Herniated Disk

Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as well as leg pain (sciatica).

Between 60% and 80% of people will experience low back pain at some point in their lives. A high percentage of people will have low back and leg pain caused by a herniated disk.

Although a herniated disk can sometimes be very painful, most people feel much better with just a few weeks or months of nonsurgical treatment.

Anatomy

Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.

Five vertebrae make up the lower back. This area is called your lumbar spine.

Other parts of your spine include:

Spinal cord and nerves:
These "electrical cables" travel through the spinal canal carrying messages between your brain and muscles.

Intervertebral disks:
In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when your walk or run.

Intervertebral disks are flat and round, and about a half inch thick. They are made up of two components:

Annulus fibrosus:
This is the tough, flexible outer ring of the disk. 
Nucleus pulposus:
This is the soft, jelly-like center of the disk.

Description

A disk begins to herniate when its jelly-like nucleus pushes against its outer ring due to wear and tear or a sudden injury. This pressure against the outer ring may cause lower back pain. If the disk is very worn or injured, the jelly-like center may squeeze all the way through.

Once the nucleus breaks — or herniates — through the outer ring, pain in the lower back may improve. Sciatic leg pain, however, increases. This is because the jelly-like material inflames the spinal nerves. It may also put pressure on these sensitive spinal nerves, causing pain, numbness, or weakness in one or both legs.

Cause
In many cases, a herniated disk is related to the natural aging of your spine.  

In children and young adults, disks have a high water content. As we get older, our disks begin to dry out and weaken. The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process is called disk degeneration.

Risk Factors  
In addition to the gradual wear and tear that comes with aging, other factors can increase the likelihood of a herniated disk. Knowing what puts you at risk for a herniated disk can help you prevent further problems. 

Gender:
Men between the ages of 30 and 50 are most likely to have a herniated disk. 








 


Improper lifting:

Using your back muscles to lift heavy objects, instead of your legs, can cause a herniated disk. Twisting while you lift can also make your back vulnerable. Lifting with your legs, not your back, may protect your spine.

Weight:
Being overweight puts added stress on the disks in your lower back.

Repetitive activities that strain your spine:
Many jobs are physically demanding. Some require constant lifting, pulling, bending, or twisting. Using safe lifting and movement techniques can help protect your back. 











Frequent driving:

Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks. 

Sedentary lifestyle:
Regular exercise is important in preventing many medical conditions, including a herniated disk.

Smoking:
It is believed that smoking lessens oxygen supply to the disk and causes more rapid degeneration.


Symptoms
For most people with a herniated disk, low back pain is the initial symptom. This pain may last for a few days, then improve. It is often followed by the eventual onset of leg pain, numbness, or weakness. This leg pain typically extends below the knee, and often into the foot and ankle. It is described as moving from the back or buttock down the leg into the foot.

Symptoms may be one or all of the following:

-- Back pain 
-- Leg and/or foot pain (sciatica) 
-- Numbness or a tingling sensation in the leg and/or foot 
-- Weakness in the leg and /or foot 
-- Loss of bladder or bowel control (extremely rare) This may 
   indicate a more serious problem called cauda equina 
   syndrome. 

This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.
Not all patients will experience pain as a disk degenerates. 

It remains a great challenge for the doctor to determine whether a disk that is wearing out is the source of a patient's pain.

Doctor Examination

To determine whether you have a herniated lumbar disk, your doctor will ask you for a complete medical history and conduct a physical examination. The diagnosis can be confirmed by a magnetic resonance imaging (MRI) scan.

Medical History and Physical Examination

After discussing your symptoms and medical history, your doctor will examine your spine. During the physical examination, your doctor may conduct the following tests to help determine the cause of your low back pain.

Neurological examination
A physical examination should include a neurological examination to detect weakness or sensory loss. To test muscle weakness, your doctor will assess how you walk on your heels and toes. Your thigh, ankle, and toe strength may also be tested. 

Your doctor can detect any loss of sensation by checking whether you are numb to light touch in the leg and foot. In addition, your reflexes at the knee and ankle will be tested, and sometimes may be absent.

Straight leg raise (SLR) test
This test is a very accurate predictor of a disk herniation in patients under the age of 35. In this test, you lie on your back and your doctor lifts your affected leg. Your knee stays straight. If you feel pain down your leg and below the knee, you test positive for a herniated disk.

Imaging Tests 

To help confirm a diagnosis of herniated disk, your doctor may recommend a magnetic resonance imaging (MRI) scan. This scan can create clear images of soft tissues like intervertebral disks.









Treatment
In the majority of cases, a herniated lumbar disk will slowly improve over a period of several days to weeks. Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery. 

Nonsurgical Treatment
Unless there are neurological deficits — muscle weakness, difficulty walking — or cauda equina syndrome, conservative care is the first course of treatment. Because it is not clear that nonsurgical care is any better than letting the condition resolve on its own, the focus is on providing pain relief. 

Common nonsurgical measures include: 
Rest:
Usually 1-2 days of bed rest will calm severe back pain. Do not stay off your feet for longer, though. Take rest breaks throughout the day, but avoid sitting for long periods of time. Make all your movements slow and controlled. Change your daily activities so that you avoid movements that can cause further pain, especially bending forward and lifting.

Anti-inflammatory medications:
Medicines like ibuprofen or naproxen may relieve pain.

Yoga therapy:

Yoga therapy is the therapeutic use of yoga to help alleviate or manage health concerns or disease conditions. A skilled yoga therapist can help create a yoga therapy routine targeted to your specific needs.











Osteopathy:

A hands-on approach to releasing strain, abnormal tension and restriction in the body, the structure (muscles, bones, connective tissue and nerves) and the bodies function (organs, glands, fluids) to restore optimal function and alleviate aches and pains.






Epidural steroid injection:

In this procedure, steroids are injected into your back to reduce local inflamma

Of the above measures, only epidural injections have been proven effective at reducing symptoms. There is good evidence that epidural injections can be successful in 42-56% of patients who have not been helped by 6 weeks or more of other nonsurgical care. 

Home Rehabilitation:

Overall, the most effective nonsurgical care for lumbar herniated disk includes observation and an epidural steroid injection for short-term pain relief.

Surgical Treatment  

Only a small percentage of patients with lumbar disk herniations require surgery. Spine surgery is typically recommended only after a period of nonsurgical treatment has not relieved painful symptoms. 

Microdiskectomy:

The most common surgical procedure for a herniated disk in the lower back is a lumbar microdiskectomy. Microdisketomy involves removing the herniated part of the disk and any fragments that are putting pressure on the spinal nerve. 


Rehabilitation:

Most patients do not require formal physical therapy after surgery. After your surgeon evaluates you and confirms that your incision is healed, you may begin a rehabilitation exercise program. A simple walking program 30 minutes each day, along with flexibility exercises for the back and legs, can be done as a home program. If needed, your surgeon will refer you to a physical therapist.

Considerations  
Regardless of the kind of treatment prescribed, there is a 5% chance of the disk herniating again. 

The risk of nonsurgical treatment is that your symptoms may take a long time to resolve. If after about 6 months, you elect to have surgery, the final outcome may not be as good as if you had elected surgery earlier. 

The risk of surgical complications is exceptionally low. Possible complications include: 
-- Infection   
-- Nerve damage  
-- Dural leak — An opening of the thin lining of the nerve 
   root canal may cause loss of the watery liquid 
   (cerebrospinal fluid) that bathes the nerves roots. When 
   seen during surgery, the lining may be repaired.  Sometimes headaches occur afterward, but typically improve with time.   
-- Hematoma causing nerve compression — This is caused 
   by blood collecting around the nerve roots after the 
   surgery. 
-- Recurrent disk herniation — another piece of disk material 
   may break off at the same site and cause the leg pain to 
   return. This may be managed with conservative treatment, 
   but another surgery may be necessary.

Outcomes
The results of microdiskectomy surgery are generally very good. The outcome of leg pain improvement is much more reliable than back pain and therefore this surgery is rarey performed for back pain only.

Most patients notice improvement over the first several weeks following surgery, but may also experience continued improvement over several months. Pain is typically the first symptom to improve, followed by improvement in overall strength of the leg, and then sensation. It is common for some patients to state that although pain symptoms are better, they still have a numb spot on their leg or foot.

Most patients will slowly resume normal daily activities over the first several weeks following surgery. Over the last several years, there has been extensive research on lumbar disk surgery and patient improvement. 

One of the most publicized research projects in this area is the Spinal Patient Outcomes Research Trial (SPORT). The study followed patients with herniated disk from across the country. Half were treated with conservative measures, and half with surgery.

The initial outcomes for patients treated with surgery were much better than those who followed conservative treatment, including improvement in pain relief and function. At the 2-year follow-up, patients treated with surgery again showed improvements over those treated conservatively. 

However, over the course of the study, numerous patients did change their treatments. Your surgeon will be best able to explain what the actual study results are with any recommended approach for you. 

WHAT IS PAIN?

What is pain?
Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" by the International Association for the Study of Pain (IASP).

When thinking about chronic pain, it is important to realize the difference between chronic pain and acute pain. 

Acute pain is a normal reaction to an injury that provides an early warning system that an injury has occurred. Acute pain does not last very long, as the majority of injuries will normally heal within three months.

Chronic pain is pain that doesn’t go away after three months. Chronic pain can be intermittent (occurring on and off). It may vary with intensity during the day or it can be persistent. Chronic pain can result from a known cause, such as surgery or inflamed joints, or a consequence of a disease process, such as rheumatoid arthritis. Many times the cause is unknown.

Chronic pain can be an abnormal processing of pain where the original injury or cause of acute pain has resolved, but the warning system has failed to shut off. When this occurs the warning bells are still going off, however it is no longer signaling “danger” or “harm” but rather indicating a problem of pain processing.

There are different types of chronic pain. Two of the major, non-cancer chronic pains are:

Musculoskeletal Pain:
Pain that affects the bones, muscles, ligaments and tendons. Musculoskeletal pain can result from various causes including sports or occupational injuries, motor vehicle collisions, repetitive strain injuries and disease processes, such as, arthritis. 

Neuropathic Pain:
A complex, multi-faceted state of chronic pain that may have no obvious cause. It can involve damaged tissue, injury or malfunctioning nerve fibers or changes in brain processing. An example of neuropathic pain is phantom limb syndrome. 

The brain still receives signals from nerves that originally carried impulses from the now missing limb. Other types of neuropathic pain include numbness, burning, "pins and needles" sensations and shooting pain.

If you are suffering from chronic pain, there are many effective treatments and self-management techniques that you can use to increase your functionality.

Experiences of Chronic Pain
Pain is a very complex experience and many factors contribute to how an individual perceives, responds to and manages their chronic pain. Everyone brings a unique mix of cultural, family and social adaptations to their pain experience. 

Some people appear to be better able to manage their chronic pain than others. There are social and psychological benefits to maintaining relationships and usual activities as much as possible at home and at work.  

People who take an “active" role in learning and practicing coping behaviors tend to experience less of the following:

Social Isolation:
Some people with chronic pain may lose their friends, strain their family relationships and wear down social supports. With this loss of community comes a loss of interaction and engagement with people or activities that previously helped them cope with their pain. 

Psychological Shifts:
 A person’s mental health and overall attitude toward life can greatly affect their pain experience. For example, research has shown that for people with low back pain, feelings of helplessness, fear and a ‘glass-half-empty’ perspective are linked to poorer health outcomes. Conversely, those with a strong sense of psychological wellbeing and a more positive outlook on life tend to cope better with chronic pain. 

Work/Career Shifts: 
Some people with chronic pain struggle to keep their jobs.  Sometimes the challenge is convincing employers to let affected employees modify their jobs or their workloads so that they can manage their pain while continuing to work. 

Research has shown that workers who return to work earlier have better health outcomes. Being engaged in work reduces focus and attention on pain. The reduction of focus on pain actually changes how the brain processes pain experiences. 

Self-redefinition:
Chronic pain can lead to fundamental changes in how people see themselves and their lives. These changes affect how they feel.  Fortunately, there are several new ideas around thinking, feeling and “being” - or acting - that can help people recognize and control what’s going on with their bodies.  
 
If you are feeling the effects of any of the above issues, it's important that you talk with your doctor. 

You may also consider joining a local support group of others who live with chronic pain.

TRADITIONAL YOGA vs YOGA THERAPY

Many people wonder what the difference is between Yoga and Yoga Therapy, and which one is right for them. Here are the highlights of what Yoga Therapy is, what its benefits are, and how yoga therapy differs from traditional Yoga Asana classes.

Basically, Yoga Therapy uses the ancient science of yoga to enhance health and wellness at all levels of the person: physical, emotional, and spiritual. 

Yoga Therapy focuses on the path of yoga as a healing journey that brings balance to all aspects of life through an experiential awakening of our essential nature.  

Yoga therapy is useful both for people who seek relief for specific health challenges, as well as for people who want to enjoy good health, prevent disease, and slow the progression of aging.

Yoga therapy is based on a view of the individual as a wholeness. For true health to occur, all aspects of a person must be addressed as a whole. Many forms of yoga therapy, such as Integrative Yoga Therapy, use the ancient Vedic model of the Five Koshas as a framework for creating holistic healing and transformation.

In yoga therapy, the tools and techniques of yoga serve to reconnect each client to him or herself at all levels—from the physical body to the breath, the energetic body, mind and emotions, the higher wisdom faculty, and to the spirit. 

Some of the main ways in which yoga therapy differs from yoga are:

• Yoga therapy works with your goals:
Each session is tailored to your needs, whether you want to gain relief from chronic pain, facilitate injury recovery, improve flexibility, reduce stress, improve well-being, get help with depression, or simply retain your youthful appearance and energy.

• Yoga therapy targets the practice to specific   
disease condition:
Most disease conditions benefit from some yoga asanas or yoga breathing techniques and not others. A yoga therapy program for back pain, for example, would be very different from a yoga therapy practice targeting depression. Some yoga therapists specialize mainly in one disease condition, while others have a more broad focus.

• Yoga therapy adjusts the poses to your body's needs:
A yoga therapist shows you how to modify and adjust poses to your body’s specific needs, using props, modifications, and alignment assists.  This ensures that you get the full benefits from each pose.




• Yoga therapy uses adjunct techniques to speed your progress:

When called for, some yoga therapists may use deep tissue massage and fascia release work while you are in the pose to release tight muscle groups and facilitate a deeper core awakening.

• Yoga therapy deepens body awareness:
Yoga therapy is offered in individual sessions or small classes, enabling the therapist to guide you in the fine subtleties of muscle relaxation, stretching, and strengthening. This increases body awareness and helps you make more rapid progress in reshaping your body.

Yoga benefits for golf player

Flexibility
Many muscles, tendons and ligaments play an important part when performing the complete golf swing movement. If the muscles required for the swing are not flexible enough, it will be utterly impossible to achieve a technically correct shot and still worse, our body will be subject to such stress that it will become prone to injuries and pains derived from this particular physical limitation.

Flexibility is also very closely related to the range of movements of the joints. In order to be able to manage a fluid swing, golfers need to reach certain articulating angles with their shoulders, hips or spine –just to name a few of the joints involved. Only those players with no shortened muscles will succeed in doing so.

Yoga provides us with great tools to improve our flexibility by allowing our joints to move more and more easily until they can achieve an optimal range of movement.

Strength
The swing is a movement that requires not only flexible but also sufficiently strong muscles which must alter the position of the body both quickly and powerfully so as to confer speed to the ball. It is also a muscular function to absorb the repeated impact of shots, especially of the wrong ones that hit the ground.

The upper part of the trunk is essential for an effective swing. Increasing the muscular tone around joints, shoulders, elbows and wrists reduces the risk of lesions in them. It is particularly important to strengthen the shoulder muscles. Tough abdominals and a strong back can prevent the pain that appears in the lumbar region as the result of adopting a bad position during the swing. The hips and the pelvis need to be reinforced as well, as they are responsible for initiating the swing rotation.

The practice of yoga improves our strength and endurance by working on all the muscular groups in the body. In fact, the dynamic phase of some asanas (postures) enhances our cardiovascular capacity. The conscious movement of only those parts of the body that are needed at each moment allow for better strength management.

Body postures
A good bodily posture in the practice of golf is as crucial as in many other sports. An incorrect position of the body while playing invariable leads to a certain degree of muscle imbalance that might end up as a lesion. Thus, it is indispensable to pay attention to body posture in all the phases of the game.

In yoga we work on proprioception, an essential concept for the golf player. This results in better control and awareness of one’s bodily posture as well as in an enhanced coordination of both sides of the body. Self awareness also helps to maintain the central nervous system alert level and positively affects the golfer’s emotional development and behaviour.

Breathing
Inadvertent as it often is, the act of breathing plays a major role during the golf game. Practicing correct breathing by making good use of our diaphragm improves circulation and the cardiovascular system. It also lessens the fatigue and tiredness that affect the players in the game.
A slow and deep breathing is also our most powerful ally to deal with stress. If we do not breathe correctly, tension will settle in our body.

Breathing is essential to the practice of yoga and it is the key element to recognize and alleviate tensions. Yoga also focuses on the synchronization of breathing and movement with the intention of gaining body awareness and of 
optimizing the functioning of muscles and joints.

Balance
Another challenge for golfers is to achieve balance in the movements required by the swing. The nature of swing causes imbalance and asymmetry in the body. The muscles of one side tend to become stronger and more limber and flexible than the muscles of the other side; those that play a minor role in the movement end up debilitated. Balance is important because a swing which is symmetrical in force will also be more precise and powerful. 

Yoga includes a series of positions and techniques aimed at improving balance. Once more, proprioception plays a crucial role in this issue by helping us recognize where each body part is placed in relation to the others and to space. Yoga also treats the muscular imbalance produced by the asymmetrical nature of the swing. It focuses on both sides of the body and reinforces those muscles that hardly are used in the swing.

Concentration and mental game
An adequate physical preparation and a correct use of the technique are not enough to ensure the golfer’s success. This is because the mental challenge is as important as the physical one. Golf players are perfectly aware of how difficult it is to hit the ball under pressure. Relaxation and mental focus are not always related to practice and experience.

The most common mental traps include anxiety and nervousness, lack of concentration and the inability to become emotionally detached from the development of the game. When golfers show anger and disappointment, when they worry too much and become easily affected by their rivals’ game or even when are too proud of themselves, they fail to optimize their performance.

The players’ mental preparation is at least as important as their technical training Yoga embraces both the physical and mental aspects of the game. Its positions not only involve physical activity but also include mental and psychological training. All the asanas require attention to the body’s response and to the act of breathing. The practice of yoga helps golf players to become more and more aware of their own body and of its movements. They learn to be in the present, to leave aside projections and expectations, thus avoiding the stress and frustration that are so often associated to the game.