A herniated disc, sometimes referred to as a slipped or ruptured disc, is a condition affecting the spine where the inner, gel-like material (nucleus pulposus) of an intervertebral disc escape through a tear in the tough, outer layer (annulus fibrosus). This can occur in any part of the spine but is most common in the lower back (lumbar spine) and neck (cervical spine).
The choices you make in your day-to-day activities play a critical role in managing a herniated disc. It’s essential to protect the spine from further injury, reduce symptoms, and promote healing. Avoiding certain activities and adopting healthier habits can make a significant difference in your condition’s progression and your overall quality of life. In some cases, it may even help you avoid surgery. Studies have shown that proper management, including lifestyle modifications and correct activity choices, can improve outcomes and quality of life for patients with herniated discs [1].
Explanation of the anatomy of the spine and the disc
The human spine is an intricate structure designed for both strength and flexibility. It’s composed of 33 individual bones called vertebrae, stacked one on top of another. Between each vertebra, you’ll find a disc – a circular pad filled with a gel-like substance. These discs act as shock absorbers, allowing the spine to flex, bend, and twist. The disc itself is composed of two main parts: the annulus fibrosus and the nucleus pulposus.
Anatomy of the Spine
Vertebrae: The spine is made up of 33 individual bones stacked one on top of the other, known as vertebrae. These are divided into five regions: 7 cervical (neck) vertebrae, 12 thoracic (chest) vertebrae, 5 lumbar (lower back) vertebrae, 5 fused sacral vertebrae, and 4 fused coccygeal (tailbone) vertebrae.
Spinal Canal: This is a hollow space in the center of the vertebrae that houses the spinal cord and nerve roots.
Facet Joints: These are small, paired joints at each segment of the spine that allow for movement and provide stability.
Ligaments: There are numerous ligaments running up and down the spine that hold the vertebrae together.
Muscles: The muscles supporting the spine allow for the spine’s movements and help maintain the structure of the spine.
Spinal Cord and Nerves: The spinal cord extends from the brain and travels down the spinal canal. Nerves branch out from the spinal cord through openings in the vertebrae and carry messages between the brain and muscles.
Anatomy of the Disc
Annulus Fibrosus: This is the tough, flexible outer ring of the disc. It consists of several layers (lamellae) of fibrocartilage that are rich in collagen and fibroblasts.
Nucleus Pulposus: This is the soft, jelly-like structure in the center of the disc. It’s composed mostly of water and serves as the main shock absorber in the spinal column.
Vertebral Endplate: These are the superior and inferior bony surfaces of the vertebral bodies, which the discs are attached to. The endplates are crucial for delivering nutrients to the disc cells.
The discs in the spine act as shock absorbers between the vertebrae, allowing the back to flex, bend, and twist. Aging, injury, or other factors can cause these discs to herniate or rupture, leading to a herniated disc.
Read More: The best treatment of PLID/ Disc herniation / Disc prolapse in Bangladesh
How a disc becomes herniated
A disc herniates when the nucleus pulposus pushes out from the disc’s center through a tear or weakness in the annulus fibrosus. This can occur gradually over time due to aging and wear and tear, or it can result from a sudden injury or strain.
When the nucleus pulposus herniates, or protrudes, it can press on the nearby spinal nerves, This can result in symptoms such as back pain, numbness, and weakness in the affected area [2]. The body’s inflammatory response to the herniation can also contribute to nerve irritation.
Symptoms of Herniated Discs
- Pain: This is the most common symptom of a herniated disc. Depending on where the herniated disc is, the pain may occur in the neck, low back, or may radiate to the extremities.
- Numbness or tingling: Patients often report sensations of numbness or tingling in the area of the body served by the affected nerves.
- Weakness: Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or it could affect your ability to lift or hold items.
- Radiating pain: If the herniation occurs in the lower back, you might feel pain radiating down the leg (sciatica). A herniated disc in the neck may result in pain radiating to the arm and shoulder (cervical radiculopathy).
- Loss of bowel or bladder control: This is a rare but serious symptom that may indicate a more severe nerve involvement called cauda equina syndrome.
Complications of Herniated Discs
- Long-term nerve damage: If the herniated disc compresses a nerve for an extended period, it can lead to long-term nerve damage, potentially resulting in a loss of sensation, muscle weakness, or paralysis.
- Chronic pain: If left untreated, a herniated disc can lead to persistent, debilitating pain.
- Reduced mobility: Chronic pain, muscle weakness, and numbness can affect your mobility and quality of life.
- Bladder or bowel dysfunction: In severe cases (such as cauda equina syndrome), a herniated disc can cause loss of bladder or bowel control.
- Permanent nerve damage: In rare instances, a herniated disc can cause permanent nerve damage, leading to conditions like saddle anesthesia (loss of sensation in inner thighs, back of legs, and around the rectum).
- Depression: Living with chronic pain can lead to mental health issues such as depression and anxiety.
Read More: Self-diagnosis of lumbar intervertebral disc prolapse/PLID/Disc Herniation
Activities to Avoid When Living with a Herniated Disc
Understanding what activities and behaviors can exacerbate herniated disc symptoms and complications is key to managing the condition. Actions such as heavy lifting, twisting, bending at the waist, and maintaining certain postures for extended periods can place undue stress on the disc, increasing inflammation and pain.
Additionally, lifestyle choices such as smoking, lack of exercise, and poor nutrition can also worsen the condition by impairing the body’s natural healing abilities and promoting disc degeneration. Recognizing these factors is crucial for effective management and recovery.
A. Prolonged Sitting or Standing
How prolonged positions can increase pressure on the disc
Prolonged sitting or standing can increase pressure on the discs in your spine, including a herniated disc. A study published in the Journal of the American Medical Association found that prolonged sitting or standing can exacerbate herniated disc symptoms [3]. This is because maintaining a single position for an extended period of time leads to increased static load on your spinal structures. Over time, this can exacerbate pain and other symptoms associated with a herniated disc.
Advice on taking breaks and changing positions often
To mitigate the negative effects of prolonged sitting or standing, it’s crucial to take frequent breaks and change your position regularly. If you’re sitting for a long time, for instance, while working at a desk or during a long drive, aim to stand and move around at least every half an hour. If you’re standing for extended periods, try to take breaks to sit and rest.
B. Heavy Lifting
The strain heavy lifting puts on the spine
Heavy lifting can put a significant amount of strain on your spine. When you lift a heavy object, particularly if you do not use proper techniques, it can cause you to bend and twist your spine in ways that put pressure on your herniated disc, worsening your symptoms and potentially causing further damage. Research has shown that those who regularly engage in heavy lifting are more likely to suffer from disc herniation and related complications [4]
Safe lifting techniques and alternatives to heavy lifting
If you must lift something, it’s essential to use proper techniques. Keep the object close to your body, use your legs and not your back to lift, and avoid twisting your body as you lift. Moreover, consider using tools and devices to assist with lifting, or ask for help when dealing with heavy items.
C. High-Impact Exercises
Detailing exercises that can worsen the condition
High-impact exercises, such as running, jumping, and certain types of aerobic dance, can exacerbate a herniated disc. These activities often involve jarring movements and sudden changes in direction, both of which can put extra pressure on your spine.
Alternatives to high-impact exercises
A study in the journal Spine found that low-impact exercises, including walking, swimming, and yoga, are less likely to aggravate a herniated disc and can help to improve overall fitness and flexibility [5]. Moreover, exercises like yoga and Pilates can also be beneficial, as they focus on core strength and flexibility, but they should be done under professional guidance to ensure correct technique and avoid injury. Always consult your healthcare provider before starting a new exercise routine.
D. Poor Posture
The role of posture in exacerbating herniated disc symptoms
Posture plays a significant role in the health of your spine, and maintaining poor posture can worsen herniated disc symptoms. When you slouch or hunch over, your spine is not properly aligned, and the pressure distribution across your discs is uneven. This additional stress can exacerbate the herniation and intensify associated pain and discomfort. A study in the European Spine Journal showed that people who practiced regular postural exercises experienced less pain and improved functionality [6].
Tips for maintaining good posture
1. Awareness and Posture Checks
Regularly check your posture throughout the day. This includes being mindful of your posture when sitting, standing, and even when moving around. Over time, this increased awareness can help you intuitively correct your posture.
2. Proper Standing Posture
When standing, your weight should be evenly distributed on both feet. Your knees should be slightly bent, and your feet should be shoulder-width apart. Stand tall with your shoulders pulled backward. Always maintain your head level — your earlobes should be in line with your shoulders.
3. Correct Sitting Posture
Choose chairs with good lumbar (lower back) support, or consider using a backrest or cushion. Your knees should be at or below hip level, with your feet flat on the floor. Avoid crossing your legs, as this can contribute to poor posture.
4. Ergonomic Workspace
If you work on a computer, ensure it is ergonomically set up. The top of your computer screen should be at eye level, and your keyboard and mouse should be positioned so your arms form a 90-degree angle at the elbow. An ergonomic chair that supports your back’s natural curve can also be beneficial.
5. Regular Exercise and Stretching
Incorporate exercises and stretches that strengthen your core and back muscles into your daily routine. Pilates, yoga, and similar activities can improve flexibility, balance, and strength, which are beneficial for good posture. Also, regular physical activity can help keep your weight within a healthy range, reducing strain on your spinal structures.
6. Frequent Breaks
If your work involves long periods of sitting, aim to take breaks every 30 minutes to stand or walk around. This can relieve pressure on your spinal discs and prevent muscle fatigue.
7. Correct Lifting Technique
Always bend your knees and use your legs, not your back, when lifting heavy objects. Keep the object close to your body, and avoid twisting or turning while lifting.
8. Sleep Position and Mattress
Your sleeping position can also affect your posture. If possible, sleep on your back or side rather than your stomach. Use a pillow that supports the natural curve of your neck. The right mattress is crucial too; it should support the natural curves of your body and maintain alignment of the spine.
9. Professional Guidance
Regular check-ups with a healthcare professional, such as a physical therapist, chiropractor, or occupational therapist, can provide personalized advice on maintaining good posture, taking into account your specific needs and circumstances.
Improving posture can seem challenging at first, especially if you’re dealing with pain from a herniated disc, but consistent effort and the incorporation of these practices into daily life can lead to significant improvements over time.
Read More: 6 Tips for Relieving Pain From Herniated Discs or Disc Prolapse
Ignoring Pain or Discomfort
The dangers of pushing through pain
Ignoring pain or discomfort and pushing through it can lead to more severe damage. Pain is your body’s way of signaling that something is wrong, and consistently ignoring these signals can exacerbate an existing herniation and potentially cause additional health issues. For example, you might unintentionally alter your movements to compensate for the pain, leading to imbalances and strains elsewhere in your body. If your pain increases, it’s essential to rest, modify activities, and consult a healthcare provider [7].
Importance of listening to your body and seeking professional help when needed
It’s essential to listen to your body and not disregard signals of pain or discomfort. If you experience increased pain, new symptoms, or if your current symptoms persist or worsen, it’s crucial to seek medical attention. Proper management of a herniated disc often involves a team of health professionals, including physicians, physiotherapists, and possibly specialists such as neurologists or orthopedic surgeons. Regular check-ins with your healthcare team can help track your progress and adjust your treatment plan as necessary. Remember, early intervention often leads to better outcomes.
Effective Lifestyle Changes to Support Herniated Disc Management
Brief overview of beneficial activities, such as gentle exercises, physical therapy, and maintaining a healthy weight
When living with a herniated disc, incorporating beneficial activities into your routine can be instrumental in managing symptoms and promoting healing. Gentle exercises, such as walking, swimming, and cycling, can strengthen the back and core muscles, which in turn can provide better support for the spine.
Physical therapy is often recommended for herniated disc patients. A physical therapist can provide a personalized exercise and stretching program that targets specific needs, enhances flexibility, reduces pain, and improves function [8].
Maintaining a healthy weight is also critical. Excess weight can put additional stress on the spine, exacerbating the symptoms of a herniated disc. A balanced diet and regular exercise can help manage weight and promote overall health. A study in the journal Obesity Reviews linked higher body mass index (BMI) with increased risk of disc degeneration [9].
The role of diet in spinal health
Diet plays a significant role in spinal health. Consuming a nutrient-rich diet can contribute to the overall health of your spine. Foods rich in calcium and vitamin D, for example, are vital for bone strength. Omega-3 fatty acids, found in fish and flaxseeds, have anti-inflammatory properties that can help manage pain and inflammation associated with a herniated disc [10]. Hydration is also critical as the discs in your spine require water to maintain their structure and function [11].
The importance of rest and good sleep hygiene
Rest is a crucial part of managing a herniated disc. Adequate sleep allows your body to heal and recuperate, which can help reduce pain and other symptoms. Proper sleep can aid in the healing process and alleviate pain associated with a herniated disc [12]. Good sleep hygiene practices include maintaining a regular sleep schedule, creating a comfortable and quiet sleep environment, and avoiding caffeine and electronic screens close to bedtime. If your herniated disc makes certain sleeping positions uncomfortable, a healthcare provider or physical therapist can suggest modifications to support your spine while you sleep.
Strategies for stress management to prevent muscle tension
Stress can exacerbate herniated disc symptoms by causing muscle tension and pain. Incorporating stress management strategies into your routine can help. Techniques such as deep breathing, meditation, yoga, and progressive muscle relaxation can help reduce stress and prevent muscle tension. Activities that you enjoy, such as reading, gardening, or listening to music, can also help reduce stress. Additionally, staying socially connected with friends and family and seeking support from a mental health professional when needed can also contribute to better stress management.
Conclusion
Living with a herniated disc necessitates making certain changes in your daily life. It’s important to avoid activities that can exacerbate your symptoms, including prolonged sitting or standing, heavy lifting, high-impact exercises, and maintaining poor posture. Additionally, ignoring pain or discomfort can lead to further complications, so it’s crucial to listen to your body and respond appropriately to its signals.
Careful management of a herniated disc can not only alleviate pain and discomfort but also improve your overall spinal health and quality of life. Incorporating beneficial activities, maintaining a healthy diet, ensuring adequate rest, and employing stress management strategies are all part of a comprehensive approach to managing this condition.
Everyone’s experience with a herniated disc is unique, and what works best may differ from person to person. Therefore, it’s essential to seek professional advice for a personalized treatment plan. Regular consultations with your healthcare team can help manage your symptoms effectively and prevent further complications.
FAQ’s
Should I lift heavy objects when I have a herniated disc?
No, lifting heavy objects can exert additional pressure on the spine, leading to worsening of the symptoms. If you need to lift something, it should be lightweight, and always follow the proper technique: bend at the knees, not the waist, and use your leg muscles to lift.
Can I continue with my high-impact exercise routine?
High-impact exercises can put undue strain on the herniated disc and potentially exacerbate your symptoms. Consider replacing high-impact exercises with low-impact activities such as swimming, walking, or yoga, which are easier on the spine. Always consult with a healthcare professional before starting a new exercise regimen.
Is it okay to ignore the pain if it’s not too severe?
Ignoring pain, even if it seems tolerable, is not recommended. Pain is your body’s way of signaling that something is wrong. If you’re experiencing chronic or persistent pain due to a herniated disc, it’s important to seek medical advice. Over time, untreated herniated discs can lead to more serious complications.
Should I maintain my regular sitting posture at work?
Prolonged sitting, especially with poor posture, can put additional pressure on your spine and worsen the symptoms of a herniated disc. Try to take frequent breaks to stand or walk around if your job requires long periods of sitting. Consider ergonomic office furniture, such as standing desks or chairs that support proper spine alignment.
Can I manage my herniated disc without seeing a medical professional?
While minor symptoms might be managed at home with rest and over-the-counter pain relievers, a herniated disc is a serious condition that requires medical attention. Proper diagnosis and treatment are key to preventing further damage and alleviating symptoms.
Is it harmful to wear a back brace all the time for support?
While a back brace can provide temporary relief and support, wearing it all the time isn’t recommended. Over-reliance on a brace can lead to muscle weakening over time, as the muscles become dependent on the brace for support. Always follow the guidance of your healthcare provider regarding the use of a back brace.
Is bed rest recommended for a herniated disc?
While rest can help in the initial stages of a herniated disc, prolonged bed rest is not recommended. It can lead to muscle weakness and stiffness, potentially worsening the condition. Gentle movement and specific exercises, usually under the guidance of a physical therapist, can help to alleviate symptoms and strengthen the muscles supporting your spine.
References
- Lurie, J. and Tomkins-Lane, C., 2016. Management of lumbar spinal stenosis. Bmj, 352.
https://www.bmj.com/content/352/bmj.H6234.abstract - Radcliff, K., Kepler, C., Hilibrand, A., Rihn, J., Zhao, W., Lurie, J., Tosteson, T., Vaccaro, A., Albert, T. and Weinstein, J., 2013. Epidural steroid injections are associated with less improvement in the treatment of lumbar spinal stenosis: a subgroup analysis of the SPORT. Spine, 38(4), p.279.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622047/ - Tissot, F., Messing, K. and Stock, S., 2009. Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day. Ergonomics, 52(11), pp.1402-1418.
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https://bjsm.bmj.com/content/54/5/292.abstract - O’Sullivan, P.B., Smith, A.J., Beales, D.J. and Straker, L.M., 2011. Association of biopsychosocial factors with degree of slump in sitting posture and self-report of back pain in adolescents: a cross-sectional study. Physical therapy, 91(4), pp.470-483.
https://academic.oup.com/ptj/article-abstract/91/4/470/2734992 - Rhee, J.M., Schaufele, M. and Abdu, W.A., 2006. Radiculopathy and the herniated lumbar disc: controversies regarding pathophysiology and management. JBJS, 88(9), pp.2070-2080.
https://journals.lww.com/jbjsjournal/fulltext/2006/09000/radiculopathy_and_the_herniated_lumbar_disc_.23.aspx - Rainville, J., Hartigan, C., Martinez, E., Limke, J., Jouve, C. and Finno, M., 2004. Exercise as a treatment for chronic low back pain. The Spine Journal, 4(1), pp.106-115.
https://www.sciencedirect.com/science/article/pii/S1529943003001748 - Shiri, R., Karppinen, J., Leino-Arjas, P., Solovieva, S. and Viikari-Juntura, E., 2010. The association between obesity and low back pain: a meta-analysis. American journal of epidemiology, 171(2), pp.135-154.
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