Low Back Pain Series - Intervertebral Disc Issues
What is the disc made of, and why is it important?
The discs are structures that sit between the bodies of each spinal segment and provide distribution/transmission of force through the spine. Strong annular fibers line the outer ring of the disc, while a more gelatinous nucleus helps with providing shock absorption through each segment.
Long periods of sitting or loaded rotational movements tend to be the provocative motions that irritate intervertebral discs and cause things like bulges, herniations, and sequestrations. Many people historically have described this as “throwing your back out” while lifting or moving something. Due to the altered force being placed on the disc, the annular fibers become weakened, allowing for that nuclear material to press outward in varying degrees. Depending on the degree of injury, pain can be heightened due to the pressure on the spinal nerves, muscles, and innervation to the disc itself.
Before considering spinal surgical procedures, always consider utilization of conservative measures first. Surgery is not always the best course of action for treatment of LBP, particularly if there is a non-radicular component to it.
Very similar to other pathologies, your body is trying to prevent the irritation from continuing, so muscles tend to tighten and guard secondary to the pain.
Targeted soft tissue mobilization and joint mobilization techniques can provide relief, while exercises that first help find positions of comfort mitigate pain. Functionally building progressive loads and improving lifting mechanics will help with control and prevention of future injury.
If you’re dealing with this issue either chronically or acutely, prioritize these strategies:
Finding a position of comfort - Managing the inflammatory response in the low back is key, primarily reducing the irritation in the surrounding structures such as the muscle, joint, and nerve. Find a position of comfort (typically either prone or supine with knees bent).
Finding directional preference - Depending on the severity of the disc issue, certain movements may be more irritable or relieving. Multiple repetitions will typically help drive some of that decision. For example, if pain increases with multiple repetitions forward-bending, the directional preference should be lumbar extension. Laying prone on elbows, or leaning back on a table/surface, will likely be uncomfortable, but will ultimately reduce some of the irritation.
Remain consistent through the process - Understand that it may not be complete reduction in discomfort after only a few rounds of exercises. Look for small percentage changes each time performing the exercises and stay on top of it. View the positional exercises similarly how you would utilize some pain-relieving medications.
Mobilize, stabilize, and strengthen - For both acute and chronic disc issues, the underlying theme is that your body has developed a maladaptive pattern that puts you at risk for a recurring issue. For some, it might be getting those glutes active, whereas others may struggle to engage their abdominals to prevent overactivation of the lumbar extensors.
General Exercise Recommendations:
Mobility - Prone on Elbows, Press-ups (REIL), Lean-Backs (REIS) Figure-4 Stretch (Piriformis), , Open Books, Lower Trunk Rotations
Stability - Pelvic Tilts, Glute Bridges, Prone Hip Extensions, Supermans
Remember with most of these Mobility exercises, the goal will be to repetitively move in that positional preference (often extension). Perform 20+ reps for all movements and hold the stretches for 45sec to 1 min at a time. Don’t be afraid to perform 2-3 of these movements multiple times in a given day depending upon the severity of the issue.
Reach out with any specific questions and equipping you with tools that prevent further injury will undoubtedly help with returning to the activities you love.
Move Better. Live Well.
