The disc is the cushion between the bones of the spine. They are made up of a fibrous outer ring called the annulus fibrosus, and a jelly-like inner material called the nucleus pulposus. It is the nucleus pulposus that acts as the primary shock absorber within the disc. Over time, or because of a traumatic accident the annulus fibrosus becomes torn and the jelly-like inner material will start to leak out towards the edges. If the material reaches the outer edge and pushes the annulus fibrosus out, it is called a disc bulge. If the last layer tears and the inner material leaks all the way out into the open space, this is called a disc herniation. The outer third of our disc has nerve innervation, which means the disc itself can also be a source of pain. If the nucleus pulposus leaks out and the nearby nerves become irritated or compressed this can cause many symptoms, including: pain into the buttocks or down the legs, numbness/tingling down the leg, and/or weakness of the lower extremity.
If the disc does not respond to conservative treatments, a surgeon may decide that they need to perform a microdiscectomy. This procedure consist of going in and clipping out the portion of the disc that has extruded out. There are usually multiple symptoms that can occur with a disc herniation including: pain, muscle spasms, muscular inhibition, and myotomal weakness. Physical therapy will assess all of theses components and create an individualized program to address the impairments found. We have found that teaching postural control, reactivating the deeper spinal stabilizers, and activity modification has produced great outcomes with our patients, and has reduced future exacerbations.
