Greetings to MiTo readers, here is another blog regarding one of the most common issues for your spine: disc herniation. Probably you’ve already heard of it may be from one of your friends, or parents, or you may have suffered from it.
It is very common among musculoskeletal disorders, every year around 2% of the global worldwide population has been diagnosed with disc herniation. The third decade is the most affected age group.
What is a disc herniation? Before giving you a clear answer we must understand a little bit of basic anatomy and biomechanics, it won’t be too boring, trust us!
Your spine is composed of rectangular-shaped bones stacked on top of each other, these bones are called vertebrae. In between the vertebrae they can be found spongy components called discs. Discs are shock absorbers and give stability and protection to our spine and our nerves.
They can be divided into 2 components:
Annulus Fibrosus: is the external part of the disc, more resistant as it is made of stronger fibres.
Nucleus Pulposus: is the internal part of the disc, gelatinous and very hydrated.
The discs are not a fixed structure, but have some degree of mobility and change their position according to the amount of pressure put into them, you could imagine them like a slime stress ball.
Your discs can be squeezed as much as a slime stress ball, but during any movements of our spine it will shift accordingly, e.g, if you side bend to the left your disc, will be squeezed mostly on the left part and then it will move to the right if you bend forward your disc will shift backwards.
So if the disc is used to being squeezed and moved in every direction, why disc herniation is happening? Disc herniation is the final result of a prolonged and repetitive injury all over time (bending forward in awkward positions, sitting for hours without having breaks, lack of stretching, lifting heavy objects, poor lifting technique, body twistings etc.); in the disc herniation, the disc will bulge out from its natural position, usually bulging occurs backwards toward the spinal cord and the nerves.
A disc herniation could occur on any level of the spine, in the neck (cervical herniation), in the upper and mid-back (thoracic herniation), lower back ( lumbar herniation).
The most common site of disc herniation in the lower back is the disc called L5-S1. This section represents the last lumbar vertebra and the first part of the sacral bone. It is mobile and it is a point of major pressure for our body: any type of spinal movement such as lean forward, twisting or side bending to one side involves putting pressure into L5-S1.
Another common site of disc herniation is the C6-C7 area which is one of the most mobile joints in the neck and for this reason, is subjected to moderate overuse through the years.
A thoracic herniation is very rare and usually are linked to severe traumas or other spine conditions such as a tumour, infections or osteoporosis.
There are 4 stages of disc herniation and these are called:
1. Disc Degeneration: there is symmetrical flattening of the disc in all directions, there is minimum damage to the fiber of the annulus fibrosus and the nucleus pulpous is still inside the inner portion of the annulus fibrosus.
2. Disc Prolapse: there is a bulging of the nucleus pulpous (the inner part of the disc) to the annulus fibrosus which is damaged to its inner aspects, but the disc still does not bulge outside the outer portion of the annulus.
3. Disc Extrusion: part of the disc bulges out from the outer portion of the annulus fibrosus.
4. Disc Sequestration: The entire part of the nucleus pulpous together with some fragments of the annulus fibrosus bulge completely out from the disc.
If the disc herniation is pinching the nerves you’re gonna suffer from different neurological symptoms:
On top of the above disturbances you will probably suffer from:
Usually, you discover to have a disc herniation because you have been referred for an MRI by your GP, in this case probably you have suffered from severe pain and maybe some of the neurological symptoms described above.
According to the severity of the symptoms, you may be asked to see an orthopedic surgeon who will assess and propose you a surgical operation.
Surgical operation is always considered as the last option in the case where physical or manual therapies (physiotherapy, osteopathy, chiropractic, massage) did not work.
Please be mindful that every single patient is different from another, the similar clinical presentation may have different outcomes: a disc herniation may be completely asymptomatic, in fact, in the young adults population 20% of the disc herniation are asymptomatic while in people older more than 70 years old more than 75% of disc herniation are asymptomatic.
The most common surgery used for a herniated disc is the discectomy.
Discectomy is a type of surgery where an incision is made on your back and a portion of the entire disc is removed.
Another type of surgery involves cutting other parts such as the laminae of your vertebra to free the space in your spine avoiding compression or sometimes 2 vertebrae are fused.
After the surgery, long-term rehabilitation is required you will always need to watch your back, especially during lifting loads and you will always have to practice regular exercises to strengthen the muscle in your back and your core to prevent relapses and further damage.
As a healthcare clinic, our final goal is to make life easier for our patients and also to create medical awareness through online content, below you will find a list of exercises useful to prevent and manage general pain related to a disc problem.
Please be mindful that if you’re suffering from any symptoms mentioned earlier, especially the neurological ones you are strongly advised to check with your GP if you need any further examination such as an MRI.
Here few exercises that you can try to alleviate your symptoms, you will find exercises for low back, upper back, and neck disc bulge.
Lower back mobilization in a supine position
1. Muscles involved: Lumbar Erector Spinae, Gluteal muscles
2. Joints involved: Lower Back, Hips, Knees.
3. Procedure: Bend your knees as shown. Move both of your hips towards one side. Go back to a neutral position. Repeat to the other side.
4. Precautions: it is not a twisting exercise, stop the hips rotation until you feel that your lower back is engaged. If you feel pain stop doing the exercise.
5. Effects: Improve lower back mobility and help with low back pain.
Glutes Stretching in a supine position
1. Muscles involved: Gluteal muscles (Gluteus Maximus, Gluteus Medius and Gluteus Minimus), Lateral Rotators of Hip (Quadratus femoris, Gemellus inferior, Obturator externus, Gemellus superior, Piriformis)
2. Joints involved: Hips, Knees.
3. Procedure: Bend your knees to 90 degrees as shown in the video. Place your ankle into the opposite knee, and pull the opposite knee towards your chest until you feel a stretch into your glutes. Go back to the neutral position. Repeat to the other side.
4. Precautions: Pay attention to the hip rotation, do not force the movement beyond measure If you feel pain stop doing the exercise. Be particularly cautious if you are suffering from hip osteoarthritis or hip impingement.
5. Effects: improves Glutes flexibility, reduces lower back stiffness, improves hip mobility
Chair Hamstrings Stretching in a standing position
1. Muscles involved: Hamstrings (Biceps Femoris, Semitendinosus, Semimembranosus).
2. Joints involved: Hips, Knees, Ankles.
3. Procedure: Place your foot into the chair and keep your leg straight, make sure to maintain a good posture with your back and with your pelvis without any twists. Move your foot toes towards your knee as shown in the video. You should feel a stretch at the back of your thigh and knee. For a more powerful stretch push gently your knee towards the floor. Go back to the neutral position. Repeat to the other side.
4. Precautions: Pay attention to not push too hard on your knee, do not force the movement beyond measure If you feel pain stop doing the exercise. Be particularly cautious if you are suffering from knee osteoarthritis or other condition such as meniscus tears.
5. Effects: improves hamstrings flexibility, improves hip and lower back range of motion.
Cat Camel Stretching in a 4 point kneeling position
1. Muscles involved: Upper and Mid Back, Lower Back Muscles (Thoracic Erector Spinae, Latissimus Dorsi, Rectus Abdomini, Trapezius, Supraspinatus, Lumbar Erector Spinae).
2. Joints involved: Lower Back, Hips, Mid Back, Upper Back, Shoulder blades, Neck.
3. Procedure: lay down in a 4 point kneeling position as shown in the video. Round your upper back up, and exhale during this phase of the movement. Go back to the neutral position and slightly arch your back, inhale during this phase of the movement.
4. Precautions: Pay attention to not arch too much your lower back as you may injure your spine, do not force the movement beyond measure. If you feel pain stop doing the exercise.
5. Effects: encourages a good posture, and improves spinal flexibility and mobility.
Bird Dog Exercise in a 4 point kneeling position
1. Muscles involved: Upper and Mid Back, Lower Back Muscles (Thoracic Erector Spinae, Latissimus Dorsi, Rectus Abdomini, Trapezius, Supraspinatus, Lumbar Erector Spinae, Quadratus Lumborum, Gluteus Maximus, Gluteus Medius and Gluteus Minimus).
2. Joints involved: Lower Back, Hips, Mid Back, Upper Back, Shoulder blades, Neck.
3. Procedure: lay down in a 4 point kneeling position as shown in the video. Lift your arm straight in front of you and lift the opposite leg, the leg is straight as well. Engage your abdominal muscles bringing your belly button towards the lower back. Go back to the neutral position and change the side.
4. Precautions: Pay attention to not arch too much your lower back as you may injure your spine, do not force the movement beyond measure If you feel pain stop doing the exercise. If you feel too unbalanced, try just to lift one arm or one leg as you build up strength the exercises will become easier.
5. Effects: improves spinal stability, encourages a good posture, and relieves low back pain.
Back Extension on a Chair
1. Muscles involved: Mid Back muscles (Thoracic Erector Spinae, Rhomboids, Trapezius, Latissimus Dorsi, Teres Major and, Minor, Supraspinatus, Infraspinatus).
2. Joints involved: Lower Back Mid Back, Shoulder blades.
3. Procedure: Place your hands interlaced behind your neck to support your cervical spine. Arch your lower back slightly and slowly bend backward focusing the movement on your upper back.
4. Precautions: Pay attention to not arch lower back too much as you may injure your spine, do not force the movement beyond measure, and if you feel pain stop doing the exercise.
5. Effects: Encouraging good posture, strengthening back muscles.
Bruegger’s Postural Exercise
1. Muscles involved: Upper Back muscles, Mid Back muscle, and Lower back muscles.
2. Joints involved: Lower Backarching, Mid Back, Neck, Shoulders.
3. Procedure: Stand up against a wall. Make sure your head, shoulders blade, buttock, and heels are well attached to the wall. Your hand palms should be facing outwards. Tuck your chin slightly back without arching your neck and push your shoulder blades downwards and towards the midline. Take deep breaths throughout the exercise.
4. Precautions: Pay attention to not arching the lower back and neck too much as you may injure your spine. Do not force the movement beyond measure and if you feel pain stop doing the exercise.
5. Effects: encourage good posture and gives you a nice stretch of the chest and front.
Scapular Retraction
1. Muscles involved: Mid Back muscles (Trapezius and Rhomboids).
2. Joints involved: Mid Back and Scapulo-Thoracic (Shoulder Blades).
3. Procedure: Sit down facing the back of a chair and grip your hands on it. Squeeze your shoulder blades towards the midline.
4. Precautions: Pay attention to not arch the lower back or neck too much as you may injure your spine. Do not force the movement beyond measure and if you feel pain stop doing the exercise.
5. Effects: improve shoulder blade mobility and thoracic spine stability.
Chin Tuck Exercise in a supine position
1. Muscles involved: Cervical Erector Spinae, Deep neck flexors, Lower neck extensors.
2. Joints involved: Cervical Spine (neck)
3. Procedure: lay down flat on a carpet or a mat as shown in the video. Move your chin towards the back of your head as you exhale. Hold for a couple of seconds. Relax. Go back to the neutral position and repeat.
4. Precautions: Pay attention to keeping your neck aligned and moving your chin backward and not downward. Do not force the movement beyond measure. If you feel pain stop doing the exercise.
5. Effects: strengthens deep neck flexor muscles, and promotes good neck posture.
Isometric Neck Extension Exercise in a seated position
1. Muscles involved: Cervical Erector Spinae, Sternocleidomastoid muscle, Neck extensors, Scalenes.
2. Joints involved: Cervical Spine (neck)
3. Procedure: Sit down on a chair or sofa as shown in the video. Remember to maintain a good posture with your body. Place your hand on the back of your head. Start pushing gently against your hand. You should feel the muscles at the back of your neck contracting. Hold for a couple of seconds. Relax. Go back to the neutral position and repeat.
4. Precautions: Pay attention to keeping your neck aligned. Do not force the movement or push beyond measure. If you feel pain stop doing the exercise.
5. Effects: strengthens deep neck extensor muscles, promotes good neck posture, improves neck stability, and helps with neck pain.
Isometric Neck Rotation Exercise in a seated position
1. Muscles involved: Cervical Erector Spinae, Sternocleidomastoid muscle, Neck extensors, Scalenes, Suboccipitals (part of them).
2. Joints involved: Cervical Spine (neck)
3. Procedure: Sit down on a chair or sofa as shown in the video. Remember to maintain a good posture with your body. Place your hand on the side of your head. Start pushing gently against your hand. You should feel the muscles at the side of your neck contract. Hold for a couple of seconds. Relax. Go back to the neutral position and repeat.
4. Precautions: Pay attention to keeping your neck aligned. Do not force the movement or push beyond measure. If you feel pain stop doing the exercise.
5. Effects: strengthens neck rotator muscles, promotes good neck posture, improves neck stability, and helps with neck pain.
Upper Trapezius Stretch Exercise in a seated position
1. Muscles involved: Upper Trapezius
2. Joints involved: Cervical Spine (neck)
3. Procedure: Sit down on a chair or sofa as shown in the video. Remember to maintain a good posture with your body. Move the chosen side ear to the shoulder until you feel a gentle stretch. Hold for a couple of seconds. Relax. For a more powerful stretch, you can gently assist the stretch with your hand and push down the shoulder of the stretched side. Go back to the neutral position and repeat.
4. Precautions: Pay attention to keeping your neck aligned. Do not force the movement or push beyond measure. If you feel pain stop doing the exercise.
5. Effects: improves Upper Trapezius flexibility, improves neck range of motion, reduces neck stiffness.
Frequency
Based on the area of pain you should perform the above exercise routine at least twice a week.
Stretching exercises: Hold the position for at least 5 seconds, and repeat 5 times on each side.
Strengthening exercises: Repeat 10 times in total. For each single repetitions try to hold the position for 5 seconds, this amount can increase after you become more confident with the movement.
Golden rule: If an exercise is hurting you or triggering your symptoms don’t do it.
If you have any doubts, questions, or need any help to relieve any pain. Call or Book an appointment with us.
That’s MiTo for you!
1. Your spinal cord weight is just 35 grams!!
2. The total number of vertebrae at birth is 33 but we lose some of them as we grow old. This is because around 8-10 of them fuse to form the coccyx and the sacrum.
3. Your spine is extremely flexible it can bend almost to the point to form a full circle
4. Your spine can work independently from your brain as it can send direct electric signals to your muscles.
This is the end of the blog, MiTo Team says thank you to have read it and hopes that you enjoyed it.
All the information on this blog post is made with passion, love, and expertise by the MiTo team, however, we always rely on what science says on this topic so you will find our source of information at the bottom of the page in the Bibliography section.
1 . All the pictures from Wikimedia commons and Unsplash.
2. Al Qaraghli MI, De Jesus O. Lumbar Disc Herniation. 2021 Aug 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
3. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015 Feb;29(2):184-95.
4. Amin, R.M., Andrade, N.S. & Neuman, B.J., 2017. Lumbar disc herniation. Current Reviews in Musculoskeletal Medicine, 10(4), pp.507–516.
5. Anon, 2020. Slipped disc: Overview. InformedHealth.org [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279472/.
6. Lachman, D., 2015. Analysis of the clinical picture in patients with osteoarthritis of the spine depending on the type and severity of lesions on magnetic resonance imaging. Reumatologia/Rheumatology, 4, pp.186–191.
7. All the videos have been provided by MiTo Healthcare Clinic who recorded and posted them on the MiTopedia blog.
Although the MiTo team is composed of healthcare practitioners, we are not your healthcare practitioners (yet XD). All the content on this website is for informational and educational purposes only and does not constitute medical advice. We always strive to provide an accurate and reliable source of information, but the information on this website does not substitute any professional advice and you should not rely solely on this blog content. Always seek medical-professional advice in the area of your particular needs or circumstances before making any decision concerning your health.
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