Watch Your Back!

Herniated disks are some of the most painful and common back injuries, and while there’s no guarantee you’ll never fall victim, there are ways to decrease your risk.
[By Stacey Stapleton]

’ve always been a healthy person—strong and active, with a busy writing career and a young son to chase after. Imagine my surprise then, after a weekend spent unpacking and setting up a new home, when I found myself sidelined with lower-back pain so excruciating I could compare it only to childbirth. At first I thought the pain would pass if I simply took it easy for a day or two, but the pain grew worse and soon I was completely unable to walk. With help from my husband I hobbled to a chiropractor. She put me on a regimen of hourly ice packs and stretching exercises that eventually eased the acute, take-my-breath-away pain, but I was still achy, stiff, and unable to perform everyday tasks. Desperate to have my life back, I went to a physician who immediately ordered a series of X-rays and an MRI. The diagnosis: a massive herniation of the L5 disk (the second disk from the bottom of the spine).

When I heard those words my heart sank—didn’t all herniated disks require debilitating surgery? Not to worry, the doctor assured me; I would recover without surgery, but it would take months of physical therapy to not only live pain-free but rebuild my former strength and flexibility. Determined to heal (and to stay out of the O.R.), I went to see the therapist my doctor recommended. At our first meeting I was surprised to learn that herniated discs are incredibly common among young women, especially young mothers. As much as I was hurting, I was relieved not to be alone, suffering from an injury I imagined was exclusive to frail old ladies. I also learned that many back injuries can be prevented with just a few simple strategies and smart choices—information I wish I’d had when I needed it.

Disc Facts

Spinal discs are soft cushions between the vertebrae of the spine. As we age, these disks begin to lose their elasticity (even as early as our thirties) and become more vulnerable to rupturing. When this occurs, a portion of the disc pushes outside its normal perimeter, irritating, pinching, and compressing the spinal nerves in what is known as a herniated disc.

Some herniated discs occur suddenly, as the result of a fall or accident, but they can also happen gradually, silently, with repetitive straining of the spine. Although there is a lot of mystery and debate surrounding herniated discs—especially over whether or not they ever truly heal, despite a patient being pain-free—the one certainty is the roster of unmistakable symptoms. These include radiating pain down one or both legs (also known as electric shock pains), tingling or numbness in one or both legs, or muscle weakness (caused by the compressed nerve interrupting signals sent from the brain to affected extremities). Another symptom is bowel or bladder problems known as cauda equina syndrome, which can be a medical emergency. If you experience trouble urinating or having a bowel movement or have numbness in the genital area along with intense lower-back pain, see your doctor immediately or go to the emergency room.

Often the diagnosis of a herniated disc can be made by simply evaluating a patient’s symptoms and testing for nerve sensation and muscle strength. Sometimes X-rays and/or MRI are required to see exactly what is going on inside the spine.

Types of Treatment

Once a herniated disc is definitively diagnosed, there isn’t one standard of care applied to every patient. In fact, the best course of action is determined by a number of factors, including the types of symptoms, the patient’s age and activity level, and whether the symptoms are spreading or worsening.

Contrary to popular belief, surgery is not always inevitable for herniated-disc patients. Typical treatment begins conservatively and becomes more invasive only if symptoms persist or become increasingly debilitating. If you’re diagnosed with a herniated disc, your doctor may recommend one or more of these therapies.

Rest: You’ll be encouraged to rest and limit activities that aggravate the back, while applying ice and heat packs to help minimize inflammation and relax your back muscles. Ice and heat applications can also relieve muscle spasms, a significant source of disc pain.

Physical therapy: While therapy does not directly affect the herniated disc, it’s often a significant part of recovering because it can help stabilize spinal muscles and decrease the pressure put on fragile vertebrae during everyday activities. “Low-back problems are extremely common, but also extremely complex,” says New York City physical therapist Gabriel Ettenson, MS, PT, “and a physical therapist can address each component of the problem while helping the patient develop tools to maintain the improvements made in therapy.” When you visit a therapist for the first time, be sure to bring any information provided by your doctor to help in assessing your situation. Once the problem is thoroughly evaluated, your therapist will establish a treatment plan for you typically consisting of strengthening work, posture training, flexibility and stretching exercises, neuromuscular re-education exercises, and soft-tissue mobilization techniques. According to Ettenson, you should also receive a home exercise program to do between sessions, “so you can actively participate in your own healing process.”

Medication: Initially your doctor will probably suggest over-the-counter anti-inflammatory medications (NSAIDs) to reduce inflammation and ease some of the pressure on compressed nerves. If NSAIDs don’t do the trick, however, prescription oral steroids like prednisone and Medrol can be helpful (especially in the case of a sudden disc herniation). Like NSAIDs, these powerful medications work by reducing inflammation around irritated nerves. If all else fails, narcotic pain meds and muscle relaxers may be prescribed for a short period of time to relieve painful muscle spasms.

Cortisone injections: As an alternative to oral steroids, cortisone can be administered directly into areas where the nerves are compressed. Many doctors favor these injections because the steroids can be placed exactly where they are needed rather than being taken orally and traveling throughout the body.

Surgery: “In the past, physicians used the level of a patient’s pain and suffering as a determinant for surgical intervention,” explains Ettenson. But recently doctors have come to realize that back surgery actually offers limited long-term success and so now most herniated-disc patients never go under the knife. But if less-invasive measures do not help or there appear to be significant neurological deficits, compromised motor function, or muscle weakness, it may be necessary to operate. Typically the disc is removed endoscopically or microscopically to free up space around the compressed nerve.

Protect Yourself

While herniated discs can happen to anyone, some people are more vulnerable than others. “There is a long list of risk factors for low-back issues,” says Ettenson. These include scoliosis, rheumatological diseases, osteoporosis, poor posture, jobs that require heavy physical demands, or long-term static positioning (like sitting at a computer or standing at a checkout counter all day). Being excessively overweight also puts you at risk, since the extra pounds can place added stress on the discs in the lower back.

If you fall into one of these categories, don’t despair: Back pain isn’t necessarily something you’ll inevitably have to face. On the flip side, you’re not off the hook simply because you don’t fit into any of the above scenarios. Regardless of our lifestyles, jobs, or medical histories, we would all do well to learn the few simple strategies that can significantly minimize the risk of sidelining disc injuries.

• Lift smart. One of the biggest causes of herniated discs is improper lifting—of anything from our kids to our luggage. “But how can I not pick up my kids?” you’re probably thinking. The answer is, you can pick them up—you just have to know how. “The lower body can be quite powerful when used for lifting,” says Ettenson, “thus the phrase, ‘lift with your legs.’ ” To lift an object, squat down with your knees bent. Be sure to keep your back straight and hold in your abdomen. Pick up the object and keep it close to your body, then use your legs to stand up straight. Avoid lifting and twisting at the same time or turning your head to one side while lifting.
  


• Practice and maintain good posture. When standing, keep your shoulders in line with your hips and hold your abdomen in to support your lower back. When sitting for long periods (like at the office), use a lumbar support device, small pillow, or rolled towel. And avoid sudden twisting motions.
  


• Sleep right. If you sleep on your back, slide a pillow under your knees for support. Stomach snoozers should tuck a pillow under their bellies, and side sleepers should place the pillow between their knees.
  


• Quit smoking. Chronic exposure to nicotine actually lowers the spinal discs’ ability to absorb the nutrients they need to stay healthy, eventually leaving them dry and brittle and more prone to rupture.
  


• Suck it in. It’s important to understand how to correctly contract your core muscles when doing things like lifting, bending, or reaching. “Properly contracting your core will support and stabilize your spine during any stressful movement,” explains Ettenson. Although this may sound complicated, it’s actually a cinch to learn in just a few sessions with a therapist, Pilates instructor, or personal trainer. So consider it a minor investment that can help secure your mobility for years to come.