What is it? Can it repair? How is it treated? Does it require surgery?…..
These are all super common questions to a super common problem. I remember a mentor of mine telling me that something like 70% of people over the age of 40 have a herniated disc in their low back, but a lot of them don’t even know it. They go about their lives, living a normal and active lifestyle, with the dreaded herniated disc (aka, bulging disc). Right off the bat, this suggests that people can live happily even with such a dreaded injury. Furthermore, if so many people have it, it also suggests that it is almost a normal occurrence. This was mind-blowing to me. The discs are found in between each vertebral bone in our spine and serve for many functions. Yes, they do serve to help with shock absorption, but they also greatly serve to allow our vertebrae to move properly. When discs herniate, there usually is a loss of disc height. It is fair to say with a loss of disc height, there is a reduced ability for that disc to assist in shock absorption and to allow for normal movement of the vertebral bones above and below it. Discs can herniate suddenly, due to a traumatic event, or gradually. The later is usually due to abnormal forces constantly being placed on that disc, such as poor posture or something repetitive in nature. In my opinion, sometimes the normal stresses of life cause our disc to gradually degenerate, or even slowly herniate. A small herniation doesn’t always have to be pressing on a nerve to create Sciatica. It also doesn’t have to cause low back pain.
For a long time, highly intelligent people thought that disc herniations could be put back in to place. If you were to examine any long term studies over the past several years, you would find this is simple not true. Injuring a disc is almost like cutting a nail….it doesn’t repair…their is no blood flow to it. There are also no nerves that supply it, indicating there is no sensation. It is the swelling associated with an acutely ruptured disc, or the impinging on a nerve that causes the perceived pain, but if neither of these occur, it can be suggested the person may experience no pain. Discs often fatigue and tear/bulge/rupture in a posterior (backward) and lateral (toward the side) direction. This is why if someone has nerve-type pain, such as a feeling of electrical zapping or pins-and-needles, it is usually in one leg and not both. When this happens, the pressure within the disc is guided toward that weak spot, and often feels better when the pressure is guided away from it. With good Physical Therapy techniques, the pressure can be “centralize” or guided away from tear in order to reduce painful symptoms the patient may be having. At this point, it is important to use certain techniques to stabilize the disc pressure in order to prevent painful symptoms and any further worsening of the herniation.
I always recommend proper Physical Therapy care to people with disc pathology. Studies show there is better long-term results with conservative treatment rather than with surgery, although short term effects may be perceived better with surgery. However, this depends on the severity. In minor cases, short-term and long-term results are better with proper Physical Therapy care. In severe cases, it is always recommended to first try conservative care, however, if conservative care is found to be ineffective, a surgical procedure may be done and Physical Therapy should immediate follow in order to work to stabilize the surgical area (it is HIGHLY possible that even after surgery, the disc can further herniate if proper rehab is not administered after surgery). If you have further concerns or questions, or if you know someone who suffers from low back pain or disc herniations, have them reach out to me and I’d be glad to give guidance. John Lathrop