What is Disc Protrusion, and how to treat it fast

Most of us might not be aware the meaning of disc herniation and its causes. What we didn’t know is that this condition is very common for most of those middle-aged adults, both male and female equally. In addition, if your occupation involves sitting in the office all time, then the risk to have disc herniation will be greater. In this article, you will understand about disc herniation in a simple way.

spinal_stenosis

Disc Protrusion, which is known as “Slipped disc” is a condition in which there is a tear in the outer fibrous ring of the intervertebral disc, allowing a soft round gel called nucleus pulposes to bulge out beyond the damaged outer ring, which will then compress the spinal nerve.


 

CAUSES

sitting bending forwardSource

One of the common causes is sitting down with trunk bending forward for long period of time or those people who usually work in the desk office. For those who just sit all the time, they have high risk of low back pain compare to those who are usually standing or moving a lot. That is because the pressure in your disc of the spine becomes greater compared to those who just stand especially when you are stooping or bending forward. Your disc has a two-layer: The outer ring we called it the “Annulus Fibrosus” and it surrounds the gel-like content called the “Nucleus Pulposes. When there is a high pressure in the disc, the annulus fibrosis layer is degenerating which eventually there is a tear and the nucleus pulposes will start to get out or in another word bulging and the moment it compresses the nerve, you will start to experience pain and other symptoms. The common area that is usually affected is in the L4-L5 area, which is why most of the people usually complain low back pain, rather than upper or middle back pain.


Stages of Disc Herniation

When you have Disc Herniation, the severity of this conditions depend on what stage is it. There are 4 Stages of Disc herniation which is in order from minor to severe.

disc herniation  Source
  1. Bulging or Protrusion
  2. Prolapse
  3. Extrusion
  4. Sequestration

A. Bulging

This is the mildest form of Disc Herniation which is called Bulging or Protrusion. In here, the bluish gel-like disc called Nucleus Pulposes will start to swell out. However, the layer which surrounds this gel called Annulus Fibrosus hasn’t broke out yet and it is still within the boundaries.

In this condition, the patient usually complains of only Low Back pain without spreading down to the legs.

B. Prolapse

The disc is starting to move out beyond the boundaries of the layer annulus fibrosus. However, the outer layer hasn’t still broke yet.

In this condition, because the disc is starting to put pressure on the spinal nerve root, the person is starting to have sharp pain that will spread down to the legs known as Sciatica. To know more about Sciatica there is a separate page that is briefly discussed about this problem

C. Extrusion

The outer layer that surround the gel-like Disc called Annulus Fibrosus had already degenerate and the disc or nucleus pulposes broke out, which  mean the disc is getting out of the layer and it is starting to spread out, putting more pressure on the spinal nerve.

It is at this stage, this is where the person will be regularly experiencing Sciatica pain.

D. Sequestration

This is very similar like extrusion but the only difference is that a tiny fragment of the disc had break out, which separate from the main disc and travel it down toward the space on where the spinal cord is located.

Unfortunately, this is the most severe type of Disc Herniation, and usually, surgery is indicated for this kind of situation.


 

Aggravating Positions

Below here, I have specifically enumerate which positions will the disc pressure becomes greatest based on the percentage. For Reliability purpose, the sources I got them comes from Physical Therapy Books which I used them when I was a student.

Lying down: 25%
Side-lying: 75%
Standing: 100%
Standing with Bending forward: 150%
Standing with Bending forward and holding weights: 220%
Sitting with your trunk straight: 140%
Sitting with bending forward: 185%
Sitting with bending forward with weights: 275%

Based on those significance above whether you are holding a weight or not, sitting with bending posture has the greatest pressure in your disc, followed by standing with bending posture. But if you manage to maintain your proper body mechanic when you are sitting or standing, the pressure in the disc reduce significantly, which subsequently reduce the risk of disc herniation that induce low back pain.

 

SYMPTOMS

Because the spinal is being compress, the common symptom is usually sciatica. This is when pain spread down from the back to the lower leg when you bend forward and the pain got relieved when bending backward, we called this “extension biased” since the pain got better when you extend or bend backward. Other symptoms are like tingling or numbness sensation, hyporeflexia and sharp pain in the back.


What will the Physical Therapist or the Doctor examine on you?

When you will be going to the Physical Therapist or the Medical Doctor, the first thing they would do is to perform Physical Examination on you. There are 3 specific kind of examination they will need to perform on you to possibly confirm you might Disc Herniation.

A. Straight Leg Raise Test

straight leg test Source

In this test, you will be asked to lie down in the mat and he or she will passively lift your leg up with your knee remain straight. Based on the picture above, when you reach 30 to 60 degree, you will start to experience sharp pain on your Low Back. This test is considered positive, and based on this finding it indicate that your nerve is being compressed, which is why you experience this sharp pain.

B. Testing your Reflexes by using Neurological Hammer

The Physical Therapist or the Medical Doctor will be using a Neurological Hammer that will tap your tendons in the Knee, which there will be a reflexes response. If you potentially have a presence of Disc Herniation, the reflexes response will be very weak, and this is what we call Hyporeflexia.

3. Sensory Testing

In this test, they will be checking your sensation in both leg and your back by using either the Cotton for soft touch, the sharp tool for pain, or using its own Thumb for pressure. If you have difficulty sensing them or you feel abnormal sensation such as numbness or tingling, this is considered positive finding.


Will you be asked for an X-ray or MRI for Disc Herniation?

In here you might wonder why do the doctors will require you to have MRI despite your X-ray results remain negative. This is because X-ray is only useful if bones are involved, for instances if you might potentially have Fractures, Osteoporosis or Arthritis. But for MRI on the other hand, the problem is not the bones but rather the Discs, nerve and other soft tissue involvement, which they can only be visualize by MRI.

mri-discSource

This is an example of Disc Protrusion that is being done by MRI. As you can see the structures are very detailed which this cannot be seen by X-ray.


 TREATMENT

There are two ways that your disc herniation will be treated. Either the doctor will prescribe you medication for pain killer or he would refer you to Physical Therapy, which they will teach you how to perform the exercises while you are in the house. You will be instructed to perform exercises that will help relieve the pressure in the nerve and strengthening your back muscle, which will help provide support in the disc, reducing pain.

Also you must remember that when you have sciatica, the source of the problem could not just be from disc herniation, but it could also be you have a tight Piriformis muscle, on which it will compress the nerve on the back of your thigh called sciatic nerve, and by the name itself it causes sciatica.

These are the managements that are being used by the Physical Therapist to help relieve the pain.

1. Stretch the Piriformis muscle

2. Perform McKenzie exercise for low back pain.

3. Aside from the exercises mention above, the Physical therapist will teach you how to perform Dynamic Lumbar Stabilization Exercise. This exercise will help provide stabilization on the muscle of your back, which will help reduce low back pain.

4. Providing education on your proper body mechanic to prevent aggravating the symptoms, such as preventing bending forward or avoid positions that place greater pressure on the disc which they will be taught by Physical Therapist

5. In Physical therapy clinic we usually use a machine called Electrical Stimulator (ES) or Transcutaneous electrical stimulator (TENS) which produce electric like relieving pain, this is very useful and easy to use. Research have shown, that using TENS for relieving pain produce similar effect like pain killer medications.

6. Also in Physical Therapy Clinic, they will be using a machine that will help relieve the pressure on the spine called Lumbar Traction, which will relieve the pain by pulling the disc apart.

7. In some cases, the medical doctor or the Physical Therapist will recommend you to buy a Lumbosacral Belt which will help support your back and relive the pain.

8.  In some cases, A manual technique known as Joint manipulation will be performed by Chiropractors, Physical Therapist and even some Physicians who have extensive background on this technique.

Normally in most cases the Disc Herniation are usually relieved by non-operative management such as through Physical Therapy. In some cases if your pain doesn’t get better, Surgery are usually the last option.


VIDEOS

In this video this will illustrate a simple concept about Disc Herniation, which can help you understand better. Please remember I do not own this video and the source comes from YouTube through this link

 

 

10 comments

  1. My husband suffers from lower back pain. This site is very helpful. Looking at the different positions for alleviating back pain is very helpful. Thank you!

    1. Thank you so much merherbani. That is the reason why I made this page, is to educate the viewer about pains. We must take pain very seriously and fortunately they can be prevented or relieved without the necessity of medications.

  2. I have been seeing a chiropractor for about the last 4 years to get ahead of the game before something like this happens. So far, my chiropractor says I have a lovely spine. But I do worry about all the sitting that I do in a day. I try to get up and move around every so often, but some days I never leave my chair. I do try to have good posture and never lean forward in weird angles. I just got to work on not sitting so much.

    1. Hi Jessica, that is why it it important to change your position regularly especially if it puts a lot of pressure in the disc. Moreover, it is important that you must stretch your back and perform the exercise Mckenzie as this will help prevent the disc moving out.

  3. I’m almost at a loss for words of what to say. There’s a lot of information in this post about herniated disc. What I like is that you seem to be an expert and know all about disc herniation, what causes it and how to treat it.

    I’ve heard people talk about a herniated disc but I never really understood what it meant. The video does a great job of explaining what it is from the inside out and how our vertebrae are put together.

    You said there are a couple treatments. Medication and/or physical therapy. What type of pain medication do doctor’s prescribe? Is it Lortab or another kind of opiate?

    Rawl

    1. Hi Rawl. Usually the kind of medication the physician will prescribe you are usually NSAID. Opiate is only given if the pain is so severe that no other pain medication can relieve it, also this medication is very addictive and it is not recommended to use it for long term. Another kind of medication the physican will prescribe are Neuropathic Drugs such as Gabapentin or Amitriptyline. This drugs are usualy recommended and preferred if you have neurological symptoms such pain that spread down to your leg known as sciatica, numbness or tingling sensation. I hope you learn something 🙂

  4. Wow! Great post Saif! You gave some really great information regarding this particular medical problem. I know many people who will benefit from this information, because it seems there are so many people who suffer from sciatica. Wonderful explanation of the actual problem, and how it can be treated.

    Rebecca

    1. Thank you Rebecca, it is indeed very common in this days that people are having disc problem leading to sciatica, especially those who works in the office all day.

  5. I actually suffered form this last year and my back just gave out. I got x-rays and my discs were actually fusing together and I could hardly walk.

    I can not even describe the pain I went through and my doctor really did nothing for me. I went to a good chiropractor and have been seeing him for the past 6 months.

    I never thought much of chiropractors but they can work wonders “trust me” You will need to see them on a regular bases but if you do suffer from lower back pain you must at least consider them.

    I am now back to my normal self and I can even cross my legs “something I have haven’t been able to do in years” so it’s definitely something for everyone to consider.

    Cheers
    Joel

    1. Hi Joel, I agreed Chiropractor will really help for your back pain. It is really effective because they perform spinal manipulation, which is also performed by Physical Therapist who are trained to practice this techniques, but it also depend on the medical condition as well. For severe Disc protrusion or bulging, doing spinal manipulation is contraindicated as it will worsen the position of the disc. But I think the way you explain your condition, it looks to me it is a lumbar radiculopathy, which can be relieved by this technique. Hope it gives you an idea about this.

      Regard

      Saif

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