When someone complains of pain associated with a herniated disc, it rightfully draws sympathy from anyone within earshot. Our spine is central—literally and figuratively— to our existence. A herniated disc can occur in any region of the spine, from the neck all the way to the lower regions of the spine, with potential symptoms including loss of mobility and pain. A herniated disc can occur suddenly and traumatically; for example, by lifting an object from the floor or awkwardly reaching for an object. A disc can also herniate over time, such as, for example, when one sits with poor posture over a period of years. Surprisingly, most people never experience pain with a herniated disc; however, symptoms can range from nonexistent or minimal to debilitating. You can minimize your risk of herniations by learning and following proper movement techniques, especially when standing, sitting, or bending, and by correcting poor posture habits. For those who already experience this pain, learning to protect the spine through core-strengthening exercises will aid in the healing process.
Herniated discs, also referred to as slipped or ruptured discs, impact millions of Americans. A herniated disc can occur in any part of the spine. While it’s most commonly experienced in the lower back (lumbar spine), a herniated disc may occur in the neck (cervical spine), and more rarely, in the upper back (thoracic spine). This article will focus on the most common type of herniated discs, known as lumbar herniations.
Not all cases of herniation result in pain. Studies have shown that as many as 55 percent of people with signs of disc herniation do not experience any pain. Those who are not so lucky will experience pain ranging from mild to crippling.
Symptoms vary greatly from patient to patient. Some patients experience no symptoms at all; other patients feel mild to severe pain in the lower back. Related symptoms can include numbness and tingling (“funny bone sensation”) in the buttocks and down the leg, and leg weakness. This condition, known as sciatica, is the most common symptom of a herniated disc in the lower back. When the herniation is severe, the pain may shoot down the legs as far as the toes. Bowel and bladder control issues are uncommon, but this can be a sign of a very serious compression, and requires immediate medical attention.
Small, spongy discs sit in between each bone (vertebra) of your spine. When healthy, they provide padding and protection from weight-bearing forces. When a disc is damaged, however, the vertebrae can begin to squeeze on the discs, causing them to bulge, rupture, or break into pieces.
Think of the discs as jelly donuts. When a donut is squeezed, it begins to leak its contents. In the case of discs, this “jelly,” called the nucleus pulposus, begins to come out of the disc. The nucleus pulposus contains inflammatory proteins that can irritate the nerves of the back when they leak out. Additionally, the pressure of the bulging disc on a nerve—particularly the sciatic nerve—leads to pain, tingling, and numbness from the lower back all the way down the back of the legs (sciatica).
Herniations usually occur due to progressive changes in alignment caused by poor or lazy posture and wear and tear as we age, or as a result of acute spinal injuries. Poor alignment, such as slouching or slumping, causes excessive pressure on the vertebrae of the lower back (lumbar spine). This excessive strain in the muscles, coupled with movement that is not properly supported by the abdominals, can lead to a herniated disc. Similarly, as we age, the potential deterioration of the bones and muscles in the back (from conditions like osteoporosis or lumbar spinal stenosis), along with gravity’s force on the spine, can give way to the development of a herniated disc.
In an acute spinal injury (a single traumatic event), the vertebrae press down on a disc, causing excessive pressure on that one spot, and the disc may bulge out and/or rupture, ultimately causing pressure on nearby nerves.
Herniations can also occur from improper lifting. If proper technique is not maintained, the back can become overly stretched, causing injury to the disc resulting from the vertebrae crushing the disc between them. Strong core muscles can help, however. If you have strong core muscles and engage them when you lift, they can keep your vertebrae from compressing and crushing the disc.
- Lift with care. When lifting a heavy object, place your body directly in front of the object, bend your knees, engage your core, and lift slowly. Avoid simultaneously bending and twisting, especially when lifting an item off the ground. The closer you hold the object to your body, the better leverage you will have, and the lower your risk will be for straining the back.
- Keep your home organized. Many herniations occur at home while moving furniture and heavy objects around the house. Keep heavy objects in easily accessible areas in the house to allow for easy lifting and moving. This reduces your chances of having to lift and twist simultaneously, such as when pulling something out of the back corner of a closet.
- Stand tall. Gravity causes the spinal bones to naturally compress throughout the day. This is made worse when we assume slumping or slouching postures. To combat gravity, maintain proportionate space in the spine and reduce your risk of developing herniations, be sure to stand tall. Here’s how: While standing, create equal pressure on the left and right foot. Now, find optimal alignment by stacking the knees directly over the ankles, the hips over the knees, and the shoulders over the hips. Align the head atop the spine by pulling the chin back as if to make triple chins. Finally, engage the abdominals by lengthening the side body—the space between the hips and ribs—and pulling the belly in toward the spine and up toward the ribs. Practice standing tall 3 times each day—like when standing in line at the grocery store, waiting for the bus, or cooking dinner.
1. Ground the Feet. If your weight is disproportionately shifted toward one foot or the other, your pelvic alignment may be compromised. This can mean one hip hikes, your sacroiliac joint is instable, the abdominals cannot engage properly, and the low back is at risk for herniation. Grounding the feet ensures equal distribution of weight on each foot, essentially removing the potential for favoritism. In short, it sets up the foundation for good alignment in the rest of the body. To Ground the Feet, first create equal pressure on the left and right foot. Then, imagine points at the base of your big toes, pinky toes, outer heels, and inner heels. Pull the toe stems long and push all four points of the soles into the ground. In everyday life, you can Ground the Feet when you stand in line at the grocery store, brush your teeth, or sit at your desk at work. No matter if you’re seated or standing, connect to the ground beneath you by simply pressurizing through the four points of the soles (with equal weight on both feet) and reach long through the toes.
2. Anchor the Hips. One of the primary reasons people develop herniations in the lumbar spine is a lack of support through the hips and abdominals. Anchoring the hips is a technique that ensures the hips are properly aligned and the abdominals properly engaged. This engagement supports and stabilizes the lower portion of the spine and reduces the risk of developing herniations. To Anchor the Hips, make “L” Mudra with your hands. Place your thumbs on your ribs and your index fingers on your hips. The space between the thumbs and the index fingers is called the side body. This area shortens when you slump or slouch. Increase the space between the index fingers and thumbs to lengthen the side body. Now, draw the lower belly—the space between the belly button and the pubic bone—back toward the spine and up toward the ribcage to engage the deepest layer of abdominal muscle (transverse abdominis). Finally, release the glutes (butt muscles). To learn to release your glutes, it may help to understand what it feels like to do the opposite—grip the glutes. To grip the glutes, squeeze them together. Now release. In everyday life, you can Anchor the Hips when standing up from a chair. Before rising, lengthen the side body. On an exhale, Ground the Feet, and simultaneously pull the belly in toward the back and up toward the ribcage and release the glutes to stand.
3. Stimulate the Spine. Gravity can lead to spinal compression. This compression places excess pressure on the vertebral discs. When paired with improper alignment (pretty much anywhere in the body), this compression can lead to a herniation. Reducing the pressure on the spinal discs requires us to increase the space between each vertebra. To Stimulate the Spine, set your gaze slightly above the horizon, and pull the chin back as if making double, triple, even quadruple chins! This aligns the head atop the spine. Now, you’ll want to lengthen the spine to reverse the compressing effect of gravity by increasing the space between the tail and the head. To do this, create opposition by pushing your feet down and pulling the crown of your head up. In everyday life, you can Stimulate the Spine while waiting for the bus or train. First, align the head atop the spine. Now, exhale to push the feet down. Keep the feet pushing down toward the earth, and inhale and stretch the crown up toward the sky.
Strengthen the core. A weak core is a primary cause of herniation in the lower back. Engage the core by inhaling to lengthen the side body—the space between the hips and the ribs. As you exhale, maintain the length in the side body, but simultaneously draw the navel in toward the spine and up toward the ribs. By engaging the abdominals in this way, you activate the transverse abdominis—the deepest layer of abdominals—to stabilize the back and hips.