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How to differentiate between a pinched nerve, bulging disc, degenerative disc and a herniated disc

Pinched nerve - Spine, discsThe goal of physical therapy for the pinched nerve is to provide yowith a way of strengthening and stretching the muscles that are in the area of the pinched nerve. The exercises are specifically chosen and formatted to work the effected area. By stretching the muscle, you'll be relieving the pressure that is on the pinched nerve. Don't make the mistake of stopping your rehabilitation program too soon. Having patience and keeping a full line of communication with the therapists and physicians involved will prove to be a great success.

Bulging disc - A bulging disc occurs when the soft tissue sac between the vertebrae bones of the spine develops a weak spot or shifts outside of the area it should be in and into the spinal canal. This injury occurs most often in the lower section of the back (lumbar). When a bulging disc first occurs, it may not be immediately apparent due to the lack of nerves it touches. Over a period of time pain, numbness, and tingling may occur. When the pain is in the buttocks and leg associated with a lumbar bulging disc, it is a painful condition called sciatica. A bulged or slipped disc will not move back into place on its own, and as the body ages, the disc tissue will only become more dry and less flexible, exacerbating the painful effects.

A bulging disk is different from a herniated disk in that a bulging disk typically occurs gradually over time rather than suddenly. A herniated disk is often the result of an injury or trauma to the spine.

Degenerative disc or Protruding disc - As the human body ages, our spinal discs break down, or degenerate, this may result in degenerative disc disease in some people. Year after year discs can deteriorate and bulge out of their normal positions in the spinal column. What happens is a loss of fluid in your discs which leads to the narrowing of the gap between each vertebrae. This also reduces the ability of the discs to act as shock absorbers to protect the outer layers. The degeneration process can also create tiny tears or cracks in the outer layer of the disc. The jellylike material inside the disc may be forced out through the tears or cracks, which will cause the disc to bulge, rupture, or break into spurs.

You are more likely to get degenerative disc disease if you:

  • Smoke
  • Do heavy physical work or played extreme sports
  • Don’t exercise and are overweight or obese.
  • Sedentary lifestyle

Herniated disc -Also called a ruptured or slipped disc. Herniated disc is when the disc ruptures or cracks and the jellylike portion of the disc pushes outside its normal boundaries. The ruptured portion can "pinch" or press on spinal nerves or the spinal cord. The pressure can lead to back pain, numbness, or weakness in the legs. Symptoms from herniated discs are made worse by certain activities or positions. The pain is often made worse by sitting, bending, and reaching. It may be worse first thing in the morning and after staying in any one position for a long time. If you have a herniated disc in the neck, symptoms are often worse with prolonged sitting and when lying down.

How can physical therapy help?

Having good muscle control of the spine can help compensate for a degenerated disc. It will also reduce pain and increase stability. To get relief from the four diagnoses listed above there are many factors that will be addressed by your physician and with your physical therapist. The therapist will design a treatment program specifically for your symptoms and goals you have for the future. Your weekly treatments may include some or all of the items listed below.

  • Postural education to teach you how to manage your condition. Conversations about what positions you are sleeping in, how you are sitting, bending and lifting things up. Educating you on what muscles should be used and making you aware of how to manage your condition in your everyday lifestyle.
  • Manual therapy techniques are aimed at relaxing tense back muscles and stiff restricted joints in order to decrease back pain and increase flexibility as well as improve mobility of tight muscles that may be contributing to your symptoms.
  • Exercises that involve specific movements, Stretching and flexibility exercises to improve mobility, and strengthening exercises to build muscles to support the injured joints.
  • Ice, traction, and electrical stimulation will help reduce pain symptoms.
  • Finding an aerobic exercise that is enjoyable to you. This is important in managing your long term goals, promoting a healthy body weight and improving overall strength.

Once your pain is gone, it will be important for you to continue your new posture and movement habits to keep your back healthy.

In Summary - The first stage is often a bulging disc. The next stage of disc deterioration may be classified as a disc protrusion, when the disc bulge is still contained within the disc’s outer wall, but it has worsened and is pushing even further into the spinal column. The final stage may be a herniated disc, which means the disc’s outer wall finally breaks open, allowing the inner nucleus pulposus to leak out