Physiotherapy Management of a Herniated Disc

Problems with intervertebral discs are a common health issue that appears across various age groups.

Most of us have probably already encountered someone who has had an intervertebral disc problem. Most often it is a herniated (herniation) disc or some other degree of its impairment. Typically, these changes are detected through a CT scan or magnetic resonance imaging, which is most often ordered by a neurologist or orthopedist.

Diagnosis: Herniated Disc

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If a person already undergoes an MRI examination, it is rare for them to leave with the result that nothing “wrong” was found on their discs. Interestingly, the first signs of some disc degeneration often appear as early as around the age of 18, when a person usually has no symptoms.

The result of the examination itself often significantly affects the overall perception of the problem.

Sometimes it happens that the finding of a damaged disc and its suboptimal interpretation turns a person with back pain into a patient with a diagnosis and a negative prognosis, which does not help their mental state. Yet, the problems may not actually be associated with the disc, which may have been damaged for years without any symptoms.

There is not always a direct correlation between the imaging findings and the problems a person experiences. Sometimes there is, sometimes there isn’t, and sometimes it’s halfway. However, it is very difficult to determine exactly what is causing the difficulties. Therefore, it is good to view degenerative changes with some caution, whether they are on the disc or elsewhere.

A Bit of Anatomy

The intervertebral disc, as the name suggests, is located between the solid bony vertebrae. Its main function is to absorb shocks that affect the spine. The shock absorption is also aided by the S-shaped curve of the spine, which closely resembles a spring.

The disc is largely made up of water, which decreases with age, and this is also the main reason why from a certain age we “shrink”.

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Degenerative Processes of the Intervertebral Disc

In perfect condition, the disc stays in place. We can assume this in very young individuals, but even in adolescents, it may happen that the disc starts to bulge over the edge of the vertebral body.

This is called bulging, in layman’s terms, disc overflow. I think that if we examined the whole population, some form of bulging would be present in a large part of us, and this without us feeling any symptoms.

Problems may occur in the next stage of the degenerative process, when a small part of the disc protrudes (herniates) more significantly toward the nerve structures.

Here, it depends on the direction of the protrusion. Protrusions into areas where, in layman’s terms, the nerve roots have nowhere to move are problematic. There, even a small protrusion can cause big problems. However, there are also situations where a large herniation occurs but the person is symptom-free because the herniated part missed the sensitive areas. So not all herniations are the same.

If a part of the protruding disc already affects the nerve root, we usually feel it not only at the specific site of compression but also along the course of the nerves connected to this root.

Causes of Intervertebral Disc Herniation

The causes of this unpleasant condition can be, as with most degenerative processes in the human body, multiple, and often it is a combination of various factors.

Congenital Predispositions

• Lower quality of connective tissue
  
  People who are born with lower quality connective tissues (ligaments, tendons, cartilage, discs…) more often suffer from problems associated with their wear or injury.

• Lower quality of movement control
  
  The economy of movement and posture largely determines the load on the intervertebral discs. Not everyone is blessed with perfect movement control, and this is then reflected in the entire musculoskeletal system, including the discs. 

• Suboptimal shape of the spine
  
  The ideal model of the spine is S-shaped. Such curvature creates a spring that absorbs shocks during movement and reduces the load on the intervertebral discs. People whose spinal curve is flatter (less cushioning) are more likely to have disc problems.

• Long-term overloading
  
  Just like any joint in the human body, the intervertebral joints with discs have a limited lifespan. Overloading can refer to virtually any unilateral static or dynamic load.

• Single extreme overload
  
  Sometimes symptoms of a herniated disc occur after a sudden movement or when lifting a heavy object.
  
  Personally, I do not think that herniation can occur in a disc that was previously completely healthy. I rather believe that the disc is already “compromised” before such a moment and the sudden overload is the final straw.

Symptoms of Herniated Disc with Nerve Root Compression

Disc herniation most often appears in the lumbar and cervical spine regions. The location of the difficulties also depends on the height of the affected section. In the case of cervical herniation, symptoms are most often evident in the upper limbs. Herniation in the lumbar section often manifests in some part of the lower limb.

Common symptoms include shooting pains along the nerve path associated with tingling in the affected area. There may also be reduced sensitivity of the affected area. Sometimes there is also muscle weakness in the affected limb.

Treatment

If nerve root compression and unpleasant symptoms already occur, conservative (if the condition is not clinically severe) or invasive treatment can be chosen. Conservative treatment is usually started and is mostly based on physiotherapy.

Physiotherapy for Herniated Disc

The goal of physiotherapy for disc problems is:

• restoring muscle balance
• involving the deep stabilization system in movement patterns (DNS)
• modifying and improving movement habits
• adjustment of the work environment
• setting up a movement regime

The result should be a reduction in the load on the intervertebral disc, which will reduce the pressure on compressed nerve structures. After successful physiotherapeutic intervention, there is a high chance of reducing or eliminating unpleasant symptoms.

Invasive Solutions

However, sometimes physiotherapy does not bring the desired effect, or the disc protrusion is so dangerous that it is necessary to proceed with invasive treatment in the form of surgery. In this case, the protruding part of the disc is surgically removed and the subsequent rehabilitation takes several months.

Conclusion

A herniated intervertebral disc is a common health issue in the area of the spine. Detecting this condition through imaging methods and subsequent suboptimal interpretation can negatively affect a person’s overall psychological well-being.

It is always important to look at the problem comprehensively, not to attach excessive importance to the clinical finding, and not to give up hope when receiving the diagnosis. Modern approaches to treating herniated intervertebral discs are, I dare say, quite effective nowadays.

Conservative treatment based on physiotherapy offers many tools for managing this condition. Through targeted exercises aimed at correcting muscle imbalances and changing movement habits, along with adjustments to activity and work routines, it is possible to effectively address not only the consequences but also the causes of the difficulties.

Invasive neurosurgical intervention for a herniated intervertebral disc is now a common, well-established procedure that can help where conservative treatment fails. However, it does not address the root cause of the problem, so it is advisable to begin comprehensive physiotherapy after surgery to prevent the difficulties from recurring.

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