Herniated Discs (Part 2): Symptoms and Treatment

This blog is the second part of a two-part blog on herniated discs. In the first post we covered the anatomy of your spinal discs and the common injuries to these discs. You can visit that post by clicking this link. Today we will discuss the symptoms and treatment of a herniated disc and what you should expect when you see a physical therapist.

SYMPTOMS OF A DISC

Just as no two people are the same, neither are our injuries. So this is a list of all possible symptoms but even just having one or two could indicate a disc injury, or you could even have a herniated disc without any symptoms. But on the flip side you could have two or more and actually not have a disc injury. (Are you thoroughly confused yet?) An evaluation from a physical therapist or medical doctor would be required to properly diagnose or rule out a herniated disc.  These are the most common symptoms of a disc injury:

  • Forward flexed posture
  • Increased pain in the morning or late at night
  • You don’t love sitting (standing might also not be that great due to more pressure on the disc)
  • Symptoms radiating down your leg or arm such as numbness, tingling, and/or pain
  • Weakness in arms or leg
  • Muscle cramping or tightness in your neck or back

HOW CAN PHYSICAL THERAPY HELP?

Physical therapists can design treatment programs that help the discs heal and address any other associated issues the back and lower body have from compensating. The back will try to protect itself as you still try to function and it can result in muscle tightness and guarding, sacroiliac joint dysfunction, tension in the nervous system, core weakness, and injury to other structures in the spine (ligaments, joints, nerves) as the disc fails to do its job. Treatment of these related issues can help your pain and provide good stimulus for the disc to heal.  Additionally we can design exercise programs so you don’t risk re-injury.  You don’t have to become completely immobile while waiting to heal. For example walking 15-30 min can help pump nutrients to the disc to allow itself to repair.

Therapy can also involve “passive modalities” like traction, ultrasound, electric stimulation, heat and ice. These can help you feel better and promote healing, but you aren’t the type of person who lives your life laying down on a table. You need to lift, reach upwards, pick things off the ground, hike up 14,000ft while carrying a 20 lbs backpack.

Therapy will also include exercises to re-activate the small stabilizers (called the multifidus) of the vertebrae that “shut off” with low back pain. When these don’t work, the large muscles of the back to take over which leads to fatigue and spasm (aka more back pain and tightness). There is a large variety of simple to advanced exercises to work the muscles you need to and these aren’t your weight lifter grandma’s intense sit ups.

You might also be put through exercises to restore motion of the spine, improve the hydration of the disc and to improve flexibility of the lower limbs.  These help combat the stiff and “stuck” feeling of your low back.

Finally, PTs can teach you positions to ease your pain. Remember how I said sitting tends to be a painful position? Try a rolled up towel placed in the low back to maintain the natural curve. Don’t rely on the “lumbar support” from your desk chair or automobile seat. Don’t rely on a “one size fits all” for your specific back anatomy.

Low back bothering you through the day or at home? Try lying on the floor on your back with your hips and knees flexed to 90 degrees such as when you lay on the floor with your legs up on the sofa or a chair.

CONCLUSION

If after reading this you have further questions or suspect you may be suffering from a herniated disc, feel free to call us or stop by one of our offices to schedule an appointment with me or another therapist. One of the keys to a quick recover is to not only beginning to receive treatment right away, but also knowing what to do and what not to do. This is where we take each patient as an individual and create a specific program that matches your symptoms and abilities. So don’t waste any more time, come by and see us to get your back in shape and allow us to help you recover quickly and effectively.

Kacie Rognlie, PT

Clinic Manager – South Office

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Rehabilitation following a meniscus tear

So your doc said you have a meniscus tear? Ouch! And now you are wondering what rehabilitation will be like. This is going to depend on whether or not you had surgery and how bad the tear is. Small tears are common and can even heal on their own if in the right place, which is the outside one-third of the meniscus. This is due to the rich blood supply in that area. So if you are lucky enough to have chosen this place to tear it you are in better shape. Other tears, even small tears, that occur in regions without such a blood supply will not heal or may take extensive time to heal if they do. This is when your doctor may tell you surgery is your best option.

What is rehabilitation like following a meniscus tear?

As with everything about our bodies, it is difficult to compare one person to another due to our composition and genetic makeup. If you are a fit athlete who is in great shape chances are you will have a much faster recovery time than the couch potato. Rehabilitation following a meniscus tear begins with a baseline assessment of how much you are limited. Can you squat? Descend stairs without pain? Walk or stand for > 10 minutes? The answers to these will allow us to establish where in the rehabilitation plan you will begin.

Baseline rehabilitation will start with improving your strength and range of motion (ROM), typically in a non-weight-bearing manner. For strengthening we will have you do isometrics (a fancy way of saying contracting your muscle without movement), seated knee extensions to improve quad strength, and hip exercises that will improve the stability of your knee. To improve your ROM we may have you start on a stationary bike, lay down and then pull your foot toward you using a strap, ball, or slide it along the table.

Patients who are farther along may begin with light-weight bearing options such as small squats, stepping up and/or down on a small step, balance activities, leg presses and resistance exercises for the hip and knee. This will include the greater use of weights, elastic bands, and machines. We typically won’t be pushing you through any painful activities that are in the moderate to severe levels, especially if you have not had the knee surgery. And at this phase we will also be more aggressive with our ROM activities. In order to walk properly you will need 60-70 degrees of knee flexion, but for descending stairs (which is the most common complaint with a meniscus tear) you will knee 110-120 degrees. Note: between 130-145 degrees is a normal ROM for the average person.

Advanced stages of recovery will focus on function, function, function. Doing the things you need to be able to do to perform your activities of daily living or return to your sport. Of course, if you are returning to a sport it may take longer and be more intense than an individual just looking to return to walking and a desk job. Activities at this stage will be things such as walking on the treadmill, advanced stability exercises, running or jumping activities, stair or ladder climbing, squatting and lifting items off of the floor. This is when we try to make sure you are ready for any of the challenges you may face after you are discharged.

Meniscal tears are extremely common knee injuries, and with proper diagnosis, treatment, and rehabilitation patients often return to their pre-injury abilities. Even if you elect to try physical therapy first and your meniscus does not heal, you will be in a better position following your surgery. Recovery also depends on the motivation of the patient, so listen to your physical therapist and do your homework….. yes, you WILL have homework!

We wish you a great recovery and remember, at Synergy Manual Physical Therapy here in Colorado Springs we are always here to provide excellent rehab and answer any questions you may have. Call us today for an evaluation or you may also leave any questions in the comments section. We look forward to hearing from you!
- Synergy Physical Therapy Team

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112