Disc Injuries are more often found in the lumbar spine and cervical spine. An injury to the disc can be described as an irritation, a bulge, a protrusion, a herniation or a dessication. A disc, however, can not be slipped due to the amount of connective tissue attachment via the end plates to the vertebrae bodies above and below.

When you bend forwards, you put pressure on the anterior (front) part of the disc, pushing and stretching the disc posteriorly and vice versa. Discs are usually injured in this loaded flexed position or a loaded flexion and rotation position, e.g., picking up a heavy, awkward-shaped box when moving house or while playing golf. Another position which increases the risk of damage via increasing the pressure onto the discs is prolonged sitting (i.e., overseas plane trips).

Now consider how many hours each day you or your clients spend in this flexed spinal position – sleeping, driving, vacuuming, washing, picking up kids, studying, at the office… Compare these hours with how frequently you bend backwards, putting the spine into extension – not very often. The imbalanced ratio between these postures leads to very imbalanced pressures and stretching of the intervertebral discs, resulting in injury.

Active Anatomy Revision
  • Between the vertebral bodies are inter-vertebral discs.
  • They are made up of fibro-cartilage tissue.
  • The centre has a jelly-like substance called the nucleus pulposus, which is surrounded by a tougher outer fibrous layer called the annulous fibrosus.
The function of a disc
  • Provide shock absorption to the body.
  • Allow fluid movement while maintaining a connection from one vertebrae to the other.
  • The gelatinous centre adapts to the shape of the spine as one moves (e.g., left side bending, the disc will become compressed on the left side but not on the right side.

Top tips for training
Lumbar spine discs rely on control of vertebrae movement to help reduce the amount of pressure and stretch going through the injured disc. Remember that the injured disc will never be the same shape following injury and is therefore always prone to being re-injured at a later date. Keep this in mind when training these clients.

Remember that core stability (control of the individual lumbar spine vertebrae) and pelvic stability (stability of the pelvic ring joints) are two separate issues. So – retraining these two vital components individually is very important. These two systems rely completely upon the simultaneous functioning of each other to ensure optimal movement quality.

When retraining stability for the lumbar spine and pelvis, the core stability must be functioning before the global movement muscles responsible for pelvic stability can be strengthened.

Due to this imbalance in postures, (such as posteriorly rotated pelvis – or flat back postures), discs usually bulge, protrude or are herniated posteriorly and may impinge upon the spinal cord or spinal nerves directly behind the discs. This may cause extreme pain, pins and needles, numbness and weakness in the area of the body which that nerve supplies.

E.g., in the lumbar spine the L4/5 disc and L5/S1 disc are most commonly ruptured – they supply the sciatic nerve which runs through the gluteal region down the back of the leg to the calf. An irritation of this nerve is known as sciatica. Disc injuries and sciatica symptoms are commonly presented simultaneously.

Exercises to avoid
Spinal flexion/ impact / prolonged sitting / end range spinal rotations

  • Seated cycling
  • Treadmill running (particularly on incline)
  • Dead lifts
  • Good Mornings
  • Leg press
  • Free squats
  • Standing hamstring stretches
  • Reverse abdominal curls
  • Seated shoulder press
  • Seated chest press/ pec dec
  • Roll-ups/ roll downs
  • Teasers!

Suggested exercises to include
All neutral spine core/ back extension (mild)/ non-impact cardio

  1. Supine core exercises
  2. Side-lying core stability exercises
  3. Prone core exercises, e.g., 4pt, hover, plank or arm/leg transfers
  4. Prone/ standing glut max exercises
  5. Sidelying or standing gluteus medius exercises
  6. Back endurance exercises (swimming/ superman)
  7. Latissimus strengthening
  8. Bent knee hamstring stretch in supine position in neutral spine
  9. Piriformis, hip flexor, rectus femoris, calf /Achilles stretches
  10. Prone cobra extensions (gentle)

For more examples of core and pelvic stability exercises, along with their descriptions and pictures in order of progression, contact Merrin on 0414 423744 or visit www.activeanatomy.com

Merrin Martin, BAppSc (Physio), BSpSc (ExScience)
Merrin is the director of a successful health professional education business called Active Anatomy. Combining her experience as a physiotherapist, Pilates instructor and exercise scientist has enabled her to become a specialist in corrective exercise programs. To contact Merrin or the Active Anatomy team call 0414 423 744 or visit http://www.activeanatomy.com