The Back & Joint Rehab Center Specializes in the Evaluation and Treatment of Spinal Disc Herniations. A Herniated Disc Describes a Problem of the Substance Between the Spinal Vertebrae (bones).  We Provide Therapy For Patients Suffering With Herniated Discs. Majority of Herniated Discs Do Not Require Surgery. Majority of Herniated Discs Will Resolve With Therapy. We Work Collaboratively With Orthopedic Surgeons & Pain Specialists to Better Serve the Patient. You Do Not Need a Referral to Schedule an Appointment.

Overview

The intervertebral disc is a shock absorber of the spine and provides stability while maintaining ability to bear and transfer weight throughout the spine.  There are 23 discs in the spine.

• Cervical Spine (Neck) – 6 Discs
• Thoracic Spine (Midback) – 12 Discs
• Lumbar Spine (Low Back) – 5 Discs

The intervertebral disc is made up of primarily 2 components: An Inner Shell (Nucleus Pulposus) & An Outer Shell (Annulus Fibrosis). The Annulus Fibrosis is a strong circular exterior surrounding to protect the Nucleus. The Nucleus is intended to stay within the Annulus Fibrosus. While there are several types of terms describing a herniated disc, the premise of what is happening is the same. The Nucleus begins to protrude and bulge through the Annulus Fibrosis until it tears through the Annulus Fibrosis resulting in a herniation.

A herniated disc has the ability to irritate nearby nerves resulting in pain, numbness, weakness, inability to move and loss of spinal movement. On the other hand, greater than half the population has a herniated disc and yet, has no symptoms. Therefore, it is important to clinically determine the involvement of the disc and nerves to reflect the patient’s presentation. This is why majority of patients with herniated discs can resolve pain and return to function without surgery.

Symptoms

The most common region for herniated discs is the Lumbar Spine (L4-L5, L5-S1), followed by the Cervical Spine (C5-C6, C6-C7), and herniated discs in the Thoracic Spine is more uncommon.

• LUMBAR SPINE
  • Low Back Pain – The most common reason for lower back pain is a herniated disc. The pain can vary in intensity, frequency, and randomly provoke you throughout the day with daily movements and postures.
  • Leg Pain – A herniated disc can lead to pain that shoots down one or both legs. The pain can shoot into the butt, thigh, lower leg, or foot. Activities such as bending, walking, sneezing, coughing, or sitting can lead to greater exerted onto the disc and irritate the nerve to produce leg pain.
  • Leg Numbness or Tingling – Commonly, a herniated disc in the lumbar region will produce numbness or tingling in the foot, but can also produce these abnormal sensations in the butt, thigh, or lower leg. The nerve root commonly affected by a herniated disc is L5 or S1 Nerve Root.
  • Leg Weakness – Weakness can occur in the foot, lower leg or thigh affecting the ability to walk or rise from seated positions. Most commonly, we hear the term “foot drop”.  Again, this correlates with the most common area affected by a herniated disc, L4-L5, L5-S1. The affected Nerve Roots (L5 or S1) lead to foot drop weakness walking. Herniated discs in the middle region of the Lumbar spine (L3-L4) tend to affect the thigh.
  • Acquired Lumbar Deformity – Herniated discs can lead to more severe presentations affecting a persons ability to stand upright. There are 3 types of acquired spinal deformities. Patients will describe that prior to experiencing pain, the patient was able to stand upright and appear normal. Upon onset of the problem, the patient loses the ability to stand upright and is stuck in a deformed position.
    • Three Types of Acquired Spinal Deformity
      • Acquired Kyphotic Deformity – The patient is hunched forward (flexion) not able to stand erect. Commonly, the patient is worse after periods of sitting or sleeping and upon initial standing, the patient demonstrates a worsening of being stuck in the forward bent posture.
      • Acquired Lordotic Deformity – The patient is locked in an upright position (extension) and is unable to bend forward (flex).
      • Acquired Lateral Shift Deformity – This deformity has the ability to present 3 different ways.
        • Left Lateral Shift – The patient’s shoulders are shifted to the left and the hips are shifted to the right. The patient is unable to stand upright and be centered.
        • Right Lateral Shift – The patient’s shoulders are shifted to the right and the hips are shifted to the left. The patient is unable to stand upright and be centered.
        • Bilateral, Lateral Shift – This presentation of a Bilateral, Lateral Shift is much less common. The patient is locked in either a Left or Right Lateral Shift and by moving into flexion the patient is then locked into the opposite Lateral Shift. For instance, the patient is locked into a Left Lateral Shift, then flexes forward, and leads to being locked in a Right Lateral Shift.
• CERVICAL SPINE
  • Neck Pain – The most common reason for neck pain is a herniated disc. Although, neck pain does not imply you have a herniated disc. The research simply suggests that there are greater findings that people who have neck pain also have a herniated disc or bulge.
  • Arm Pain – A herniated disc can lead to shooting pains that travel down one or both arms. The pain may begin in the shoulder blade and then begin to travel to the shoulder, arm, forearm, and hand.
  • Arm Numbness or Tingling – Typically, when arm numbness or tingling is present, there is a herniated disc irritating a nerve root, however, the nerve root can also be irritated by stenosis. Numbness and tingling is typically seen in the hand, but is also seen in the forearm and arm. Keep in mind, that numbness or tingling can occur in both arms. This leads to confusion for patients believing they have carpal tunnel syndrome; however, this is not the case, they simply have symptoms that appear like carpal tunnel and not actually have peripheral nerve root impingement.
  • Arm Weakness – A herniated disc in the cervical spine can lead to weakness in one or both arms. Commonly, weakness in the hand is present affecting grip strength or weakness in attempting to raise the arm overhead.
  • Acquired Cervical Deformity – More severe conditions can lead to patients who present with locked neck postures. These patients have the inability to move their neck to an upright position.

CAUSES

Majority of herniated discs are a result of gradual degeneration. The daily stressors that include activity and postures influence disc degeneration leading to herniated discs. Aging leads to decreased water content in the disc, therefore, making the disc more inclined to rupture or tear as the decreased water content weakens the integrity of the annulus making it less flexible and more rigid. Contrary to belief, it is extremely rare for traumatic events such as motor vehicle accidents or falls to herniate a disc. Poor mechanics or lifting strategies that are repetitive lead to high risk of herniated a disc.

DIAGNOSIS 

Physical examinations & patient history can lead to significant clinical reasoning that a herniated disc is present. However, a herniated disc can only be confirmed with an MRI. The physical examination includes spinal orthopedic tests, nuerological testing, and mechanical evaluation of spine.

The nuerological testing includes:

• Reflexes of the Upper & Lower Extremity
• Muscle Strength of Upper & Lower Extremity
• Soft or Pinprick, Temperature, or Vibratory Sensation

TREATMENT

Understand that there are various forms of therapies available. However, patients should be made aware of the types of therapies. There are therapies that are meant to help tolerate pain. And there are therapies meant to help resolve the condition. Understanding which are necessary to use is helpful for the patient to understand what to expect as a response to care. 

• Therapies to Help Tolerate Pain – These types of therapies will respond to simply temporarily decrease the intensity of pain, however, do not allow the patient to maintain better. Remember, the problem is a disc herniation. This is a mechanical condition needing a mechanical input of therapy. The herniated disc may produce temporary bouts of inflammation, pain in the muscles, spasms, paresthesia, or weakness. Therefore, we understand that therapies that address inflammation such as pain medication, massage, or passive modalities such as TENS units, only temporarily reduce symptoms. If the patient cannot tolerate the pain intensity, it is important to introduced these therapies as more conservative means to help the patient tolerate symptoms to begin other forms of therapy to resolve the condition.
• Therapies to Help Resolve the Condition – These types of therapies will involve spinal components of movement or positioning of the spine. Improving the movement of the spine in the affected region will improve the mechanics of the affected spinal area, therefore, reducing symptoms and improving ability to move.
  • McKenzie Therapy – This is the leading therapy for spinal disorders. We are the longest standing Credentialed McKenzie Providers in Northwest Indiana.
    • A Form of Therapy that Assesses Which Specific Spinal Movements and Positions Reduce Symptoms.
    • The Patient Learns How to Take Control of Their Pain Through Specific Exercises and Positioning.
    • The Patient is Educated on How Their Pain Will Respond to Activity and Posture.
    • Preventative Education and Exercises are Given to the Patient
    • For More Information About McKenzie Therapy, Please Visit: https://www.mckenzieinstituteusa.org/method-patients.cfm

PREPARING FOR YOUR APPOINTMENT

If you have a herniated disc and are struggling with arm or leg symptoms, make an appointment as soon as possible to prevent worsening of symptoms. If you have prior MRI reports, please bring them to your appointment. If you would like your family doctor or nurse practitioner to be updated regarding your condition, please have the contact information readily available.  You can call to schedule your appointment (219)-310-8822 or schedule online.