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.

When should I change my running shoes?

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I was pondering this one the other day.
With so many people constantly pounding the streets/fells/treadmills, there is a massive market for running shoes. However, they are rather expensive, so when you have a pair of shoes you naturally want them to last for as long as feasably possible. Once their running days are over, you may use them as a pair of slippers, a trophy or something to keep handy in order to throw at next doors cat.

The question is when is a good time to buy a new pair? How long can I continue wearing these bashed up old shoes- they feel comfortable, so therefore they can't be too bad, right?

It has been said by some people, (and a lot of shoe companies, who stand to make a fair old whack from it), that you should have a general rotation of 3 pairs of shoes, an old pair, which are beginning to wear out, a middling pair which have been broken in, and a pretty much brand new pair, which you are in the process of breaking in. The advantage of this is you don't continually trash one pair into the ground, gradually destroying any semblance of support it might once have had and then buy a brand new pair of trainers which have a level of support/cushioning etc. which you then have to get used to all over again. Instead, you have a constant rotation of old and new shoes so that you never have a massive step from one type of shoe to another.

This is really good if
a) you always use the same shoes and
b) you have a lot of money

I don't think I've ever actually bought the same shoes time and again, mainly because I never used to run enough to wear out a pair before some snazzy new thing came out that I wanted to try- and by the time I wore them out, again, there was some brand new "tech" that was innovative, and again, I'd buy those shoes.

Notice that I have just been talking about "cushioning" and "support". A lot of Barefoot runners will be sitting there sneering saying, well, my shoes don't have any cushioning OR support. That all comes from my foot and the way in which I run.
Well. inov8 X-talons are pretty close to minimalist shoes, and when they look like this....
its about time to replace them.



Lets have a closer look at those shoes.

I asked the runner to stand evenly with both feet shoulder width apart. Obviously the left foot is a bit worse than the right- the grip isn't being utilised fully, and the inov8 symbol certainly isnt pointing straight up and down the shoe. You might also notice all the wrinkles (in the shoe, not the legs), where long term, some might say excessive use has slowly deformed the shoe into its current state.
I'm not saying this runner shouldn't use Inov8s because they don't correct his gait issues, I'm simply drawing attention to the fact that even "barefoot" or "low profile" shoes, also have a life span and need to be replaced and that isn't necessarily to do with when the grip wears out.

Take a quick look at a non-destroyed pair of inov8s look- (they've been worn, but not worn out)

Take note of the way an inov8 shoe looks from the back when it isn't completely destroyed. The foot symbol on the back of the shoe points straight up. The grips are all touching the floor. It is a stable platform on which your foot sits. The platform is flexible and your foot controls it in an intuitive way- which makes it more like barefoot running than "shod" running, however, as you run in them, be aware that if you have bad biomechanics, you will wear the shoe out faster.

Have a look at your shoes and ask yourself if they are still providing a decent platform for your feet. Yes, new shoes are expensive, but so is a knee/ankle op when things go wrong and you get an overuse injury from bad biomechanics... and if you say- ah well- I can wait for the op on the NHS, think about the long months during which you won't be able to run because you've screwed up your knee. Surely thats worth looking at how good/bad your shoes are, and forking out for a replacement if necessary.

Advice on treating acute injuries – the R.I.C.E protocol

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Injuries, like a sprained muscle, strained tendon, torn or damaged ligaments need immediate first aid treatment to help increase speed of recovery and reduce the risk of potential complications.

R.I.C.E. is an acronym for Rest, Ice, Compression and Elevation.

Injuries are frequently accompanied by pain, bruising, swelling, bleeding and inflammation. These are all natural responses of the body as a result of injury and are part of the healing process. By applying the four elements of the RICE protocol you can help to reduce pain or swelling and help to speed up recovery by aiding the healing process.

REST: stop the activity which caused the injury, and anything else that may further increase pain or exacerbate the injury. You may need to see a doctor or other medical professional – it is important to follow their guidelines as to when you may be able to resume activities.

ICE: applying ice to the injury site and immediate surrounding area has the benefit of reducing bleeding, swelling and pain. It is important to apply ice as soon as possible after the injury has happened.

How is Ice applied?

As a guide use cold packs indirectly (wrapped in a clean dry cloth to prevent skin burning) for 20 minutes every 2 hours, for the first 1 to 3 days. Crushed ice in a plastic bag (or a bag of frozen vegetables) works best as you can mould the bag around the injury site. 

 

Do not apply ice directly to the skin as it can cause ‘ice burns’. If your skin is sensitive to ice or you have circulation problems you may need to adjust the duration/frequency of ice application. Please use your own judgement as you know your body best. It is better to apply ice for a shorter duration and more often if you find the cold excessively painful. Remember though, it is ice, so it will be cold!

You may have heard that heat should be applied to an injury but this is not the case in acute injuries, which is usually during the first 1-3 days following injury. Heat can increase the level of bleeding and therefore cause an increase in swelling and pain. Heat is best applied once the injury is sub-acute (3-21 days after injury, depending on the severity).

COMPRESSION: is used to prevent and reduce any additional swelling by wearing an elastic compression bandage around the swollen area. The aim is to reduce swelling as much as possible as it can slow down the healing process. Some people may also experience pain relief from applying compression. If a throbbing sensation or feeling of tightness is experienced it means the compression is too tight and should be loosened off immediately.

ELEVATION: the final step in helping to reduce swelling and speed up your recovery. The injured area needs to be higher than your heart – this is because you want the excess fluids to drain towards your heart, and clearly gravity will help this immensely. For example, if your ankle is sprained you need to put your leg up higher than your heart; a good way is to lay on the floor with your leg on the sofa or bed – and ensure that the foot propped up on pillows higher than your knee.