If you suffer from back pain — especially lower back pain — you’re definitely not alone. Back pain is one of the most common medical problems, affecting 8 out of 10 people at some time in their lifetimes, and for many, a painful back injury will be more than just a one-time occurrence. There are many reasons for lower back pain to strike, and one of the most common is a herniated disc, or specifically, a lumbar herniated disc.
Understanding Spinal Discs
The spinal discs that run along the length of your back play a critical role in their capacity as shock absorbers between the vertebrae, as well as allowing for multi-directional movement. Spinal discs also act as ligaments that hold the vertebrae of the spine together.
There are essentially two parts to a spinal disc — a tough outer portion surrounding a soft gel-like inner core, sort of like a biological “jelly doughnut”. The outer portion is known as the annulus fibrosus, while the inner core is called the nucleus pulposus. These two pieces fit together and are held in place by cartilage-covered endplates. In order for each disc to function properly, it relies on moisture. Some 80 percent of a disc is composed of water when we enter the world as infants. Over time as we age, our discs dehydrate and become stiffer, making them less able to adjust to compression.
Disc Herniation
But a disc can also herniate — leaking some of its gelatinous inner core — and quickly go from shock-absorbing effectiveness to a nerve aggravating cause of back pain. A herniated lumbar (lower back) disc can occur when we lift something heavy, twist the wrong way, or for no apparent reason at all. It is, however, more likely to happen as we age, and commonly affects people between the ages of 35 and 50.
The now protruding disc can then put pressure on or irritate the nearby spinal nerve root, causing pain in the buttocks that runs down the leg, a condition known as sciatica.
The Good News and the Bad
Given that most of us presented with a choice between hearing good news or the bad news first, prefer to save the good news for last, here’s the bad … A herniated lumbar disc can be extremely painful, making everyday movements like putting on shoes or getting in and out of the car sheer misery! But here’s the good news … It often does not require invasive treatment such as surgery to resolve. Physical therapy can go a long way toward easing pain and restoring movement until the injury becomes asymptomatic and the pain stops. This happens for a few reasons:
- Your immune system goes to work and ultimately reduces the size of the injury, as well as removing inflammatory proteins.
- The water contained in the herniated fragment is reabsorbed by the body, also causing the fragment to shrink.
- Extension exercises can sometimes help move the herniated portion of the disc away from the spinal nerve, alleviating pain.
Speed Up Healing With These 3 Exercises
- Laying Prone on Your Elbows: Start in a face-down, prone position on a firm surface. Place a soft flat pillow under your hips and abdomen if needed. Push up onto your forearms without raising your hips. Don’t strain! Hold for up to 30 seconds and then slowly lower yourself back to starting position. Aim to work up to 10-15 repetitions and 2-3 sets with rests in between.
- Prone Press Up: Lie prone on your stomach, placing a folded towel or soft flat pillow under your hips and abdomen if needed to make you more comfortable. Bend your elbows by your sides so that your palms are flat on the floor on either side of your body with your forehead on the floor. Inhale and press up, keeping your head, neck, and back in alignment. Hold for 5 to 30 seconds and don’t forget to breathe! On the exhalation, lower yourself back to the starting position. Repeat 3 to 5 times.
- Standing Lumbar Spine Extension: Place your hands on the backs of your hips and lean backward as far as you can. Repeat as many times as directed by your physical therapist.
All of these exercises are “recapturing” techniques that use the direction of extension to force the disc material forward and away from the source of the pain (i.e., the spinal cord or exiting sciatic nerve roots). They should eliminate pain and numbness in the leg, and the goal is to reduce leg symptoms first, which is known as “centralization of pain”. Perform them on a comfortable surface (use an exercise or yoga mat). Soreness is common but should subside with rest. Pain should not increase. If it does, stop doing the exercise(s) and consult with your physical therapist for help.
At Cawley Physical Therapy and Rehabilitation, we’re committed to providing our patients with the most comprehensive, personal, individualized skilled physical therapy services available. Call us at (570) 208-2787, or email us at cawleyptfrank@gmail.com.
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