Monday, February 17, 2020

Intervertebral Disc Herniations and Bulges—And Yoga

Vertebrae and Vertebral Discs 

by Andrew McGonigle

This is the first in a series of posts that I'm delighted to be writing for the Accessible Yoga Blog, which will be about some of the most common injuries and medical conditions that students show up to yoga classes with. This is a topic that I am really passionate about, and a book that I have written about this subject, called Common Injuries and Conditions: A Practical Guide for Yoga Teachers, will be published early next year. In each post I will provide some up-to-date information about the injury or condition and then relate this to practicing and teaching yoga. The details I will include here are by no means exhaustive and are simply intended to be a guide. The suggestions are not a replacement for the personal advice of a healthcare professional. 

Before I begin, here’s a little about me. After originally training to become a medical doctor, I moved away from western medicine to pursue a career as a yoga teacher, massage therapist, and anatomy teacher. I have been practicing yoga and meditation since 2005, and have been teaching strong, grounding, and inclusive classes since 2009. I combine all of my skills to teach anatomy and physiology in Yoga Teacher Training courses and as part of my own trainings. For more information about me please visit:

About Intervertebral Discs 

Intervertebral discs are really remarkable structures that are found between the vertebrae of our spine (see illustration above). They have the multiple roles, including providing the primary support for the vertebral column, permitting all the required movements of the spine, and absorbing shock. 

The discs accounts for around 25% of the overall height of the spine. We are tallest first thing in the morning when the discs are their most plump, and we slowly become shorter during the day as the discs subtly flatten under our body weight. So always measure your height first thing in the morning! 

These discs have a central, gelatinous structure that is surrounded by a tough but elastic region. The discs are interwoven with their neighboring vertebrae and are supported by many spinal ligaments.

Intervertebral Disc Herniations and Bulges 

As a result of the natural aging process, the elastic material in the discs begins to be replaced by more fibrous tissue. An older disc is therefore less elastic, and its ability to respond to all the demands put on it decreases. The intervertebral disc also has no direct blood supply by the third decade of life and absorbs its nutrition from neighboring areas. 

An intervertebral disc herniation or bulge occurs when part of the disc pushes outward beyond its normal boundaries. The term ‘herniated’ disc is used when the distance of the displacement is less than 25% of the total disc circumference while the term “bulging” disc is used when the distance of the displacement is greater than 25% of the total disc circumference. The vast majority of bulges or herniations occur in the backward direction and slightly to the side. 

By the way, the discs cannot “slip” out of place. This term makes me think of a game of Jenga! Also, a “ruptured disc” is also not an accepted medical term and suggests trauma when none might have occurred. 

What Does the Research Tell Us? 

One study, Herniated lumbar disc in BMJ clinical evidence, suggests that only 1% to 3% of people seen with lower back pain in primary care have a herniated intervertebral disc. 

Disc bulges and herniations are highly prevalent in pain-free populations and their presence is not strongly predictive of future lower back pain. One landmark study Evaluation and Treatment ofAcute Low Back Pain in Am Fam Physician 75 showed that in a group of 20-year-olds who were not experiencing back pain, 30% had bulging intervertebral discs. 

A second review Diagnostic Evalution ofLBP. Reaching a Specific Diagnosis Is Often Impossible in Archives of Internal Medicine 162 reported that in a group of 50-year-olds who were not experiencing back pain, 60% had bulging discs. Furthermore, when a person who has a herniated disc also has back pain, there is often a poor correlation between the extent of the herniation and the levels of pain and disability experienced. A systematic review of the literature found that 50% of patients had spontaneous resolution of herniated discs after conservative treatment. This review also reported that the more severe the herniation the greater the chance of spontaneous resolution! 

In a Nutshell: Disc herniations and bulges are part of the natural aging process, are not always associated with back pain, and can often heal without surgical intervention. 

Advice for Yoga Students 

If you have a disc herniation or bulge, always get the go-ahead from your healthcare practitioner before practicing yoga. But when you get the go ahead, don’t be afraid to move your spine! Movement is medicine and motion is potion. So move your spine through its full, pain-free range as often as possible. Some suggested asanas include Seated Cat-Cow, gentle side bends, and controlled twists. 

Remember that our bodies have the most incredible ability to heal and that no experience is permanent. Try to be patient as you continue to practice yoga. Restorative yoga asanas are a great option for when a lot of movement doesn’t feel like the right choice. 

No teacher or therapist, no matter how experienced, can you tell you which movements will work for you and which movements won’t. You must be guided by your own experience in each moment. If you feel pain during a movement, then you can decrease the intensity of the movement or rest. If you’re not feeling pain, then keep doing what you’re doing! 

Advice for Yoga Teachers 

If your student has a disc herniation or bulge, start by checking with them that they have been given the go-ahead to do yoga by their healthcare professional. If they confirm that they have, encourage them to move their spine within its pain-free range of motion. But keep offering them the option to decrease the intensity or to rest at any time. I often share that my definition of an “advanced” yoga practitioner is one who takes rest when they need it. 

And always keep in mind that that each student’s experience of an injury or condition is completely unique to them, so an individualized approach is absolutely key. This means teaching the student, not the injury or condition.

As a teacher, it is essential to avoid the trap of telling students what their experience is going to be, for example, “avoid spinal flexion because it will feel painful.” No amount of experience gives any teacher the ability to predict the future. A more appropriate way of phrasing this could be to say, “I suggest paying close attention to how your back feels during the different positions and movements that we explore, always backing off if you feel strong discomfort.”

Andrew McGonigle originally trained to become a medical doctor, but moved away from western medicine to pursue a career as a yoga teacher, massage therapist, and anatomy teacher. He has been practicing yoga and meditation since 2005, and has been teaching strong, grounding, and inclusive classes since 2009. He combines all of his skills to teach anatomy and physiology in Yoga Teacher Training courses and as part of his own trainings. Andrew is indebted to his teachers, who include Hamish Henry, Paul Dallaghan, Eileen Gauthier, Kristin Campbell, Anna Ashby, Richard Rosen, Sally Kempton and Jivana Heyman. For more information about Andrew please visit:, Instagram @doctoryogi1, and Facebook @doctoryogiandrew. 

This post was edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog and co-author of Yoga for Healthy Aging: A Guide to Lifelong Well-Being.

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1 comment:

  1. As a yoga teacher and yoga therapist, I think this is such a great post! Very clear and well written. My favorite rule in working with others is the 60% rule - where ever you are in a pose, back of to 60%. Forcing and pushing seem to cause the real problems.