What is a Herniated Disc? Its Symptoms and Physical Therapy

The lower back is an important structure that enables the body's movements and transfers the body's weight from the hips to the legs. There are five vertebrae in the lower back. The vertebrae are crucial in protecting the spinal cord and nerve structures. Between these bones, there are discs, joint structures, and soft tissues that allow the back to be flexible and the body to move.

Discs are a type of cartilage structure that connects the vertebrae. A disc is a tissue located between two vertebrae, with a jelly-like center and a harder outer covering. Discs act as cushions between the vertebrae and ensure the even distribution of the body's weight across the vertebrae. Various factors can lead to degeneration in the discs. A herniated disc can be defined as a disorder resulting from structural damage to the discs. In other words, due to damage to the outer layer of the disc, the jelly-like material inside the disc shifts outward. As the vertebrae press on the nerves, a condition known as a herniated disc arises. Among the symptoms of a herniated disc, leg pain is prominent. Depending on the severity of the pressure the disc exerts on the nerves, symptoms such as pain, tingling, numbness, and weakness in the thigh area between the hip and knee can also occur.

What is a Herniated Disc?

The spine consists of a series of connected bones called vertebrae. Between each vertebra are discs that increase flexibility and mobility. A disc is a firm connective tissue with a jelly-like structure that acts as a cushion between the vertebrae. The outer layer of the disc is known as the annulus fibrosus, while the jelly-like center is called the nucleus pulposus. As a person ages, the structure inside the disc loses water, and the disc between the vertebrae can no longer function properly as a cushion. This causes the outer layer of the disc to crack, leading to the displacement or herniation of the disc. This condition, known as lumbar disc herniation in medical terminology, may also result in pressure on the nerves passing through the spine. This pressure can cause leg pain, numbness, and weakness. Herniated discs can also develop due to factors such as strain, heavy lifting, excessive weight, childbirth, or trauma, leading to a decrease in the person's quality of life.

What Causes Herniated Discs?

The following factors can lead to herniated discs:

• Sedentary lifestyle: A lack of physical activity causes all the muscles along the spine to weaken over time. This can result in the load of the body, which should be carried by the body muscles, being transferred to the vertebrae and discs, leading to a herniated disc.
• Being overweight: Obesity or excess weight leads to pressure on the discs. This can cause the discs to lose their normal shape, which may lead to disc herniation.
• Sudden movements: Sudden body movements while the muscles are cold put pressure on the discs. Over time, this may lead to the formation of a herniated disc.
• Occupational factors: Professions requiring heavy physical activity, or jobs where the body is exposed to prolonged vibration, such as driving, can cause herniated discs. Additionally, professions that require prolonged periods of sitting or standing can also contribute to herniated discs.
• Pregnancy: During pregnancy, the center of gravity shifts forward, adding extra load on the spine. This can lead to the formation of a herniated disc.

What Are the Symptoms of a Herniated Disc?

Herniated discs can occur at any age but are most commonly seen between the ages of 30 and 60. Herniated discs most frequently occur between the L4-L5 and L5-S1 vertebrae, which are the most mobile. If left untreated, it can lead to issues such as the inability to walk, incontinence, fatigue, and impotence. The most common symptom of a herniated disc is leg pain, but depending on the severity and location of the disc, the symptoms may vary. Common symptoms include:

• Arm and/or leg pain: Herniated discs are characterized by pain that radiates to the arm and leg, as well as the hip and calf. This pain intensifies with sudden movements, such as coughing or sneezing.
• Tingling and numbness: Along with leg pain, tingling or numbness may occur in one or both legs. This is due to the fact that the same nerves serve both legs. If the pinched nerve affects only one leg, pain is typically experienced in just one leg. There may also be a sensation of needle pricks or burning in the affected leg.
• Muscle weakness: In the presence of a herniated disc, weakness or atrophy may occur in one leg, affecting the person’s ability to walk or lift objects.
• Incontinence: Compression of nerves at the lower end of the spinal cord can cause difficulty controlling urination and defecation.

In addition to these symptoms, a person with a herniated disc may have difficulty standing on their toes, getting up from a seated position, or lying down. Various health problems, including gait disorders, may limit the person's movement.

What Are the Exercises for a Herniated Disc?

Herniated discs are one of the conditions that restrict movement and cause pain and discomfort. The pain from a herniated disc can be severe enough to interfere with daily activities. One of the potential solutions to relieve herniated disc pain is exercise. When selecting exercises for a herniated disc, the severity of the pain should be considered. Therefore, the exercise plan should be personalized by a physical therapist. Herniated disc exercises are performed on a flat surface. The person should lie on their back and slowly pull their feet towards them, bringing their knees to a vertical position. The abdominal and gluteal muscles should contract to gently press the lower back into the ground. Then, the legs are extended, and the head and shoulders are lifted off the floor. Another exercise involves raising each leg alternately while lying on the back and then lowering it back to the floor. This exercise is also performed in a prone position. Afterwards, the person should return to the back position and raise both legs about an inch off the ground, drawing circles in the air with their feet.

Diagnosis and Physical Therapy for Herniated Disc

To diagnose a herniated disc, the patient’s clinical symptoms are evaluated, and radiological imaging techniques such as MRI and CT scans are used. If necessary, the doctor may request an EMG. Based on the findings, a diagnosis of a herniated disc is made. Treatment options for a herniated disc vary depending on the severity of the symptoms. For example, if a disc rupture, known as a "herniated disc burst," occurs, immediate surgical intervention may be required. However, herniated discs that cause mild pain can be treated with physical therapy and/or medication. Physical therapy methods for non-surgical treatment depend on the patient's condition and may include heat applications, electrical stimulation, manipulation, and local injections.

How Is Herniated Disc Surgery Performed?

Surgical treatment is another option for treating a herniated disc. During the operation, the patient is typically placed face down and may be under general, local, or spinal anesthesia. A small incision is made in the tissue over the affected disc, and the surgery is carried out. Most herniated disc surgeries are performed using the partial discectomy technique, in which a portion of the herniated disc is removed. After surgery, once the anesthesia wears off, the patient can walk. Most patients are discharged within 24 hours. After the surgery, the patient should avoid activities such as driving, sitting for long periods, lifting heavy objects, and bending for four weeks. The doctor may recommend wearing a back brace if necessary.

If you experience any symptoms of a herniated disc, don’t hesitate to visit the nearest healthcare facility for an evaluation.