Spinal Series Part 5

Spinal Series Part 5 – Disc Pathology

The final part of the Spinal Series looks at Disc Pathology and in particular, Disc Herniations. Disc Herniations can also be termed Disc Protrusions, Disc prolapses, Bulging discs, Ruptured Discs, Collapsed Discs, Slipped discs or Torn Discs. As a Pilates teacher, you may be asked by your client to explain more about their diagnosis. Fortunately, all of these terms relate to the same kind of injury and for the purpose of this article, we will refer to it as a Disc Herniation.

What is a Disc Herniation?

As the other articles have already covered, the intervertebral discs are effectively the human’s shock absorbing system in the spine. Had we of stayed on all fours as our body was originally designed for, then the loading into the intervertebral discs would have been kept to a minimum. The spine would work far more efficiently. Likewise, the occurrence of a Disc herniation would be far less common.

A Disc herniation describes the breakdown of a disc where the outer fibrous wall (annulus fibrosus) has either weakened or split and allowed the inside of the disc (nucleus pulposus) to ‘herniate’ out of the disc, potentially contacting a nerve root. In Lehman’s terms, there are a couple of good analogies to help explain what is occurring to your clients:

·      Imagine a Jaffa cake – where the outer cake and chocolate layer are the annulus fibrosus and the marmalade centre is the nucleus pulposos – excessive pressure may cause the marmalade to squeeze out of the chocolate coating.

·      Or consider a deep filled jam doughnut – where an increase in pressure on the doughnut itself can force the jam to exit through the weakened exterior.

What causes a Disc Herniation?

Disc Herniations are most commonly caused by one of the following;

1.   Sufferers of Degenerative Disc Disease DDD (as covered in Part 2 of the Spinal Series)

As we age, our fibrous tissue becomes less pliable and in turn, not as capable of withstanding the forces placed upon it. In the case of the intervertebral disc, the pressure exerted on a regular basis can be too much for the annulus fibrosus to withstand leading to a breakdown in the fibrous wall. Eventually this can lead to the nucleus pulposus herniating through the wall.

2.   Traumatic injury

Any sudden increase in loading at any level of the spine can lead to a traumatic Disc Herniation, where again the pressure exerted on the disc is too much. A good example would be landing heavily on the feet onto a hard ground without absorbing the shock through the legs. This driven into the back could be translated into the disc and force a Herniation to occur. Another common example is the classic digging posture whereby someone stoops, twists and then loads the shovel in an awkward and rare posture, loading the disc excessively.

3.   Sedentary Lifestyle

An increasingly more common cause of Disc Herniation as our lives become more sedentary with ‘computer-driven’ work. Any posture sustained for a prolonged period without regular intervals can cause excessive loading on the intervertebral discs. Couple this with staying in the same posture day in day out at work and eventually the constant loading exerted on the annulus fibrosus by the nucleus pulposus will cause it to break down the wall.

The majority of Disc Hernations occur in the lumbar spine as a result of the factors outlined above.

What are the symptoms of a Disc Herniation?

The symptoms associated with Disc Herniation can be any one or multiple of the following:

·      Back Pain (at or around the level of the Herniation)

·      Referred pain (into the head, shoulder, arms, trunk, pelvis, hips, leg & feet)

·      Numbness

·      Pins & Needles

Depending to the level that the Herniation is occurring and its corresponding nerve root will often determine where the client will feel the pain (for more information on these paths please refer to a Dermatome Chart). Also, the extent of contact from the disc onto the nerve can usually dictate how far the pain will be experienced along the corresponding dermatome.

Typically, the further the pain refers from the spine, the more irritated the nerve is and likely the greater the Herniation. Remove the irritation from the nerve root and the pain should ease out from the periphery – i.e. get the Herniation back in!

Pilates and Disc Herniation

The management of symptoms conservatively and early into injury can often save someone from requiring surgery. Conservative management of a disc Herniation will typically involve a course of NSAIDs, Analgesics and Manual Therapy. The key to success in rehabilitation of Disc Herniations is:

·       Early, Accurate diagnosis

·      Early intervention – physical exercise, manual therapy, medication

·      Lifestyle modification

·      Specific Exercise Programmes (Pilates)

As we’ve covered in several topics now – Pilates is good for everything!

Pilates is great for clients suffering from Disc Herniations because it:

1.   Educates on posture correction,

2.   Improves and helps maintain spinal alignment,

3.   Improves body awareness,

4.   Helps to strengthen the spine,

5.   Helps restore good, fluid & segmental movement

The majority of Disc Herniations will occur through the posterior aspect of the annulus fibrosus and subsequently, exercises in non weight-bearing into lumbar extension can often be most helpful. However, once the symptoms are under control, it is important NOT to neglect the other spinal movements. Build towards a full varied programme of exercise as pain or symptoms allows.