  • Poor Mechanics of the Spine and/or Hips

Other causes of lower back pain

Most back pain is not serious. According to the APTA, the majority of low back pain is caused by strain, overuse or injury, and is rarely caused by a more serious condition such as a herniated disc or osteoarthritis.

However, prior injury, prolonged poor sitting or standing postures, improper or excessively heavy lifting and poor overall conditioning can lead to low back pain. Along with low back pain, symptoms can include numbness or tingling that can radiate into the hip and thigh. "These factors can lead to excessive stress and strain to the supporting structures in the back. Although an acute episode of pain may occur for no apparent reason, the underlying cause is often poor motor or movement control, muscle imbalances, or associated stiffness," says Craig O'Neil, VP of Learning and Affiliations at Results Physiotherapy.

Facet syndrome is often described as "my back went out," according to the experts at Results Physiotherapy. A sharp pain is felt when the injury initially occurs, with symptoms that include local pain and stiffness and a dull ache radiating to the buttock or hip.

Range of motion can be limited, and the pain is usually felt more on one side when leaning, causing a "pinching" of the joint.

If you've heard of people who've complained of a sciatica — or Lumbar Radiculopathy — that's when the sciatic leg nerve becomes compressed or irritated. "It's a burning or shooting pain that's usually caused by a bulging or herniated disc place increased pressure on the nerve root," says O'Neil.

Most people with back pain focus more on the symptoms, rather than the cause of their pain. "What they might not know is that movement often provides the best long-term relief for pain," says APTA spokesperson Mary Ann Wilmarth, PT, DPT, OCS, chief of physical therapy at Harvard University. "As movement experts, physical therapists can help restore mobility, reduce pain, and improve quality of life," she adds.

Symptoms of Lumbar Disc Herniation

Disc problems are a common source of low back pain. Symptoms may include diffuse low back pain, numbness, tingling (or "pins and needle" sometimes radiating into the hip, thigh or lower leg), and weakness. Radiating leg symptoms may suggest the disc is bulging and placing pressure on a nerve root. Pain may worsen with activities that increase the pressure within the disc such as sitting, bending forward, improper lifting, and coughing or sneezing.

  • Numbness
  • Tingling ("Pins and Needles" sensation)
  • Weakness

Diagnosis of Lumbar Disc Herniation

Lumbar disc herniations can be diagnosed through a thurough history of the condition and examination. Patients may report an increase in pain with sitting, bending forward, pain is worse in the morning, and feeling symptoms run down one or both legs. Upon movement examination the patient may show a preference for their spine moving into a particular direction, such as a reduction in leg pain when bending backwards. They may also show altered reflexes, differences in strength side to side, and/or altered sensation to touch.

In most situations patients do not need to see a PCP or specialist first. They can come into physical therapy without a doctors script and be treated for this condition.

After the diagnosis the patients will be educated on postures and positions that may need to be avoided for a short time as the disc heals. They will also be educated on a home exercise program to not only treat the pain but also the underlying cause that led to the condition, as well as the use of manual techniques to help reduce the pressure of the disc on the nerve.

Treatment of Lumbar Disc Herniation with Physical Therapy

Manual therapy and exercise have proven very effective in relieving discogenic low back pain. These techniques include joint and soft tissue mobilization, passive stretching, and myofascial release,often with an extension-focused exercise program. Education on techniques to avoid stressing the injured disc while it's healing, along with taping, ice and electrical stimulation, can help relieve pain and promote recovery. A specific exercise program to re-educate the core abdominal and back muscles has been shown to significantly reduce the likelihood of recurrence.

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Prevention Tips for Lumbar Disc Herniation

Making movement part of your daily living can go a long way to preventing this condition from occurring. Every 30 minutes get up and move to reduce the amount of time sitting. Also, when picking up objects lifting with your legs instead of your back will reduce the amount of stress on the disc.

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