In between all spinal vertebrae are thin layers of cartilage known as discs. These discs support each vertebra in the spinal column and act as little pillows for shock absorption. These cartilaginous discs are made up of two parts. The nucleus pulposus is the soft inner layer consisting of gel-like fibres, and the annulus fibrosus is the callous outer layer that encases and protects the nucleus pulposus. A herniated disc can also be known as a bulged, slipped, or ruptured disc. A disc becomes herniated when the nucleus pulposus is pushed through the tough annulus fibrosis into the spinal column. They can occur between any two vertebrae in the spinal column, however, are most commonly found in the lumbar region of the spine.
As a person ages, their disc material naturally degenerates which makes them more susceptible to a ruptured disc and a very minute strain, pull, twisting motion, or even a sneeze can cause the disc to herniate (American Association of Neurological Surgeons, 2022). That said, disc material does not need to be amid the early stages of degeneration to rupture. Young, active individuals can experience disc herniation as a result of a traumatic event like a car accident or a serious fall, from an extreme twisting motion or from lifting a hefty object with improper form (Jason M. Highsmith, MD, 2019). The above scenarios are just a few of the ways in which the nucleus pulposus can bulge through the annulus fibrosus resulting in a herniated disc.
Although many activities can result in a herniated disc, sports are a very common culprit of these herniations. Football, rugby, weightlifting, gymnastics, bowling, and tennis are just some of the sports where athletes commonly experience herniated discs. This is due to the nature of the sports and the constant pressure, stress, impact, and twisting of the athlete's spines.
Symptoms of a herniated disc occur on a vast spectrum. They can vary depending on the person, the size of the hernia, wherein the spinal column the affected disc is, and its position within the column. For example, when the disc ruptures there is limited space in the spinal canal for the hernia, which may cause it to press up against a spinal nerve(s) causing severe, debilitating pain. Despite this, many people with herniated discs may only have minor pain or none at all. The level of pain experienced by an affected athlete would depend on how much the displaced nucleus is pressing against the nerve. Symptoms will also vary based on where the disc is. A herniated disc in the cervical region will often result in cervical radiculopathy which causes pain in the neck and in between the shoulder blades and/or tingling and numbness down the arms (American Association of Neurological Surgeons, 2022). A herniated disc in the lumbar region can often result in sciatica which can cause extreme pain, burning, tingling, and numbness that travels from the buttocks down the leg and into the foot (American Association of Neurological Surgeons, 2022). Sciatica has been described as one of the most painful conditions a human can experience and has many aggravating factors unique to each person. These can include sitting, standing, walking, and straightening the leg.
There are many different ways your doctor can test for a herniated disc. They can perform physical exams to check for back tenderness and determine what positions cause you pain, neurological exams to test reflexes, walking ability, and muscle strength, and there are a variety of diagnostic imaging tests like MRIs and CT scans which look at the spinal column and it’s surrounding structures and which discs are affected, as well as myelograms which show the pressure being applied to the spinal nerves. In addition to the physical and neurological exams, nerve tests can also be done to measure how well electrical impulses travel through specific nerves which allows the location of the pinched nerve to be determined. (Mayo Clinic, 2022)
The treatment of herniated discs differs based on the severity of the pain. The athlete's daily activities should be moderated and they should get lots of rest to allow the injury to heal. Many athletes will opt to use painkillers during the recovery process these can include nonprescription meds like Advil and Tylenol or even muscle relaxers and opioids or cortisone injections depending on the severity of the pain (Mayo Clinic, 2022). Physiotherapy is also a very treatment method for athletes suffering from herniated discs. The physiotherapist will devise and implement a treatment plan specific to the patient and their needs, and provide them with various stretches and exercises they can do to speed up recovery. In severe cases, herniated disc surgery is required to eliminate an athlete's symptoms if they haven’t improved in six weeks and still experience uncontrollable pain, numbness, and inability to walk (Mayo Clinic, 2022).
According to Mayfield Brain and Spine, the average recovery time for less severe herniated discs is around four to six weeks assuming activities are being modified and some sort of treatment, such as physiotherapy is being done. If the rupture is severe enough, surgery will need to be performed after six weeks with no improvement and on top of that, the recovery from the surgery itself is two to four weeks (Robert Bohnski, MD, 2018).
When a disc becomes herniated, the muscles around the spinal column tighten which can cause back pain on top of the preexisting symptoms of the herniated disc. A ruptured lumbar disc can result in weakness and even paralysis of the leg muscles as a result of the pinched nerve. (Peter J. Moley, MD, 2022)
You can never fully prevent a herniated disc, but to reduce the risk it is important to always lift heavy objects with proper form, avoid abrupt twisting movements and maintain good posture and healthy body weight to avoid excess pressure on the spinal vertebrae. Stretching your back after sitting for extended periods as well as exercising regularly are also great methods of prevention as they keep the muscles in your back healthy and strong to support your spinal cord. Finally, try to avoid wearing high heel shoes as they throw your spin out of alignment, and avoid smoking as it can weaken disc material over time (Cleveland Clinic, 2022).
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