So, here’s the deal with disc herniations. They suck. And that’s the end.
Disc herniations can seem complicated, but it really comes down to one thing: the disc eventually wears down and gives up when you flex (bend forward) at the lumbar spine too much.
The same mechanisms cause protruding discs, bulging discs, herniated discs, and slipped discs. These terms pretty much all mean the same thing, with slight variation.
First, a quick anatomy lesson. Spinal discs are those little fluffy things between the vertebrae of your spine – they look like jelly donuts (sort of). They can be different shapes and those shapes are based on your genetics (a.k.a. mom and dad) and these different shapes tolerate different stresses (bending, compression, etc.) in different ways.
So how do disc issues occur? Sometimes through acute trauma, like a car accident. Other times, herniations occur after years of general wear and tear secondary to poor movement patterns. But in both situations, your disc is now bulging out, possibly hitting nerves, and perhaps causing pain to radiate throughout your back, hips, and legs.
Also keep in mind that while something like two-thirds of the population has a herniated disc, many people never feel any pain! It’s important to remember that a small bulge in a disc or two might not cause any issues at all.
But if you’ve ever felt nerve pain throughout your back, hips, or legs, you’re probably curious as to how to deal with it, because it can be debilitating.
First, let’s get to the bottom of what causes disc issues. We know that acute trauma and long-term wear and tear can both cause bulges or herniations, but really, it’s just based on volume. One bad accident could damage a disc, and it would only take a split second. However, repeated flexion of the spine, even unloaded, could eventually cause the exact same issue (because even though I said unloaded, there’s always some sort of load because of gravity).
In both cases, the stress becomes too much and your disc gives you the middle finger. It’s like a credit card. You could cut it with a knife (acute injury) or you could fold it in half a couple thousand times before it snapped (wear and tear). Two different processes, same outcome.
So if repeated (even relatively unloaded) flexion of the spine could cause an injury, how do we avoid repeated flexion of the spine? That involves efficient movement at the hips and thoracic spine (upper back), especially at the hips which were designed for load-bearing. But if your hips and thoracic spine aren’t doing their jobs, your spine will undoubtedly pick up the slack.
More specifically, your hips were designed to flex (bend) and extend (straighten-up). This mechanism is involved in squat, lunge, and hip hinge (deadlift) patterns. That means getting up off the floor, standing up out of your chair, or picking up your cat. If your hips don’t flex and extend correctly, your spine will flex (DING DING DING!) and extend repeatedly instead.
So what prevents your hips from moving correctly? Mobility. But keep in mind that mobility can be affected by a few different things, including issues within the joint capsule and anatomical variations. Flexibility of muscles, on the other hand, involves the length and tension of certain muscles, which can be affected by things like strength levels. Flexibility can affect mobility when a muscle is too tense to allow a joint to move through its complete range of motion.
How can you discern? Get a movement screen. If you seem to have a mobility deficit throughout movements, it might make sense to check your mobility through a more thorough assessment. If a mobility issue still exists, we’ll probably refer you to a physical therapist.
If the issues are flexibility-related, then we probably need to work on your overall strength levels and resting muscle lengths (a.k.a. your posture).
But the key here is that when your posture falls away from neutral due to inflexibility, you could lose joint mobility over time. An easy example of this is the loss of hip internal rotation range-of-motion associated with anterior pelvic tilt (an arched back).
And how is this related? Well, in order to flex at the hips, the femurs need to do some significant rotating and gliding in order to avoid bumping into the actual hips themselves (which is called femoral-acetabular impingement and is pretty painful). If you’ve lost joint mobility, you’ve lost the ability to make these small, local motions in the hips and thus, the global motion of hip flexion.
And when you lose hip flexion, the end result is repeated spinal flexion instead.
But I’m actually far from done. Check out part two to continue the journey.