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Degenerative Backs and Disc Herniation

Let’s talk about Vertebral Discs, which are usually what we mean by the discs of your back. People often mistake these as your primary moving back joint. While it is true that these discs allow for motion, they are not the primary moving joints. The disc’s main job is to separate two vertebral bodies, provide support, and disperse force from lifting, jumping, and moving around.

This is a rough depiction of basic lumbar spinal anatomy to help understand where structures are.




The discs are made of annular fibers that connect the vertebral bodies above and below the disc. These fibers make a woven capsule around a jelly-like substance and semi-solid nucleus. Our two common issues that occur are the fibers being disrupted, or the disc itself losing hydration and shrinking.

Lets talk about shrinking discs. are called Degenerative Disc Disease. All vertebral discs will shrink to some extent, but not always cause ailment. I personally hate this name. “Degenerative” sounds like, “I will never get better.” but according to recent research, this is misleading. In technical terms, we talk about discogenic degeneration, which is age related, but symptoms are not inevitable. Usually when you have symptoms, there is underlying instability. If you are having symptoms, you can be helped.(1) We can call the part a physical therapist can treat “discogenic instability.”

A lot of times this disease will cause pain in an area as opposed to just one point. Usually it will get worse with sitting and sometimes standing, but laying down almost always feels better.

Aside from just squishing fibers between bones, the disc getting smaller means these little natural windows depicted above will get smaller and smaller. Eventually they may touch or rub nerves, which will make the nerve swell and worsen the situation. Once that happens, the pain can get worse, and start shooting into the areas the nerve controls. This can start small at first, only shooting pain when you bend or twist a certain way. The condition, if untreated, will likely worsen over time causing numbness, tingling, or constant pain.

This condition makes chances higher to develop a disc herniation, which will have a much muddier mix of symptoms. Once these conditions begin to mix, it becomes more important to seek medical advice and prevent worsening of injury.

Starting with herniation, grade 1 and 2 herniations happen when disc fibers are disrupted, but not enough for the inside of the disc to reach the outer membrane of the disc.

Grade 1

Grade2

Some annular fibers inside your disc have been overstretched or torn, and will likely be weaker going forward. You might have one memorable event that caused this, or maybe not. This injury can occur from simply overusing your back, lifting while hunched over, falls, prolonged poor posture especially in sitting, or trying to carry something too heavy. (2, 3) A lot of it stems from bad posture and bad body mechanics. Usually these injuries cause pain to a specific point on your back, and it won’t travel much. The herniation won't be able to push into the spinal canal or nerve root much, if at all. The pain will likely get worse when you lean one way and better if you lean the opposite way, depending on where the herniation is. Oddly, this injury will probably get better or worse with walking, and do the opposite with sitting and laying down.

These symptoms are ubiquitous to other types of injuries, making it difficult or impossible to determine if this is your specific issue without imaging. The good news is, if this is what’s wrong, it is very treatable. (4, 5)

Grade 3 and Grade 4 herniations occur when the fibers of the disc have torn enough to allow the center of the disc to bulge into the space around the disc. This hurts really bad at one point, and also spreads to a larger area of aching. Like the above, it is also very easy to irritate the pain with directional movements, but relieving factors might be less effective. If the herniation is in the right spot, it will irritate a nerve. Below are examples of herniations which would likely cause nerve pain.

Grade 3

​Grade 4

This can cause pain to ‘shoot’ into the area that the nerve governs. Sometimes this is described as numbness, tingling, or like electricity to a specific area. Depending on the location, the pain might be constant, or only happen during certain movements.

Lots of progress has been made on these issues, especially to prevent worsening. Often traction and stabilization training can improve symptoms, and potentially reduce herniation size as well as surgery in many cases. (4, 5) You definitely don’t want high velocity thrusts while suffering these conditions. Isotonic and stabilize exercises benefit these conditions, and can even improve your symptoms. You always need medical management with this severity of injury.

For these conditions, treatment usually starts with some pain management, swelling reductions, and then improving stability in the region. Improving stability is not just building muscle, and it certainly is not the kind of exercises you might do for your biceps. If nerves are irritated or there is a significant herniation, lots of movement in the area puts you at very high risk for worsening your injury. All these conditions take a patient and skilled hand to make sure you get better and stay safe.


Works Cited;

1. Swanson BT, Creighton D. The degenerative lumbar disc: not a disease, but still an

important consideration for OMPT practice: a review of the history and science of

discogenic instability. J Man Manip Ther. 2020 Sep;28(4):191-200. Doi:

10.1080/10669817.2020.1758520. Epub 2020 May 4. PMID: 32364465; PMCID:

PMC8550621

2. Benzakour T, Igoumenou V, Mavrogenis AF, Benzakour A. Current concepts for

Lumbar disc herniation. Int Orthop. 2019 Apr;43(4):841-851. Doi:

10.1007/s00264-018-4247-6. Epub 2018 Nov 30. PMID: 30506088.

3. Casiano VE, Sarwan G, Dydyk AM, Varacallo M. Back Pain. 2023 Feb 20. In:

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.

PMID: 30844200.

4. Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. Hernia

discal lumbar: historia natural, papel de la exploración, timing de la cirugía,

opciones de tratamiento y conflicto de intereses [Lumbar disc herniation: Natural

history, role of physical examination, timing of surgery, treatment options and

conflicts of interests]. Neurocirugia (Astur). 2017 May-Jun;28(3):124-134.

Spanish. doi: 10.1016/j.neucir.2016.11.004. Epub 2017 Jan 25. PMID: 28130015.

5. Demirel A, Yorubulut M, Ergun N. Regression of lumbar disc herniation by physiotherapy.

Does non-surgical spinal decompression therapy make a difference?

Double-blind randomized controlled trial. J Back Musculoskelet Rehabil. 2017

Sep 22;30(5):1015-1022. doi: 10.3233/BMR-169581. PMID: 28505956.

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