Herniated disc, or herniated disc, is a rupture of a fibrous ring that normally surrounds the intervertebral disc, a kind of cushion that lies between the vertebrae to facilitate movement and absorb trauma. A herniated disc causes a displacement of the nucleus of this disc in the space between the vertebrae, which is why it is called an intervertebral hernia. The genesis of herniated discs can be favoured by factors:

• Working (e.g. frequent lifting of weights associated with torsion or prolonged bending positions (e.g. standing in front of the PC all day) or rotation especially if associated with vibrations e.g. when driving a truck);
• Personal (height > 185, age between 45 and 65 and stress); 
• Behavioural (obesity and smoking).

Does having a herniated back mean you are lost? 

The first thing I want to say to you is take it easy, hernia is not a condemnation, hernia is a situation which regresses over time) to complete resolution of symptoms in most cases (larger hernias are even reabsorbed faster by the body). 

Disc hernia: what is it?

A herniated disc or disc herniation is therefore a rupture of the fibrous ring of the intervertebral disc, which causes the nucleus pulposus of the disc to protrude. Generally, the levels most affected are the fourth or fifth lumbar disc (which is why we find the term L4-L5 or L5-S1 herniation in MRIs). This process causes both inflammation and compression at the level of some of the most sensitive and delicate components of our body, i.e. the nerve roots that emerge from the foramina between the vertebrae it is therefore normal to feel a lot of pain. In fact, herniated discs often lead to severe and persistent pain that frequently radiates down the leg to the foot and causes one to assume positions of rest from the pain. The pain often also presents itself as numbness, electric shock, muscle weakness or tingling, and is accompanied by a major restriction of daily back movements to such an extent that normal activities of daily living are prevented. Often the pain in the leg or thigh may be greater than the pain in the back. However, it is common for back hernias to be asymptomatic. In fact, about 80% of people after the age of 50 have MRI scans that show the presence of hernias or protrusions while being completely asymptomatic. If you have a hernia but no symptoms, go on with your normal life!

Herniated disc: difference with protrusion

However, a distinction must be made between hernia and protrusion. A hernia means that the leaking material is greater than the distance between two consecutive vertebrae. Protrusion, on the other hand, means that the material that has leaked or is about to leak out is smaller than the distance between two vertebrae. The herniation can also migrate, i.e. the leaking material from the disc can move cranially or caudally, and there can also be a sequestration, i.e. a loss of continuity between the leaking material and a detached portion of the disc. Beware, however, that so-called hernia symptoms such as sciatica may be caused by causes that have nothing to do with a hernia, such as disc bulging or the presence of stenosis or osteophytes. Moreover, both hernias and protrusions, although present, can be, as we have already said, asymptomatic, so don't worry about them if they are not accompanied by the symptoms of a herniated disc that I will explain shortly.

Herniated disc: symptoms

Herniated disc symptoms

Herniated discs can lead to symptoms characterised by severe pain which on a scale of 1 to 10 can go up to 7 or even 8. You will recognise hernia symptoms in a clearly demarcated area that generally corresponds to a line pulling along the thigh and/or leg (as in the lumbocruralgia). It is normal to assume so-called antalgic postures, i.e. postures that our body seeks to spontaneously reduce pain such as lumbar flexion or a generally contralateral tilt with respect to the symptom side of the leg.

Herniated discs, due to their symptoms, also severely restrict lumbar movements that disrupt daily activities such as dressing, sitting, driving, walking, etc.. Finally, a lumbar hernia can lead to symptoms in the main muscles of the lower limb such as weakness or sagging of the leg. This, then, is an overview of the symptoms that a lumbosacral hernia can cause in your body. 

Disc hernia: can I work out?

Can you work out if you have a herniated disc? Lower back pain: can I lift weights?

International guidelines for the non-surgical treatment of herniated discs demonstrate a positive effect of physical activity instead of the bed rest that has only negative effects. Of course, just as in the activities of daily life, it is necessary to understand what can be done and what, at least temporarily, it would be better to postpone. Staying active is undoubtedly the key to improving as early as possible while bed rest if not for the very early stages and for a maximum of 2-3 days is inadvisable. So before you know whether you can work out, it is good to identify what stage of the disease you are in, and this is where your trusted physiotherapist who will be able to identify not only the diagnosis underlying your problems, but will also know how to advise you regarding the management of physical activity. If you are in the very early days of the disease and your pain is severe or even worsening, you should not rest in bed (if not for 2-3 days at the most) just as you should not think of carrying out excessively invasive activities such as a football match or a training session in the gym with high loads or stretching your legs for too long and intense a period. In the early stages, consult a specialist who can assess you and show you the best way forward.

There is no right or wrong sport to be practised towards such a condition, the advice is rather to avoid absolute rest and to listen to your body by incorporating as soon as possible a form of activity that is low in load and pleasant for you (e.g. walking, cycling, etc.). It has indeed been shown that having low self-efficacy when in pain, or a reduced ability to cope with our lives with back or leg pain, seems to have a negative relationship with back pain in the long term therefore trust your body, get on with things without overdoing it, you'll be fine! Feeling a slight form of pain while performing low-load activities such as a walk or exercise bike is not necessarily negative; on the contrary, it will be a propulsion to feeling better tomorrow. On the other hand, when you realise that the pain along your leg is diminishing and your residual aches are focused only in the middle or around your back, that is a signal from your body to tell you that you are gradually healing and that you can gradually approach more and more intense and provocative physical activity until you return to a complete resumption of pre-injury activity. 

Herniated disc: movements to avoid

What movements should be avoided in the case of a herniated disc?

Also in the very early stages, i.e. in the acute phases of the disease when the symptoms of a hernia in the back become more noticeable, there are certain movements that it would be better to avoid or limit, such as adopting postures that could put the back in a bad position. compression or excessive stretching of the nerve root. It would be better at this stage to try to avoid lying on our stomachs with our elbows resting on them, bending over on the side of the leg that hurts us, keeping our legs (on the sofa, for example) stretched out too far for too long, as well as avoiding sudden movements or jerking or lifting excessive weights. In addition, one crucial aspect remains the same: rather than being careful to avoid certain postures, let's take steps to often change the postures of our body, which is not made to stay in the same position for hours on end.Your best posture is your next posture"(your best posture is the next posture you assume), don't sit too still and don't sit too long even if you have to do it for work. 

Conclusion

A herniated lumbar spine is not a condemnation, it is just a temporary condition in which it is normal to feel a lot of pain due to the extreme sensitivity of the structures that are affected. The hernia reabsorbs and its symptoms improve over time. To understand what to do consult a specialistThis will give you an indication of what is happening to you and tell you how to manage your physical activity whatever sport you want to do. Start by avoiding bad postures and try to stay as active as possible consistent with your pain. A gradual exposure to physical activity and a gradual remission of symptoms will allow you over time to get back to your workout routine and your life!

Bibliography 

Ilyas H, Savage J. Lumbar Disk Herniation and SPORTA Review of the Literature. Clin Spine Surg. 2018 Nov;31(9):366-372. doi: 10.1097/BSD.0000000000000696. PMID: 30045110.

Chen BL, Guo JB, Zhang HW, Zhang YJ, Zhu Y, Zhang J, Hu HY, Zheng YL, Wang XQ. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin Rehabil. 2018 Feb;32(2):146-160. doi: 10.1177/0269215517719952. Epub 2017 Jul 17. PMID: 28715939.

Dr. Marco Gallotti

Graduated in Physiotherapy with 110/110 cum laude from the Catholic University of the Sacred Heart in Rome in 2015. Master in Neurorehabilitation at the University La Sapienza of Rome in 2017, Master in Rehabilitation of Musculoskeletal Disorders in 2019 at the Savona Campus. Teaching assistant at the Master's Degree in Musculoskeletal and Rheumatological Physiotherapy at Roma Tor Vergata, Lazio Regional Referent Manual Therapy Group. Master's Degree in Physiotherapy in progress.
A freelancer working in private practices in the Marconi and Laurentina areas, I also carry out home therapies.