Herniated disc

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Your spine is made up of vertebrae, each separated by intervertebral discs made of fibrocartilage.  The discs are made up of inner and outer parts - a soft gel like elastic inner core called the nucleus pulposus and the tough annulus fibrosus being the outer rim of cartilage. The nucleus pulposus is there to distribute the pressure of each disc when they are put under load, i.e. they are shock absorbers. They also enable each vertebrae to glide over the other, keeping movements smooth.

What is a herniated disc?
Also called a slipped, ruptured or prolapsed disc. What happens is the soft inner nucleus pulposus herniates - it bulges through a tear or distortion in the annulus fibrosus into the vertebral canal or intervertebral foramen. The damage to the annulus fibrosus can happen because the disc is compressed beyond its normal range.

Depending on which way the bulge protrudes will determine what symptoms are felt. The disc can compress the spinal cord or nerves which can lead to reduced, or loss of function to the areas of the body served by the nerves. To you, this will feel like mild to severe back ache with or without burning, tingling, numbness or other sensations. If really severe muscle function can be affected or even paralysis. It really depends how severe the injury is, and what structures are affected.

Why does it happen?
For a fit and healthy person it is usually caused by sudden trauma, generally because of strenuous exertion (e.g. lifting a heavy object) or exercise (e.g. improper technique when weight lifting). Trauma can occur because of the lightest of movements, e.g. picking up a small object, and this would point to an underlying cause, or with forceful trauma to the vertebral discs such as in a fall or car accident. Poor posture can also contribute to this condition. In the healthy/young population the herniation is generally sudden and acute.
For older people the herniation can occur because of wear and tear - bone disease or degeneration, and the onset can be more progressive and chronic. That said, the onset, i.e. when you feel the pain, is usually sudden and sharp.

Can it be prevented?
Obviously accidents and traumatic occurrences are difficult to prevent. You can however ensure you perform lifting with proper technique, and keep yourself generally fit and healthy. Avoiding repetitive twisting movements is generally a good idea as this can put extra pressure on the discs. In a gym ensure your trainer shows you correct posture and technique and continues to monitor you so that you continue to do the exercises correctly. This should minimise the risks.

How to treat it?
Immediate care is rest and application of ice initially, heat can be applied after the acute stage has passed. Seeing your GP or emergency doctor may be appropriate. With medical intervention anti-inflammatory and pain medication may be prescribed.  As the injury progresses bed rest may be applicable for a period but generally normal activity should be undertaken ('active rest') to prevent muscle guarding and keep the spine mobile. If there is pain then stop what you're doing. Longer term, you should be looking to undertake strengthening and flexibility exercises with a sufficient warm up. It should go without saying that sudden or excessive heavy lifting is to be avoided to prevent re-injury. In severe cases surgery may be necessary but the majority of cases resolve with this being necessary.

Can Sports Massage help?
Yes, it can. Providing the therapist avoids treating on a day when symptoms are bad then there are no reason not to massage. Sports Massage will help to relieve muscle spasms, muscle guarding and tension which is your body's natural reaction to 'protect' the area. The intention of massage is to create space around the affected vertebrae, thereby allowing for the retreat of the herniated tissues.

Massage will also help to manage pain. A good therapist will look at the wider issues occurring in your body which might be contributing to, or a result of the disc injury. For example, postural imbalances, muscle functioning (what might be inhibited or short), firing pattern dysfunction and gait reflexes should be considered as part of the treatment. The aim is to look for the cause of the issue, as well as managing the acute area and muscles surrounding the injured disc. 


It is often appropriate with this condition for massage therapy and osteopathy treatments to be included in the overall treatment plan. This is to allow the soft tissues and bony structures to be worked in tandem, since both are involved.

Desk Jockeys

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By this I mean a desk-bound employee pushing papers and typing at keyboards all day long. Low exercise levels (just on the job, we're not saying you're lazy), restricted movements and repeated actions, none of which are all that good for your posture.

So what does poor posture mean for our bodies? Well, muscles can become weak and elongated, short and overly tense, switch off completely because others have taken over their role or just generally dysfunctional. You might experience muscular pain, joint stiffness, headaches, a sense of not being quite right, or suffer from RSI (repetitive strain injury). Whatever the cause, poor posture isn't good for muscles, tendons, ligaments and joints, and the effect is felt all over your body.

Here's how it goes....you come to work, just like you do every day. Switch on the computer, check your in-tray, in-box, action list, make a coffee and settle in to the day's work. I know. I've been there. You do the same things over and over again, day in day out. Your chair stays in the same position. Your phone is probably a little out of reach because otherwise it gets in the way of the keyboard (go on, check how far away it is). Papers are piled up on either side of you. The filing piles up. If you're lucky (or perhaps unlucky) to have a paperless job then you just come in, sit down and keep your arms in the same position for what, 2-3 hours at a go? Longer? Basically, apart from the coffee breaks, a quick wander around the office and lunch (that is if you take lunch away from your desk), you're sat at your desk with your body fixed pretty much in one position.

Is that good for you? No. We've posted elsewhere (Fascia. Fascianating) about how fascia is kind of like plastic, needs to be able to glide freely and how it becomes stuck and bound together with inaction.

Now consider your desk set up and seating position. In the position you're in, with limited movements, think about what your shoulders are doing. Really take a few moments to notice how they are positioned. Now your neck. What's happening there? And what about your pelvis?

Lets look at each of those in turn.

Shoulders: most likely they'll be rounded forwards, hunched over. In general, this means the muscles on the front of your chest are short and tight (predominantly the pecs but also muscles in your neck and obviously shoulders) and those at the back will be weak and long (upper trapezius, rhomboids – in between your shoulder blades). Because your shoulders are forwards there could be a tendency for your mid back curve to be increased, putting pressure on your spine.

Neck/head: the ideal position for your head is with your ears directly above your shoulders. I'm betting your head is forwards meaning the chin is forwards and muscles at the back of your neck are long and weak, or maybe not firing effectively.

The average head weighs about 10lbs. For every inch your head is forwards your muscles have to cope with an additional 10lbs of weight – so for a 2 inch head forward position your head is effectively weighing the equivalent of 30lb – 3 times the weight that it should be!! Now imagine the strain that your muscles are trying to cope with, there's no wonder after years of sitting at a desk that a stooped forwards position leads to muscular pain, headaches and dysfunction. When your head is positioned correctly gravity distributes the weight downwards and your muscles don't have to work anywhere near as hard. This is because gravity is working in a good way, rather than pulling your head forwards and downwards.

Pelvis: are you slouching, in which case your pelvis will be tipped backwards (posterior tilt). Don't just think about what you're doing right now but about how you sit day in day out. Because you are now aware of it you probably sat upright a little more, this is perfectly normal, but what we're after is for you to think about how you usually sit. Good posture need not be sitting bolt upright, just keeping your spine in a neutral position is good. Going back to slouching, which I think it's fair to say from experience, after way too many years in an office myself, that the majority of people do slouch. What's happening to your muscles? Well, for a start, just sitting for long periods leads to short hip flexors – the muscles that bring your leg up in front of you. When you think about it it is common sense – your legs are bent in a sitting position so the muscles which bend your legs will be held in a shortened position, even if they're not contracting. Your glutes are inactive, they forget what their job is. Because your pelvis is tucked under your hamstrings (the muscles on the back of your thighs) also shorten. Even if you stand up and sit down a couple of times, its not your hamstrings or glutes that are really working, its the quads- which, as we mentioned, are already shortened. 

One thing I haven't mentioned so far is whether or not you sit with your legs crossed. I did, for quite some time, before working out (during training to be a massage therapist) that this wasn't such a good idea. It's led to me having one weak hip flexor (the psoas muscle) on the left and one which is too tense on the right – the leg that crossed. The good news is that with some strengthening work on the weak muscle I can rebalance this out fairly easily – oh, and I now keep both my feet flat on the floor when desk-bound!

It's common with head forward posture for the gravity shift to cause your upper back to curve backwards and your the hips to tilt – one thing is compensating for the other (we've said elsewhere that everything is linked and connected), and you end up out of shape, quite literally, feeling a little wonky and perhaps not being 100% comfortable but not really knowing what is not quite right.

The risk to your health because of poor posture are not only muscular aches and pains, but headaches, compression of the spine, dysfunctional muscles and postural imbalances. These can lead to all sorts of other health issues which you won't instantly connect with poor posture, such as breathing disorders.

How can you make things better? Find out if your employer will carry out a desk assessment, most places do these days because it's a serious health and safety consideration for them. Get one booked in. Your screen needs to be positioned so that you look straight at it without your chin dipping (ideally your chin should be parallel to the ground) – this will help you keep your ears positioned over your shoulders and the gravitational forces from your head going straight down. Shoulders should be positioned directly over your hips and spine in a neutral position. Your chair needs to be the correct height and if needed use a foot rest. Your telephone should be within easy reach and if you're on the phone a fair bit get your employer to invest in a headset – hands free calling significantly reduces neck and shoulder strain. Consider moving your mouse to the opposite hand for a few hours every few days – you'll get used to it quicker than you think.

To start with this will all feel a little weird. It's bound to because you've been sitting incorrectly for some time now. But please persist. Any imbalances which have worked there way into your body over months, maybe years, will take a decent amount of time to work their way out.

My final comment refers back to where this all began - restricted movements. You can change your job but for most it isn't a practical solution. So we have to make do with what we have. What you can do is to get up and move. Do as cats do every time they move or get up – Stretch! 

Most important is to move and keep your body fluid. I highly recommend a book called “Stretching” by Bob Anderson – he provides a simple easy to follow guide to stretches for various sports and daily activities, and I note the latest edition has a section on Computer Stretches!