Healing a Herniated Disc For Good

Herniated discs in the lower back are the most common root cause for the back pain and sciatica that so many experience every single day. Whether we are talking about a more minor bulging disc at L4, L5 or a raging disc herniation at L5, S1. Understanding the correct pathway to getting better is going to save you a tremendous amount of unnecessary pain and frustration. 

With this in mind we’ve got 5 steps to help you no matter how long you’ve been struggling with your herniated disc! We’ll start with understanding the actual problem, work on stopping the bad things, start providing some relief and then dig into proper strategies for recovery.

Understanding what your herniated disc is

The role of your disc is to load bear and provide cushioning between the bones above and below, creating space for the spinal nerves to leave at the junction between these two bones. The herniated discs consist of the annulus fibrosus  and the nucleus pulposus. The Annulus is the ligamentous-type tissue that holds the “gelatinous” nucleus in its place. It is the holding of the nucleus in the center, by the annulus, that gives the discs its height and ability to absorb shock, and the segment to move. In reality the Annular fibres are the things that bear most of the strain, holding the nucleus in its place, and these fibres work together with the many other ligaments of the spine to create a resting “stiffness” to all of the segments of the spine.

The herniated disc & spinal stability

To have the disc herniated, we have had a failure of the ligament layers of the annulus fibrosus. Meaning that, either repetitively, or in one go, there has been ligament damage. Due to the nature of the interconnectedness of the spine’s stabilising ligaments, this therefore must have had a negative effect on other spinal ligaments that stabilise that direction. Generally speaking, the disc is bulging to the back because the movement that caused the disc herniation was one of bending forwards, pressing on the front of the vertebral disc, focusing force to the back of the vertebra’s stablising ligaments, which failed. 

The injury to the disc, whether a full herniation or minor bulge, means that the segment has lost integrity of structures that maintain the stability and natural stiffness that all our joints should be held together with. 

You cannot control your herniated disc

Unfortunately we now have an injured joint in the lumbar spine, the L5, S1 spinal disc is herniated. What makes matters worse is that you cannot move, or stabilise your L5, S1 disc alone. As a human being you have no capacity for segmental control. What this means is that movement of the spine, or lack of cannot be focused to target, or avoid, a specific level of the spine.

Exploiting your herniated disc

The secondary issue arises in the herniated disc as a consequence of the fact that other sections of the spine are still intact. Meaning there is a good amount of natural “stiffness” maintained by the relatively more healthy discs and ligaments between these other segments of the Lumbar spine. Because you cannot control your spine, when you move, bend or twist, movement will pass through the entire spinal section, the lumbar spine in this case, HOWEVER, it will be the case that the movement will pass through the point of least resistance preferably. While the other “healthy segments” maintain their integrity and stiffness, the injured herniated disc, with its reduced stiffness and functionality, will allow movement to focus through its segment of the spine. This gives rise to further stress and strain being placed on this herniated disc and its surrounding stabilisers. 

It’s worth also noting that it is frequent that the movement through this injured segment is often no longer “normal” and it is common that bending movements that should be hinging one way or another, are more like shearing movements, as the joint stability at the level of the herniation is less normal. 

This all paints a rather dire position for the disc in question, however, the reason for this is so that you can appreciate the necessity of the next steps. We cannot possibly hope to fix something if we fail to understand what the thing is that needs fixing. 

Stop making your herniated disc worse

By far in a way the most important first step. Most with a particularly bad herniated disc instinctively feel this, that movement is making the spine worse. They cannot trust themselves to get out of bed in the morning or move around the house making breakfast without the looming threat of “catching that disc” and a terrible sensation of back pain or sciatica running down their leg. This is because without proper support, which we will get to later, the instability in the spine is constantly being exploited through our daily movements. 

Quite frankly, the habits you’ve had that caused the herniated disc, are still present and still stressing and straining your back, the only difference now is that you are more acutely aware of these issues. 

Incorrect stretching for spine mobility

The common stretches that are prescribed at this point do all the more to make this situation even worse. Cat cow, child’s pose, pelvic tucks, sciatic nerve flossing and threading the needle, among many others all serve to move that spine more. But as discussed earlier, especially when other areas of the buttocks and legs are so stiff, these movements only serve to drive more strain through the ligaments and disc fibres that are already struggling tremendously.

Essentially, while they frequently feel nice in the moment, you’re taking stretched and strained ligaments, and doing more stretching and straining of them! 

Do you think this is doing anything constructive for the instability of the spinal segment?

How child’s pose is commonly used for people with back pain is something that we discussed on an old episode of the podcast. We also covered sciatic nerve flossing for sciatica relief a while ago, so check those out for more targeted explanations of why those movements are bad.

At its root these movements are done in an effort to provide some relief, but the wisdom behind them is lacking, so what do we do instead?

A smarter relief strategy for herniated discs

Relief is important, of course, but we need to ensure the things we are doing are not chasing short term relief, for minutes to hours, at the expense of medium to long term resolution and healing. As such we talk about a few key concepts with our members and patients that will help you provide some relief for your herniated disc. 

Please note: this is done AT THE SAME TIME as the next step “Learn To Stabilise Your Spine”

Reduce strain on your back

One of the first strategies is to do some simple stretching of the buttocks muscles, the muscles on the back of your thigh, and the muscles on the front of your hip. The gluteals, hamstrings and hip flexors. While this is a TEMPORARY benefit, when done with correct technique, giving yourself 5-10% more hip mobility, means that the hips can do that little bit more before the lower back has to get involved, thereby reducing the strain on the herniated disc.

Make sure that you avoid the common mistakes of involving your lumbar spine in these stretches, as it will be just as bad as doing the bad stretches previously mentioned – child’s pose, and knee hugs. What’s more it isn’t even effective stretching. 

When doing the glute stretch, don’t twist or round your back. For the hamstring stretch, do not round your low back, and for the hip flexor stretch make sure you’re not arching your back.

Hold these stretches for 30 seconds on each leg.

Unload your spine and discs

Using a small towel to support the natural lordosis, backward arch is a vital stretch you can do to provide 3 core benefits.

1. The towel supports the lordosis taking pressure off your discs, most notably L4, L5 and L5,S1.
2. The position takes strain off the lumbar ligaments which we’ve discussed are being strained.
3. The support of the natural position helps take pressure off muscles which are also often being stretched feeling “tense”.

This stretch works by holding the spine in a neutral position, with it’s natural lordosis, just like if you had injured your wrist or ankle you’d try to hold it in its neutral position rather than bent off to one side, the towel functions in a similar way.

Start using a rolled up towel about the size of a foam roller, and do this for 20 seconds to 5 minutes at a time. You can always try a smaller or larger towel if you find this uncomfortable, it is also very common for about 50% of people to find this a challenge in the early days, but it will get easier and feel great as you make progress on your “rehab exercises”.

An optional addition to this is what we call the “bed decompression” which is a more focussed “at home” version of spinal decompression focusing more on specifically creating a gentle unloading of the discs in your low back. While it can be a challenge to get into this position for some, it makes for a great way to decompress your spine gently and safely.

Reduce congestion in your spine

The biggest reason for the pain that most of you experience beyond the initial injury or flare up, is the build up of a completely reasonable inflammatory reaction around the injured section of your spine. This is fine anywhere else in the body, inflammation is a natural way of your body to support healing. However in the confines of the spinal canal, too much congestion gives rise to irritation of the nerves and compression of tissues. Therefore the use of contrast bathing is a vital tool to help you combat this congestion. 

Contrast therapy or contrast bathing, is simply the use of alternating a hot and cold compress, directly over the herniated disc. This could be a hot water bottle and ice pack. 3-5 minutes of each repeated for about 20 minutes is what we usually suggest, finishing on the ice.

If you want to learn more about contrast bathing and a great device that could help you do this more efficiently check out this video on Therabody’s RecoveryTherm Cube for contrast bathing. 

A complete routine you can follow

This routine is one of the foundational routines that we get our members and patients doing, we call it the “Phase 1 routine” and there are a couple of variations to it, but here is a video you can watch: Back Pain Relief Routine For Herniated Discs. Ideally you consider this to be a “healthy back routine” and continue to practice it for the long term, even when the back pain or sciatica is long gone!

Learn To Stabilise Your Spine

It is vital that you begin this process, at the same time as the relief strategy above. As this is what will get you better it also helps you perform the stretches in the previous section more effectively. Through the use of simple spine stability exercises we are going to create a mesh of support around the lumbar spine. As discussed earlier, we do not have the ability to stabilise or move independent segments of our spine. Therefore we must take a whole spine approach. 

Learning to engage the midsection, the muscles around the lumbar spine can provide stability, and prevent movement. The muscles therefore focusing the control over the section of our back acts as a brace to protect the whole spine from movements running through it. In reality we are not able to completely isolate the spine’s movement, a very small amount will always occur, but this is a 95-99% reduction on the previous unrestricted motion that was going through the lumbar spine, exploiting that herniated disc.

Evaluating stability in your spine

The great thing about these kinds of stability exercises is in their simplicity and fault finding. Simply put, if you do it right, your spine doesn’t move and you get no aggravation of the symptoms because your disc wasn’t irritated. If you do it wrong, you allow your spine to move, and feel pain. This gives you great feedback when learning. It might be a humbling process, it often is, but it is one you can track very accurately. 

This feedback mechanism tells you how competent you are, it acts as an initial measure, when you first try the exercises, as a pathway for improvement as you perfect them, and a re-evaluation tool to see your progress.

Our favourite exercises for rebuilding your spine stability:

The exercises we choose should be accessible to everyone, and to save you time if we had to choose 5 exercises, they would be:

• Dead bug
• Marching bridge
• Squat
• Hip hinge
• Step up

We discussed “Why” these exercises in a podcast on the Core 5: Exercises for spine health and stability. In short, these exercises are accessible to everyone, they are easily scalable, up and down, to make them appropriate for all, and three of them in particular are representative examples of daily movements everyone is doing, no matter how bad their back pain or sciatica is. 

Ideally you’re aiming to perform 10, aggravation free reps, and repeat this for 3 to 5 sets on each of these exercises.

Rebuilding Spine Resilience & Strength

Ultimately the great thing about the latter three exercises above, is that they are used in the early days, but also long term. Steadily over time you should use these same exercises with progressively greater amounts of load to reintroduce the element of load to the disc.

Adding this load back into the spine allows you to guide the strengthening process, something that is missing too often in the rehab of people with back injuries. This is why they always have flare ups and relapses for “no reason”. They never rebuilt the strength of the disc!

Make no mistake you can certainly rebuild the ability of the disc to bear load, and I think for all but the competitive powerlifter, this can be done to a standard that is more than sufficient for the average person to fulfill all their hobbies and desires without restriction.

The biggest risk factor at this stage is that you fall off the wagon and stop doing the work. As much of this strengthening is going to be done when pain & symptoms are minimal to non existent. Therefore the motivation to continue, and the presence of distractions is ever greater. 

If you follow this kind of strategy you will find that you can heal that herniated disc for good and get back to doing all manner of things. Many of you will be able to execute this strategy yourselves, but for those of you that want a little more structure and need the support along the way, check out membership to the Back In Shape Program. Work with our team and we’ll help you every step of the way.