Herniated Discs

By Michael LaBella
 Objectives
• You will be able to identify the anatomy of the
lower back
• You will understand the types of trauma that can
cause a herniated disc
• You will be able to identify the signs of a
herniated disc
• You will be able to evaluate athletes with
potential herniated discs
• You will be able to follow a typical treatment
program for herniated discs
 Anatomy
• Vertebral column (spin)
consists of 33 vertebrae
• Spine is divided into
thoracic, lumber, cervical
• Each section of spine
containing 5-12 vertebrae
• We will be focusing on
the lower back or lumbar
region
 Lumbar Anatomy
• The lumbar section of
the spine is made up of
the lower 5 vertebrae
• Commonly referred to as
L1 to L5
• L5 connects to the top of
the sacrum
 Anatomy of Lumbar Verebra
• The vertebral body is a
thin ring of dense bone
• Consisting of the body,
pedicles and liminae
• Vertebral foramen is a
whole in vertebral body
that spinal cord runs
through
 Intervertebral Discs
• Gel like Tissue between each
vertebra
• fibro cartilaginous cushions
• serve as the spine's shock
absorbing system
• protect the vertebrae, brain,
and other structures
• The discs allow some
vertebral motion extension
and flexion.
 Intervertebral Discs
• The disc is made up of 3
structures the
• (1) Nucleus pulposus,
gelatinous center
• (2) Annulus Fibrosus.
Its job is to contain the
nucleus
• (3) Vertebral end plates
that attach the disc to the
vertebrae
 Herniated disk
• Can Occur when there is
enough pressure from
the vertebrae above and
below
• This can force some or
all of the nucleus
pulposus through a
weakened or torn part of
the annulus fibrosus.
• The ruptured nucleus will
often come incontact with
and press on nerves near the
disc.
• This can result in severe pain
• About 90% of herniated
discs occur in the lumbar
region. The discs in the
cervical region are affected
about 8%, those of the
thoracic region only about 1-
2%
• Herniated disks are one of
the most common causes of
back pain
 Mechanism of injury
• There are 3 main ways discs can become herniated of
ruptured
• Many older people get herniated disks because the disks have worn
down over time
• The extremely overweight are very susceptible because they are
carrying around excess weight which puts extra pressure on the
intervertebral disks
• Improper lifting form, usually associated with bending with back and
not with knees. Which can cause a sudden strain. This can be
everyday lifting of objects or actual weight training
• Twisting violently can also cause a sudden strain that could possible
herniate a disk
 Recognition
• How can we as coaches recognize a herniated
disk?
• Sharp and shooting pain the runs down athletes low back,
buttocks and down the thigh
• If the athlete complains of numbness or tingling anywhere
in lower back, buttocks or leg
• If athlete complains pain gets worse after any kind of
strain to the body
• Sometimes, the disk can pinch the nerve controlling
bladder functioning
 Evaluation
• The first thing a coach should ask his athlete,
would be the history of the injury; if the athlete
felt the pain immediately after performing a
heavy deadlift at the gym that would be a good
indicator of a herniated disk
• The coach should also ask athlete where the
pain is, sciatica is very typical with herniated
disks
 Doctors Evaluation
• A coach can never be 100% sure, so the athlete
must be sent to a doctor to perform an MRI
(magnetic resonance imaging) or a CT
(computerized tomography)
• An MRI is the best choice because it can clearly
show the bones nerves and disks that might be
damaged
 Treatment
• The first thing that
should be done is to rest
and stay away from
activity the agitate the
symptoms
• Then the application of
ice and heat
• This acts to relax the
muscles in the back which
can calm pain and any
muscle spasms
 Treatment
• Physical Therapy
– Although performing
physical Therapy does not
directly help the disks, it
does strengthen the
muscles around it, so as
to increase stability, which
can help prevent
herniated disks in the
future
 Treatment
• Pain relievers are often
given to patient to
alleviate pain
• Anti-inflammatory drugs
are given to reduce
swelling
• Although not all patients
report having back pain
 Physical Therapy Exercises
• Exercise #1 while lying on
your back bend your left
knee up. Clench abs and
butt, keeping back in neutral
position.
• Raise your other leg about
12in off floor, while knee is
straight
• Hold the position for 3
seconds
• Then lower leg, do for 10
reps
• Repeat the same with your
other leg
 Physical Therapy Exercises
• Exercise #2 Start with both knees
on floor, clench abs and butt, back
is straight
• Put your hands on your hips.
• Pickup your right foot and place on
floor in front of you, while your
left knee is still on floor
• Lunge forward,.
• Hold your position for 3-5 seconds
• Return your right knee to floor
• Do for 10 reps
• Then repeat with the other leg
 Surgery
• Surgery is very rarely required for herniated
disks
• The treatment previously described is almost
always done prior to surgery
• Generally if symptoms, such as pain and
numbness grow worse over time surgery is
required
• If herniated disk interferes with bladder and
bowl movements, surgery is also required
 Rehabilitation
• Herniated disks can vary in severity and the
rehabilitation plan can vary depending on the
severity of the symptoms;
• Phase #1 Rest- This can last from 2 days up to
2 months depending on the nature of the injury,
typically the older the patient the longer the rest
period. As stated before, rest should include
immobilization of spinal column as well as icing
and heating of the lower back
 Rehabilitation
• Phase #2 After symptoms have subsided,
anywhere from 10days to a few months
exercises should be done to strengthen muscles
around spinal column to help prevent another
hernia. Doctors clearance is preferred so as not
to begin exercises to early, which could cause a
re injury. These exercises may be done with
some slight lower back pain
 Rehabilitation
• Hamstring stretch
• Lay down face up with
one leg in door way
other leg on wall
• This stretches out
ligaments and tendons
that connect from leg to
lower back
 Rehabilitation
• Cat and Camel
• On your hand and knees,
allow your back to sag
for 5 seconds, then arch
your back for 5 seconds
• Repeat for 10 reps
 Rehabilitation
• Arm/Leg Raise
• On your hands and
knees
• Tighten abs so spinal
column is stiff
• Raise right arm and left
leg as shown to the right
• Do 10 reps and switch
arm/leg
 Rehabilitation
• After all pain has gone the
following exercise may be
performed
• Partial curl-lying on your
back with knees bent and feet
on floor
• Tuck the chin into the chest
• Curl upper body forward
intill your shoulder blades are
off the floor
• Hold the position for 3
seconds and repeat for 10
reps
 Return to play
• In order for an athlete
that has sustained a
herniated disk to return
to play he/she must have
clearance from their
doctor
• This will not usually
happen until all pain, and
numbness has gone
completely
 Prevention
• The stretches and
exercises listed
previously can
strengthen the muscles
around the discs, which
can increase the stability
of the discs
• Teaching and practicing
proper lifting form is
essential in preventing
these injuries
 References
• Cassisi, J. E. Ph.D.; Sypert, G. W. M.D.; Laganá, L. Ph.D.; Friedman, E. M. B.A.; Robinson, M.
E. Ph.D. Pain, Disability, and Psychological Functioning in Chronic Low Back Pain Subgroups:
Myofascial versus Herniated Disc Syndrome. American J. of Phy. Med. And Rehab. Volume
33(3), September 1993, p 379–386

• Ito, T. MD; Takano, Y. MD and; Yuasa, N. MD. Types of Lumbar Herniated Disc and Clinical
Course. Clinical J. of Pain. Volume 26(6), 15 March 2001, pp 648-651

• Vucetic, N. MD, PhD; Astrand, P. MD, PhD; Guntner, P. MD; Svensson, O. MD,
PhD Diagnosis and Prognosis in Lumbar Disc Herniation. Clinical Orthopaedics &
Related Research. 361:116-122, April 1999.

• http://www.mayoclinic.com/health/herniated-disk/HD99999

• http://www.neurosurgerytoday.org/what/patient_e/herniated.asp