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A whopping 80% of the population experiences lower back pain at some point in their lives.
The most common lumbar spine condition, the herniated disc, affects on average 5,000 to 20,000 people per 1,000,000 annually. It is most common in people 25-55, and men are affected double the rate of women.
There are many different pathologies of lower back pain; you can experience different types of lower back pain that range from dull to sharp.
We discussed how to recognize and manage lumbar spine conditions with two of our Medical Exercise Specialists, Gardy and Marina.
First of all, what is a disc herniation?
According to spinalhealth.com, "herniated disc is a condition in which the annulus fibrosus (the outer portion, pictured on the left) of the vertebral disc is torn, enabling the nucleus (inner portion) to herniate or extrude through the fibers."
The herniated material can press out, causing the nerves around the disc to be pressed down and creating pain. This pain can spread throughout your back and, if the problem is in the cervical spine, down your arms or, if the herniation is in the lumbar spine, down your legs. Herniation can compress the nerve root, resulting in numbness and tingling, radiating pain, loss of sensation, and weakness.
The primary component of injury involving the disc is the natural aging process or degeneration. Herniation is usually seen in adults less than 45 years of age.
The symptoms of a lumbar disc herniation are unilateral and include pain, which radiates into the buttocks, leg, and foot.
What usually causes a lumbar disc herniation?
There are two common reasons for disc herniation injury:
- Trauma, such as slipping discs (perhaps due to a fall.)
- Regular degeneration of the disc (perhaps due to repetitive movement or strain.)
The principle function of the disc is to allow movement between vertebral bodies and to transmit loads from one vertebra to the next.
Some common reasons for disc herniation are:
Repetitive twisting, which may result in a strain or may be related to intervertebral joint degeneration. The worse case scenario is when the spine twists while in flexion position.
Poor Posture, especially while lifting weights, which can hurt the disc. Poor posture from habit or weak musculature can compound this problem due to the misalignment of one vertebral body over another for extended periods of time.
Prolonged sitting, which results in downward compression forces and, without the proper cushioning normally supplied by the disc, can injure the vital endplate cartilage and other connective tissues in the already problematic area of the spine.
Which results in higher disc pressure - sitting or lying supine (face up)?
Prolonged sitting will result in higher disc pressure because being in a sitting position puts the spine under pressure and may lead to nerve compression. Prolonged sitting places excessive stress on the spine, causing further disc compression. Being in the supine position will often relieve pain because it reduces the compression.
Tips for Exercise Management and Workouts for Lower Back Pain
If you are experiencing chronic back pain (persistent pain for more than three months,) see your doctor. They may consider doing an MRI, CT Scan, or myelogram in order to diagnose the herniation. Additionally, McKenzie exercises, medications, and traction are all used to treat disc herniation.
There are some other ways to get back to a pain-free life.
- All low back pain clients should avoid excessive uncontrolled trunk flexion with rotation.
- Avoid flexed postures, and instead, favor those with a slight extension.
- Also, try to avoid prolonged sitting by setting a timer on your smartphone to remind you to get up and walk around a bit.
- Start each workout with a gentle stretch for your back, thighs, and hip flexors.
- Since we spend most of the time sitting at a desk with bad posture, gentle stretching may be beneficial.
- Any workout for managing disc herniation should include cardiovascular, lower extremity, and spinal stabilization training.
- Develop a cardio training program by performing stationary biking. For example, 20 min at 60% intensity, adjusting the seat low to eliminate full knee extension
- Incorporate daily spinal stretching to maintain your range of motion.
- Gluteal strengthening is vitally important.
When considering exercise for pain relief, spinal stabilization comes first. There are three levels of spinal stabilization.
The first level is performed when the spine is fully supported. It is important to understand what a neutral spine is. People with herniated discs need to find their neutral spine where it is the most comfortable, ensuring they keep to a pain-free range of motion. Usually, clients feel better in slightly arched positions when in supine (face up) lying down. The second level of Spine stabilization is performed when the spine is partially supported. Level three lumbar stabilization activities are performed with the spine completely unsupported. As you progress in your recovery process, bear in mind that utilizing this progression will help your body to heal properly and recover fully.
Although it is easy not to exercise during incidents of lower back pain, there are effective and safe exercise movements that help to manage and maintain a pain-free lifestyle. However, it is important to remember that if radiating pain, numbness, or tingling develop: discontinue exercise and avoid uncontrolled trunk rotation and flexion. Your workout should include cardiovascular training, lower body exercises, and spinal stability training as well as gluteal strengthening.