Your herniated Disc and you

Recently I have had a few people come to me, while in pain, for massage. While this is fairly normal however, the location and severity of their pain has made me suspect that they may have spinal disc problems.
While massage is generally supportive of the surrounding spinal muscles it is not a good idea to have deep work around these muscles while you have an inflamed herniated disc.

What is a herniated disc?
A herniated disc can be described in many ways. You may have heard of the terms bugling disc, pinched nerve, ruptured disc, torn disc, slipped disc, collapsed disc, disc protrusion, disc disease, black disc… The list goes on.
Essentially what is happening when a patient has a symptomatic herniated disc, the walls of the disc have become weak or injured and the inner part of the disc ‘leaks’ (as in a hernia) out of the cavity between the vertebrae.
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The disc itself is not painful, but rather the disc protruding from it’s cavity puts pressure on a nerve outside the vertebrae. This produces pain called radicular pain (e.g., nerve root pain) that may be refer to other parts of the body, such as from the low back down the leg or from the neck down the arm. Other types of spinal pain can be caused by degenerative disc disease.
Herniated disc can occur anywhere in the spine but most commonly occurs in the lower discs of the lumbar spine. Nerve pain in this region can refer down the back of the leg, known as sciatica, as it puts pressure on the sciatic nerve. Each disc in the spine can cause a pattern of radiating pain through the body and into the extremities.

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How is a herniated disc diagnosed?
Your GP or physical therapist will give you a physical examination. This will include nerve function, muscle strength and what pain you have on palpation and movement. You will also be asked a full medical history to help identify or rule out any other possible causes of your pain. Finally some kind of diagnostic test such as a CT or MRI scan, will be performed to confirm the diagnosis.

What is the treatment for herniated disc?
Usually a patient is advised to under go a period of conservative treatments to manage the pain before any kind of surgical intervention is considered. Initially rest and ice to the local area is the best option before starting any physical therapy. Your GP may also prescribe anti inflammatory medications to ease the pain. These may be in tablet form or an injection around the local area.
Physical therapy, such as physiotherapy and prescribed Pilates is a good option in learning how to care for your spine and manage your pain. Pilates will help you learn how to use your motor skills properly, eliminating and poor posture or bad habits that may be causing the problem, and strengthening the surrounding muscles to help protect the spine.

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Massage is supportive in the areas of referring pain. Reducing any muscle tension that may be putting further pressure on the nerves in the effected areas. Massage to the spinal ares however, especially while the disc is inflamed, is not recommended. A good relaxation massage may be a good idea to help rest and reduce the stress of your pain.

Will I need surgery?
If your pain is ongoing and conservative treatments are not working then surgery may be considered. The most common being a discectomy, where a small portion of the protruding disc is removed. In the last 10 to 15 years the microdiscectomy surgery has been modified to allow for a relatively small incision and less soft tissue dissection, which provide for significantly less postoperative discomfort and quicker healing.

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