Home Exercise and Rehab
Gina John is a Pilates Practitioner and Registered Osteopath who has spent many years offering help and advice, especially to the over 50 age group.
She is founder of The Osprey Clinic in the St. Johns Wood area of London and now specialises in Home Exercise and Rehabilitation Programmes. For further advice on exercising safely, and a selection of exercise films for general fitness and medical conditions, visit the website: www.home-exercise-rehab.com
This month: What exercises can ease aches and pains caused by a disc bulge?
A: The spinal ‘intervertebral’ discs are shock-absorbent cartilage between each adjacent vertebra. In individuals under 35 years of age, the discs comprise a viscous, gel-like centre (nucleus pulposus) and a firmer outer part (annulus fibrosus). The outer part of the disc may strain, forming an escape route for the viscous material at the centre, pushing it towards the periphery of the disc. This creates a bulge, which is visible on an MRI scan. If the viscous material breaches the outermost part of the disc, this is referred to as a ‘prolapse’ or ‘herniation’. The diagnosis of a disc bulge or prolapse is most common in the 18-30 year age group as symptoms are likely to be of acute onset following a mild trauma and the disc substance itself is softer and more therefore, more vulnerable. In middle-aged individuals, disc herniation may occur since the entire disc material becomes firmer as part of the aging process, but the outer ‘annulus’ is vulnerable to tears. This may allow any remaining viscous material to move towards the periphery of the disc, but is less likely to breach its outer border.
In the acute stage, presenting symptoms will vary depending on the level of inflammation around the affected disc. This commonly presents low back pain which radiates into the buttocks and hips. In severe cases, pain may be referred into the legs.
A disc bulge, prolapse or herniation is more commonly caused by lifting injuries or activities requiring flexing the spine forwards, while twisting as well as high-impact sports. This is due to the compressive forces which these activities place on the spinal column.
Research suggests that around half of all adults have a least one disc bulge or herniation in the spine, but if there are no presenting symptoms, then of course no investigation of the spine will be undertaken. Between 23 and 60 per cent of non-symptomatic individuals participating in research studies have been found to have a spinal disc bulge.
The spinal discs, unlike ligaments are poorly innervated and therefore, pain associated with a disc bulge rarely originates from the disc itself. However, well innervated soft tissues in close proximity to a bulge or herniation will fire off the pain signals locally and into the outer buttock and hip region, if they come into contact with disc material. In the case of a full disc prolapse, it is common for disc material to leak directly onto a peripheral nerve, as it exits the spinal canal and this will give rise to Sciatica. Symptoms are felt along the course of the Sciatic Nerve and its branches, which run down the back of the leg and into the foot, rather than in the low back region.
Chronic back pain associated with a disc bulge or herniation, with or without radiations of pain into the buttocks, hips and limbs may present only in middle age or later life when the body’s ability to compensate for the structural changes in the spine is reduced. This may follow a period of ill health and bed rest, when the postural muscles located close to the spine have weakened due to reduced activity levels. Arthritic changes in the spinal column will affect the elasticity and flexibility of adjacent muscles and ligaments, while the body may also need to compensate in walking, such as with arthritic hip and knees. These factors place a greater strain on the spinal column and thereby engender symptoms linked to the disc condition, which may have previously been asymptomatic, or aggravate any pre-existing, or chronic symptoms.Posture plays a significant part in the long-term health of the spine. Good posture reduces compressive forces and reduces the likelihood of a disc bulge or herniation occurring in the first place. Poor posture, resulting in a forward flexed spine, reduces support for the spinal discs provided by back muscles and ligaments, thereby increasing their vulnerability. If a disc bulge or herniated disc material to come into contact with surrounding soft tissues due to poor posture, pain and inflammation will ensue.
The following exercises, when performed daily will provide improved strength and flexibility for the back to enable you to cope better with condition, thereby helping to relieve your symptoms. However, do not perform any exercise or activity which aggravates your symptoms and consult your GP or physiotherapist for further advice.
Please send your questions for future columns, or feedback, by email to Gina John on email@example.com
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