So you slipped/popped/herniated a disc. Nope nothing sipped or popped really. But this sucker hurts. Like a lot.
Let’s back up a minute. What the hell is a herniated disc and why does it cause so much back pain?
Ok here is a bit of a small anatomy lesson. The spine is made up of bony vertebrae and in between them sits a disc that is made of connective tissue with a gel filled middle. Picture a jelly donut with the donut part actually made up of concentric rings layered like an onion. Are you with me so far? Ok, so then really close to these discs are nerves on either side of the spine at each disc level (kind of). Now that you have that picture in your head I can explain what happens to the discs sometimes when we injure them.
Sometimes with repetitive movement, lots of flexion, sitting, moving, lifting, standing (and just life in general – because these things are cumulative) the jelly in the disc starts to make its way through the concentric rings causing the outer layers of the jelly donut to bulge outwards. If this bulging is anywhere near the nerve the nerve gets ANGRY. Nerves do not like pressure. Nerves. Do. Not. Like. Pressure. In fact it only takes 8 mm of pressure to cause the nerve to have altered function and possibly cause pain, numbness or a whole host of other symptoms. 8 mm of pressure is the amount of pressure you feel on the back of your hand if you place a dime on it. So not much pressure on the nerve and you get back pain. This is just mechanical pressure but the nerve can also be irritated by chemical mediators released in the area such as inflammation… ok lets not get too complicated.
Where were we? Ok, we have a bulging jelly donut and this is causing pain in the nerve. This could translate into back pain, back pain with leg pain or even numbness and tingling in the leg. This can get even worse if the jelly makes its way all the way out of the donut rings and we call this a herniated disc.
Right so what do we do?
Firstly most herniated discs do not like flexion of the lower back or increased intra abdominal pressure. That means sitting, bending and often coughing and sneezing too. These things will cause increased symptoms and should be avoided if possible. Because of the common course of herniation bending forward at the waist actually forces the jelly in the donut backwards causing the bulge or herniation to get worse.
For this reason those with a herniated disc may respond really well to the McKenzie protocol which I prescribe to patients in my clinic. I am going to upload a video with a simple exercise below but you have to promise me that if you suspect you have a herniated disc to please go check with your health care professional to make sure that this is the thing for you to do. If you do try it on your own and symptoms worsen – STOP.
Ok now that that is out of the way – the easiest (but not always the correct) McKenzie exercise to show you are simple back bends or extensions. All I want you to do is stand up and put your hands on your lower back. Then bend backwards keeping your neck in neutral and arching only your back then stand up again. I want you to do that 5-6 times in a row – all of this should take less than 15-20 seconds. That is it. If you are doing this right and you do have a herniated disc the pain or numbness in the leg should feel better a little bit better. If it feels worse please discontinue the exercise!!!
****Important note – if you have bowel or bladder changes such as a loss of control you need to seek emergency care – as in go to the Emergency Room. Do not pass go, do not collect $200. Ok?
Good.
Right, so if this exercise does make the leg pain or numbness less but increases the lower back pain that is actually ok and expected… If it does some of all of these things you can do this up to once an hour.
You still need treatment and fast so please contact me or another health care provider so that we can help you – hope this helps!!!
Exercise video listed below (underlined: “McKenzie Exercise” please click it and it will take you to the video)