Disc Bulge / Herniation / Sequestration

Spinal Disc

• soft, gelatinous center 'nucleus' contained by concentric rings of resilient, fibrous tissue 'annulus' anchored strongly to end plates of vertebral bodies

Disc Bulge/Herniation/Sequestration

• lesions may result from injury or degenerative process
• symmetrical 'bulge' in annulus may cause localized pain
• focal 'protrusion' may exert pressure on spinal cord, causing poorly localized central or unilateral 'extra segmental' symptoms, or on nerve root in which case symptoms may be felt radiating into contiguous limb (each level of spine affects a specific area in limb), possibly compromising conductivity of nerve and thereby affecting sensation (numbness), muscle strength (weakness), and/or reflex response (decreased)
• 'sequestration' (separation/detachment) causing irritation of sensitive nerve structures results in pain and spasm
• cervical (neck) disc lesions (less common than lumbar) most often occur at lower cervical vertebral levels C5/6, C6/7, and C7/T1
• lumbar (low back) disc lesions most often occur at lower lumbar vertebral levels L4/5, L5/S1
• cervical symptoms typically include pain with neck movements
• lumbar symptoms typically include pain with heavy loading and/or pain made worse with: activity; prolonged sitting, rising from sitting; coughing and sneezing

Physical Therapy Treatment

• relative rest, with treatment, is essential during acute phase
• application of therapeutic modalities to relieve pain, inflammation, and spasm
• traction (spinal decompression) is often treatment of choice; treatment effects of traction: unloads disc by stretching and separating structures compressing disc; creates negative pressure (vacuum) within disc to centralize mobile nucleus (thereby reducing deformation of annulus and, if present, pressure against nerve root)
• manual therapy may be employed in absence of neurological signs and/or symptoms
• exercise instruction (posture, core recruitment and control, stretching) and body mechanics/joint protection

Other Treatments

• over-the-counter or prescribed anti inflammatory, muscle relaxant, or pain-relieving medications may assist in providing relief of symptoms and assist with resolution of condition
• acupuncture, trigger point therapy, or IMS may reduce muscle spasm and pain

Prognosis

• disc lesions most often responsive to conservative, versus invasive, treatment; surgery indicated only with persistent and progressive loss of function (esp saddle area numbness and/or loss of bladder control which must be dealt with promptly) and/or intractable severe (disabling) pain
• high percentage of cases resolve completely and with no significant long term sequelae within 6 weeks with conservative treatment only; less than 5% require surgical intervention

Physio Note: Exercises

Be diligent and precise with exercises prescribed by physical therapist; discontinue any exercise(s) if pain increases and discuss with therapist prior to resumption of symptom pain-provoking exercise