What is a Herniated Disc and How is it Treated?

By Ashley O'Rourke PT, DPT, ATC, LAT

Back pain is extremely common. Bulging discs and herniated discs are just as common. People often think that disc issues are a permanent diagnosis or a lifelong sentence for pain. They’re not!

Herniated Discs most often occur in the lower lumbar spine. In many cases, they cause no symptoms and require no treatment. On the other hand, others with herniated discs may experience pain, weakness, burning or tingling in their back or down their legs/arms due to the bulge pressing on the nerve. 

Disc Bulges & Herniations:

Disc bulges and herniations come and go with about 80% resolving without medical intervention. They occur in both symptomatic and asymptomatic people and are a natural part of aging. The prevalence of seeing a disc herniation on MRI in PAINFREE people increases with age. For instance: disc herniations occur in only about 30% of 20 year olds who have no symptoms, but in around 84% of 80 year olds who have no symptoms.  (Nakashima; Brinjikji)

You can think of your discs like jelly donuts. Years of poor posture (rounded back/forward head while sitting), repetitive bending forward or an acute injury such as lifting something heavy with a rounded back can cause the "jelly" [nucleus pulposas inside the disc] to shoot out the back of the “doughnut” [disc] as if you had squeezed the doughnut on one side. When this happens, the “jelly” can bulge out far enough that it puts pressure on the nerve causing back pain and/or symptoms down leg or arm.

Therefore, you must work into the opposite direction- extension. Extension exercises are those that involve strengthening the posterior chain (glutes, hamstrings and back muscles) or arching the neck/back backward. Think "superman" exercise. As you focus on extension based exercises, you are working to push that "jelly back into the doughnut”. This seems simple enough, but why then do people end up with pain/symptoms off and on throughout their entire life related to the same discs?

The answer is incomplete healing. Often times, people will do their extension exercises at PT, but when they get back to their home or work, they fall back into bad habits- sitting for hours in flexion. This “undoes” everything the patient just did at PT. Consider this paper cut analogy: