Physical Therapist’s Guide to Herniated Disk


What is a herniated disk?

A herniated disk is when one of the disks that are found between the vertebrae in your spine is damaged and the gel-like fluid in the disk begins to leak or causes the disk to bulge. Intervertebral disks are basically shock absorbers for your spine, and they are often explained as being similar to jelly donuts.

The outsides of intervertebral disks are made of several layers of fibrocartilage that create a rubbery texture that provides a strong but not rigid structure. The inside of these disks are filled with a gel that helps to provide cushioning and withstand compression.

What Causes disks to Herniate?

Disks can herniate abruptly, but they may also become slowly damaged over time. Hernias can be caused by direct, physical injury or trauma, but things like years of sitting or standing with poor posture may slowly stretch and tear a disk. The most common areas where disks herniate is in the lower back and in the neck.

As people age, they are more susceptible to this condition because the disks in your spine lose water content, which makes them more prone to tearing. Individuals who are between 30 and 50 are most likely to suffer from a disk that is herniated, and men are more likely than women to suffer disk damage.


Although there are people who have a disk that is herniated and feel no pain, it is very common to have a number of symptoms related to this condition. Individuals may find that they have pain in their extremities as well as their neck or back. It is also common for people to have numbness or tingling feelings or have weakness in their arms and legs.

Someone with a disk that is herniated may also find that some of their motions are limited. For instance, individuals may have trouble getting out of chairs or have trouble bending or rotating their body. In some cases, a person with this condition may have trouble staying in the same position for extended periods of time and may also experience pain or discomfort when sneezing, sitting down or reaching for something.


When determining if you have a disk that is herniated, a physical therapist will go over your medical history and conduct a physical exam. A therapist will normally also ask questions about where your pain is located, when you first started feeling pain and what limitations you are experiencing as a result of your pain. If it appears that there is severe damage, a physical therapist might suggest that you undergo diagnostic testing, such as getting X-rays or having a CT or MRI scan.
For most people, the best treatment for a herniated disk is physical therapy, and surgery is generally only required in extreme cases. Most individuals working with a physical therapist will find that treatment provides results in just a few weeks.

Physical therapists will work with you to determine the best exercises and activities to help you heal without causing additional pain or damage. Therapists will also help you figure out different ways to handle tasks that have become painful due to your condition.

Treatment regimes may also involve:
– Use of ice packs to reduce pain
– Help with improving posture
– Strengthening and pain reducing exercises
– Stretching exercises to reduce stiffness and improve flexibility


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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