Herniated Disc

Do you have back pain? Do you experience a sharp and shooting pain from your back all the way down the back of your legs? Is the pain the worst in the morning? You might be experiencing a herniated disc.

What is a Herniated Disc?

In the spinal column, each vertebra is cushioned with a pad or disc that cushions the joint. Each disc has an annulus or a thick outer portion with multiple rings of cartilage and a gel-like center called the nucleus. The discs function as shock absorbers and allow for movement. A herniated disc occurs when a small part of the disc’s nucleus pushes out through a tear in the outer-layer.

Herniated discs can occur anywhere in the spine, however, it mostly commonly occurs in the low back between lumber vertebrae 4 and 5.1 There are three types of herniated discs. A prolapsed disc occurs when the disc moves completely through the outer portion. An extruded disc occurs when the disc moves far enough out of the joint space that it comes into contact with the spinal cord. Finally, a sequestered disc occurs when the disc breaks apart and begins to migrate.[1]

Sports Commonly Associated with Herniated Discs:

The sport most commonly associated with herniated discs is weight lifting due to the stress placed on the spine while bending. Other sports associated with herniated discs are basketball, volleyball, throwing (in track and field), golf, hockey, football, field hockey, and gymnastics.

Causes:

Herniated discs often occur when an athlete bends forward and twists.1 Forward bending places a stress on the front of the disc as the spine compresses the disc. Twisting places a shear force and compression on the side of the disc, therefore pushing the disc in the opposite direction. Finally, an added load, from addition weight, or excess body fat can cause axial compression.

Herniated discs are often associated with the saying “lift with your legs and not with your back.” When an athlete lifts using the muscles of his or her back it can cause a muscular strain, a sprain, or a herniated disc. Herniated discs can progress over time.

Symptoms:

Herniated discs result in sharp, centrally located pain.1 The pain may be present on only one side of the body and it will go down the buttocks and down the back of the leg.[1] The pain will be the worst in the morning when the patient first steps out of bed.1 The initial loading from going from a horizontal to vertical position will increase the pressure on the disc and cause pain. Bending forward and sitting for long periods of time will cause pain. Bending backwards will limit pain.

The athlete will have a posture that is slightly bend forward and the athlete will bend to the opposite side of the disc herniation. The area around the vertebrae will be painful to touch. Actions that cause a Valsalva manuveur (coughing, sneezing, or bowel movements) will increase pain.[1]

Prevention:

The best way to prevent a herniated disc is to maintain proper core strength. All athletes should participate in core exercises that help to strengthen from the hips all the way up through the shoulders. Proper time should be spent to strengthen the abdominal muscles, the back muscles, and the oblique muscles. Through the development of core muscles, pressure is taken off of the back and the chances of a herniated disc decrease.

Additionally, extra care should be taken while lifting heavy objects. The athlete should bend from the knees and lift by standing rather than moving their back. The athlete should also avoid twisting while under load.

Treatment:

Modalities:

Modalities are best used for herniated discs in order to limit pain and increase functionality.[1] Ice will help to reduce inflammation and cause an analgesic effect. Electrical stimulation through a TENS unit will help to limit pain through the activation of the Gate Control Theory and turning off pain receptors. Traction will also help to create space between the vertebrae and reduce pain.

Stretching:

Stretching can be very helpful to reduce pain and improve the condition. Stretching can be achieved through extension exercises. The most basic of these exercises is the cobra stretch. The athlete should lie on his or her stomach and push up using his or her hands. This will cause back extension and help to open space between the vertebrae.

Strengthening:

Strengthening can help to both prevent and heal herniated discs. Strengthening that causes pain should not be completed. Bird-dogs are among some of the best exercises for athletes with herniated discs. The athlete should begin in the quadruped position and lift the right arm and the left leg straight out while maintaining balance. This can be completed in repetition. Another exercise that is beneficial for herniated discs are dead-bugs. The athlete will lay on his or her back with their arms and legs straight up in the air. The opposite arm and leg will then be lowered in opposite directions.

References:

1. Prentice, William E. Principles of Athletic Training: a Competency-Based Approach. McGraw-Hill, 2014.