Many terms are used to describe disc disorders of the spine which leads to confusion even among professionals.1 Let’s begin by describing normal disc anatomy and proceed to various common pathologies. You may find use of Integrative Learning Center of Mid-America’s online animation library particularly helpful as you read this article. See the Spine Condition of Degenerative Disc Disc Disease for the broadest overview.
The intervertebral disc or shock absorber between adjacent vertebrae throughout the spine consists of two parts, a tough fibrous outer ring or annulus fibrosis and a soft or gelatinous inner material called nucleus pulposus.3 With age discs will begin to thin and eventually may degenerate (DDD), accounting for some of the decrease in height associated with increased age. Long before a clinical diagnosis of spinal disc disease can be made on x-ray or other means, there are biochemical and cellular histological or structural degenerative changes that occur.2
The following pathologies will be discussed through the rest of this article: Thinning Disc, Torn Disc, Degenerative Disc Disease (DDD), Bulging Disc (Slipped Disc), Herniated Disc (Ruptured Disc), Pinched Nerve (including Sciatica) & Radiculopathy.
A Torn Disc usually results from trauma, injury or repetitive micro injury to an area of the spine. Through time the annulus ring weakens and becomes structurally unsound as the protein collagen fibers breakdown. After age 30, the jelly-like nucleus begins to lose fluid content as water and water attracting proteoglycan content declines.4 This decline contributes to Thinning Disc.
With DDD, the spines ability to handle mechanical stress and movement challenges decreases especially in the lumbar spine which carries most of the body weight.2 Symptoms of lumbar spine DDD include: back pain, spasm of back muscles, numbness in leg or foot, muscle weakness in leg(s), sciatica, decreased reflexes at knee or ankle, changes in bowel or bladder function.3
When discs are damaged by injury, disease, or through normal wear and tear, the annulus ring can weaken allowing some of the jelly-like nucleus to protrude (Bulging Disc) into or through the outer ring (Herniated or Ruptured Disc).4 A bulging disc may not cause any pain unless it exerts pressure on the nerve roots or spinal cord. With herniation, a pinched nerve may result.2,5
Herniated or bulging discs are often caused by aging, DDD, or injury to the spine. This can occur anywhere in the spine and at any age but is most common in the lower back with people between 35 to 45 years of age, especially if they perform manual labor. 4 The extruded disc material causes inflammation and irritation to the surrounding area leading to pain and further cyclical dysfunction as movement begins to be compromised.
Symptoms of a herniated disc may be isolated at the involved spinal level or cause Radiculopathy [symptoms radiate away from the original injury site into the arm or leg of the involved side(s)]. In such cases, typically a good sign of improvement is when the symptoms centralize or move from the distal extremity toward the spine.
About 1 in every 50 people will have a herniated disc during their lifetime, but only 10%-20% have symptoms lasting more than 6 weeks according to the American Academy of Orthopaedic Surgeons.5
In the cervical spine, symptoms include pain, numbness, tingling or weakness in the neck, chest or the associated arm.4 In the thoracic spine, herniated discs are less common but occur, and usually result in more localized back, rib or chest pain. In the lumbar spine, symptoms include pain, numbness, tingling, burning or weakness in the classic sciatic distribution (radiating from the buttock down the back of one leg and into the ankle or foot) or more localized low back pain.
Depending on the location and severity of symptoms, treatment for DDD and herniated discs may include bed rest, acupuncture, cortisone injections, weight control, medications for pain or relaxing muscles, and physical therapy with manual manipulation, strength, conditioning or flexibility exercise, cervical or lumbar traction, posture and body mechanics training, or use of back brace.2,4,5 While 80% of adults with DDD may have back pain, only 1% to 2% of these cases will require lumbar spine surgery.2
A herniated disc with radiculopathy can be a painful and debilitating condition lasting 3-6 months or more; but with conservative treatment, 90% of patients improve.4 Even without any treatment a herniated disc can heal on its own through reabsorption, as the body absorbs the ruptured tissue fragments and inflammation decreases. Surgery for this condition occurs in less than 10% of the cases and usually involves a laminectomy with discectomy (removal of disc) in cases where there is significant and progressive nerve damage (weakness & numbness).4
Precautions & Contraindications
With disc pathology and rehabilitation, it is important to consider what happens anatomically and physiologically with spinal flexion and extension. This understanding will aid you as a somatic educator in guiding students to optimal movement patterns with the least risk of injury and maximum benefit.
While there is debate in the medical community about which movement pattern is best: flexion or extension, both flexion and extension movements are desirable actions to maintain normal range of motion and function of the spine. When pathology is known to be present, caution is advised with both end range flexion and extension movements.
Flexion or forward bending exercises may help widen the intervertebral foramen or spaces between the vertebrae where nerve roots exit both sides of the spinal cord relieving the pressure on a nerve.2 However, it can also result in pushing the hydrous inner disc material posterior into a weakened annulus fibrosis ring and cause a bulge or rupture of disc material if done too forcefully.
Extension or backward bending movements can help strengthen the weakened posterior ligaments and muscles and maintain the normal curve in the spine.2 However, extension can cause a pinching of an involved nerve root with a herniated disc if done too quickly. A few minutes of passive prone or stomach lying prior to doing a more extreme extension movement will allow gravity to help migrate the disc material forward and decreases the chance for injury.
For reasons noted above. The most important guideline to consider as a somatic educator is observing which specific movement, action or activity increases or decreases the student’s symptoms. If a flexion or extension movement causes an increase in a student’s pain, numbness, weakness or radicular (into the extremities) symptoms, modify or eliminate the movement process. Teaching the student ways of becoming aware of symptoms earlier than later and how to make modifications will be of tremendous benefit to them in daily life.
After surgery for a herniated disc, flexion or forward bending, excessive sitting, lifting and driving should be avoided for at least one month.5 After surgery normal activities and movements can be resumed but remember another disc can rupture as the areas above and below the less mobile surgical site become more vulnerable as they take on an increased movement work load.
For specifics on how somatic education can benefit individuals with one of the above forms of spinal disc disease, see the addendum to this article.
Addendum: Benefits of Somatic Education with Spinal Disc Disease
The Feldenkrais Method®
Why is it that one person with a serious disc problem diagnosed on MRI or through other testing demonstrates little to no symptoms while another person with a minimal dysfunction on diagnoses has severe pain and other symptoms? There are many plausible explanations for this, but let’s propose a hypothesis from the vantage point of somatics. Perhaps a person’s organizational pattern determines their ability to function in the world with or without a disc problem. If there is a disc dysfunction of any kind or to any extent it could be interpreted as a weak link in the person’s system and structure.
Stressors of any kind, including postural, emotional and physical challenges will impact the weak link region more significantly than a normalized region of the spine. IM Korr6 in his collected works calls this a “facilitated segment” of the spinal cord and has documented that this segment has a lower threshold at which it fires. In other words, it responds to multiple stresses or insults in an exaggerated fashion. A few examples of common stressors are carrying too heavy a load, working in a compromised posture, repetitive use injuries, and personal, family, monetary or marital stress all which can lead to further dysfunction in a spinal segment especially if a disc is already compromised.
The Feldenkrais Method of somatic education can offer an improved response to these and other insults by offering an alternative to this reflexive action through optimized reorganization. These include enhanced relaxation response, improved movement capacity, effortless action which does not further engage inflamed muscles and ligaments, or finding easier ways to roll, sit, stand and walk that do not illicit the pain-spasm cycle of response to name a few.
Bones for Life®
Many Bones for Life® (BFL) processes (exercises) help a person find and maintain a neutral spine – without too much forward or backward curve in the vulnerable cervical and lumbar curves or backward curve in the thoracic. The cervical and lumbar areas of the spine are the usual culprits in spinal disc disease as too much forward curve can lend to further dysfunction, especially when attempting to function from a curve with compromised dynamics. This neutral spinal position is reinforced through the processes as the student learns to weight bear and take force without deviation in these curves. BFL uses subtle coaching of polarized movement or co-contraction to facilitate decompression and length along the entire spine. As decompression occurs, the irritation around the impaired disc region is reduced leading to decreased pain. Because BFL relates nearly all of its processes to weight bearing functions, the learning is translates easily into walking and a generally more active lifestyle.
Denise Deig is the author of Positional Release: from a dynamics systems perspective. A Physical Therapist, Guild Certified Feldenkrais Practitionercm and Bones for Life® Teacher/Trainer. She has a private practice in Fishers, Indiana. You can find out more about her and her practice at www.denisedeig.com. Deig can be reached by email at firstname.lastname@example.org. She offers certification and continuing education programs through www.integrativelearningcenter.org.
- Spine‐Health.com. What’s A Herniated Disc, Pinched Nerve, Bulging Disc…? Online access on 10/12/2007 10:46 a.m. http://www.spinehealth.com/topics/cd/d_difference/diff()1.html
- SpineUniverse.com. Lowe, TG. Degenerative Disc Disease and Low Back Pain. Online access
on 10/12/2007 10:49 a.m. http://www.spineuniverse.dom/displayarticle.php/article242.html
- StanfordHospital.com. Lumbar Disc Disease (Herniate Disc) Online access on 10/12/2007 10:53 a.m. http://www.stanfordhospital.com/healthLib/testgreystone/neuro/hdisc
- Cedars-SinalMedicalCenter.com. Herniated Disc. Online access 10/12.2007, 10:44 a.m. http://www.csmc.edu/3003.html
- American Academy of Orthopaedic Surgeons (www.orthoinfo.org) Sciatica. Online access 10/12/2007 11:20 a.m. http://www.orthoinfor.org/topic.cmf?topic=A00351&return_link=0
- Koor IM. The Collected Papers of Irvin M. Koor. American Academy of Osteopathy. Newark, Ohio. 1988.