Lumbar Disc Injuries: How to Get Them to Heal. PART 2.

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In post 1 we talked about the anatomy of the discs, their nerve and blood supply (or lack thereof) and what types of injuries may occur to a disc.  We also looked at how discs heal, and how long this takes – at least 6 months!  In this post we’ll consider how to get your disc injury to heal as fast as is physiologically possible.


What type of loads strain or damage a healing disc?

The original research on this topic was done in the 1970’s and has stood the test of time.  Different postures, movements and lifting all increase the pressure inside the lumbar discs, which if repeated or excessive can gradually cause wear and tear damage (annular tears and structural weakening) of your discs, or prevent your injured disc from healing. 

The diagram below shows the effect of different postures (with 100% being normalised to the load on your disc when standing upright with good posture).  Lying down (where there is no vertical compression) maximally unloads the pressure on the discs, whereas sitting, especially slouch sitting, maximally loads the discs (approx. 150-300% load compared to standing!).



This has huge implications for anyone with disc pathology.  First of all, it should now be obvious why driving to and from work and sitting all day for years on end causes discs to wear out prematurely! 

 

HOW TO UNLOAD A DAMAGED DISC:

If you have a painful disc, we discussed in post 1 how the disc heals by growing fragile capillaries that are easily torn in the first 4 weeks.  Scar tissue slowly forms to heal the outer 1-2mm of the disc, and this takes about 6 months to become reasonably robust.  It will never again attain the strength of a normal uninjured disc.  Disc pain typically takes 2-6 months, and sometimes up to 12 months to settle down even if the healing hasn’t finished yet.  So how do you unload the disc in the initial 6 month period to help it heal as fast as it can?

There are 3 key components to helping an injured disc heal:

  1. TIME
  2. UNLOAD: change posture and movement patterns (for the rest of your life)
  3. REHAB: get your muscles to support your spine to unload the discs

How do you change your posture and movement patterns to unload a disc? 

  • Any posture or movement that involves rounding your lower back (like sitting or touching your toes) increases the load on your discs.
  • Avoid prolonged sitting, and when you do sit have a neutral (upright) lumbar posture. Definitely no slouching!  Frequently alternate sitting with standing or walking throughout the day (a standing desk can be an excellent option if you are desk-bound at work).  Sitting in a reclined position with a straight lower back is also unloading for your disc (eg in a recliner chair).
  • Ergonomics – set your desk up correctly and use an appropriately supportive office chair.
  • Avoid lifting by bending your back. Bend you knees instead and keep your back straight.
  • Limit the load you lift (for example set a 5kg limit for the first 6-12 weeks or until pain-free, and a 10kg limit until the 6 month mark).
  • Avoid lifting weights in the gym for 6 months. Your Physiotherapist can advise regarding a resistance training program that can increase your strength without risking damaging the disc again.  This program is likely to emphasise body weight resistance rather than heavy weight training or kettle bells.
  • Strengthen the muscles supporting your spine under the guidance of your Physiotherapist from day 1. Getting the muscles to take the load off the spine will help unload the disc.  Keeping your torso muscles strong and balanced into the future helps prevent re-injury. But be careful and seek the advice of your Physiotherapist – high load abdominal exercises (such as planks and sit-ups) that are performed too early in the healing process may place excessive load on the healing disc and can make things worse.
  • Get your hip muscles flexible and keep them flexible, especially the hamstrings and gluts. If these muscles are tight you will not be able to sit up straight in your chair, and as the graph above demonstrates this can increase your disc pressure by almost 300%.

 

Lastly, TIME is a key component for disc healing.  Be patient, do your rehab and follow the “disc precautions” listed above in terms of posture, movement patterns and lifting and things will usually improve slowly but surely.  If they don’t DO talk to your physiotherapist.