At some point in our lives, a good number of us will experience a herniated disc. When it comes to resolving a bulging disc, we can thankfully rely on the natural healing abilities of our body to do this, with most herniated discs healing themselves within a few months. The thing is, that’s a decently long time and it’s something we don’t want to rush for obvious reasons.
But what treatment options are available to you to support the process of healing? In my completely biased opinion, Thai Massage has a pretty great potential to help the body do its thing.
Before we start to talk about how it can help we should first understand a little bit about what a herniated disc is.Each vertebra of the spine is separated by intervertebral discs (hopefully…). These discs are comprised of essentially two main parts: the nucleus pulposus and the annulus fibrosus. The inner regions of the disc (nucleus pulposus) are more fluid/gel-like and the outer layer (annulus fibrosis) is more fibrous, and this combination supplies the best mix of stability/support and mobility, and in fact the discs are what allow our spines to move.
Herniated discs occur for a number of reasons, but results from the annulus fibrosus tearing (to differing degrees), allowing the nucleus pulposus to protrude from its original position into the interstitial space / spinal canal. This commonly presses on nerves and produces a rather noticeable sensation of pain. As well, many studies have found that a considerable portion of the pain felt with a herniated disc also comes from chemical irritation due to the inflammatory mediators (that are really trying to help you heal).
Before we can approach working with a client who has a herniated disc, the first thing we need to know is in which direction the herniation is occurring – is it posterior, anterior or laterally? This will have a very significant effect on how we work through a session, so it’s very important to know. If you or your patient doesn’t know then it’s best to seek this information from their physician. The majority of lumbar herniations occur posterolaterally as that is the generally the thinnest region of the annulus fibrosus, and it isn’t reinforced by the anterior or posterior longitudinal ligaments. And yet, even with this information we cannot make any assumptions. Mostly you will see that if extension of the spine is painful, then the herniation is anterior and vice versa, but nor is this always the case so it’s best to get the results of CT scan (which is commonly used as a diagnostic tool).
Once you know the direction of the herniation, you’ll know which movements to avoid. For example, if the herniation is posteriorly, you’ll want to avoid any postures that utilize flexion of the spine. This is because you’ll be compressing the anterior region of the disc, which pushes the central fluid/gel posteriorly – and that places more pressure on the annulus fibrosus tear and protruding nucleus pulposus. On the other hand (again if the herniation is posteriorly located), gentle extension movements should produce the opposite effect, resulting in the redirection of the fluid/gel anteriorly and alleviating the pressure on the herniation. You’ll generally be looking for sensations of relief in your patient.
Also, gentle twists through the region of their spine that is experiencing discomfort can also feel really great and distribute pressure differently through the intervertebral space. There is some moderate-strength research to suggest that such gentle mobilisations are indeed therapeutically advantageous.
On top of this, and perhaps a little controversially, decompression techniques are generally going to be powerful in relieving sensations of pain caused by the pressure of the herniation on the surrounding vasculature. I say ‘controversially’ because the evidence to support the therapeutic use of non-surgical decompression techniques is relatively weak at this point. Even still, in the context of simply facilitating immediate sensations of relief, they can be useful based on my own past experience. Extended holds in a decompressed position have a greater potential to create some lasting reduction of discomfort.
The movement and massage work done around the area should always be within pain-free tolerances (injury or no injury), and in doing so you’ll also be encouraging greater movement of synovial fluid and blood in and around that region. The more fluid and blood moving through a region, the greater potential the body has to heal itself.
This my friends, is the soap-notes version of things to consider when approaching a Thai Massage treatment with someone who has a herniated disc.