A herniated disc, also known as a slipped or ruptured disc, occurs when the soft inner gelatinous nucleus pulposus of an intervertebral disc is pushed out through a tear in the tougher exterior annulus fibrosus. This can cause pain, numbness, tingling and weakness in the area supplied by affected nerves. Massage therapy is sometimes used as part of treatment for a herniated disc, but can it help?
What causes a herniated disc?
There are several potential causes of a herniated disc:
- Age-related degeneration – As we get older, the discs lose fluid and become less flexible and more prone to injury.
- Injury – A significant twisting movement or strain on the back can cause a disc to rupture.
- Repeated minor strains – Minor strains repeated over time can weaken the annulus fibrosus and lead to a rupture.
- Heavy lifting – Lifting heavy objects with incorrect technique can increase pressure on the discs.
- Genetics – Some people may inherit weaker connective tissue that makes discs more likely to deteriorate.
Herniated discs most often occur in the lumbar spine (lower back) and cervical spine (neck), as these areas bear the most weight and are subjected to frequent movement and strain.
Symptoms of a herniated disc
Symptoms of a herniated disc can include:
- Localised lower back or neck pain
- Pain, numbness or tingling radiating down the leg or arm (sciatica or cervical radiculopathy)
- Muscle weakness in the affected leg or arm
- Reduced range of motion
The specific symptoms experienced depend on the location of the herniated disc and which nerve roots are affected. Not all herniated discs cause noticeable symptoms.
How is a herniated disc diagnosed?
A herniated disc is often first suspected based on symptoms and medical history. To confirm the diagnosis, tests may include:
- Physical examination – Neurological testing of reflexes, muscle strength and sensory function
- Imaging – MRI or CT scans can visualize the disc herniation and nerve root compression
- Discogram – Dye is injected into the disc space to determine if the disc is the source of pain
These investigations help determine the location and severity of the herniated disc, and rule out any other potential causes of symptoms.
Conservative treatment options
Treatment for a herniated disc focuses first on conservative (non-surgical) options, which may include:
- Rest – Avoiding strenuous activities that aggravate symptoms.
- Ice/heat – Applying ice packs or heating pads can help reduce pain and inflammation.
- Medication – Over-the-counter pain relievers or prescription drugs to reduce inflammation and pain.
- Physiotherapy – Exercises and stretches to improve core strength and flexibility.
- Massage – Light massage techniques applied by a qualified therapist (see below).
- Epidural steroid injections – Steroid medication injected into the epidural space can reduce inflammation.
- Spinal decompression – Gentle traction on the spine to take pressure off the discs and nerves.
Most herniated discs heal through conservative treatment over 6-12 weeks. Surgery may be considered if symptoms persist and significantly impact daily functioning.
How can massage help a herniated disc?
Massage therapy is sometimes incorporated as part of a multi-faceted treatment plan for herniated discs. Potential benefits may include:
- Increased blood flow to promote healing
- Reduced muscle spasm and tension around the injury
- Improved mobility and range of motion
- Pain relief through release of endorphins
- Decreased nerve irritation
- Enhanced function for quicker return to activity
However, massage application must be cautious, within comfort levels, and avoid any aggressive or deep tissue techniques over the affected area. Some general massage recommendations include:
- Light pressure – Deep pressure on an acute injury may worsen inflammation.
- Avoid direct pressure over the disc – Focus on surrounding muscles and soft tissues.
- Stretching – Gentle motions to improve mobility and relieve nerve tension.
- Relaxation techniques – Calm the nervous system and reduce muscle guarding.
- Heat packs – Increase blood flow and relax muscles prior to massage.
- Sequential and rhythmic movements – Slow and methodical massage strokes.
Massage therapy should always be discussed with the treating doctor to determine safety and suitability.
When should massage be avoided?
While massage can provide some benefits, it may need to be avoided in certain situations including:
- Acute disc herniation causing severe symptoms – Wait until the most inflammatory stage has settled.
- Disc extrusion or sequestration – Free disc fragments require surgery, not massage.
- Spinal stenosis – Narrowing of the spinal canal indicates need for caution.
- Disc infection – Massage may spread infection further.
- Cauda equina syndrome – Emergency condition requires immediate surgery.
- Allergy/sensitivity to massage oils or lotions.
- Use of blood thinners – Increased risk of bruising.
Caution is also needed for broad generalizations on massage benefits, as research quality on herniated discs is limited. More rigorous studies are still required to define optimal massage techniques, duration and safety precautions for different stages of disc herniations.
Clinical evidence on massage for herniated discs
Some research studies investigating massage for herniated discs include:
- A 2011 study found 8 weeks of soft tissue massage improved flexibility and mobility in patients with lumbar disc herniation.
- A 2015 case study reported 10 sessions of massage therapy decreased pain and disability in a patient with a large L5-S1 disc herniation.
- A 2018 case series followed patients with lumbar disc herniations receiving 12 massage therapy sessions over 6 weeks. Improvements were noted in pain, range of motion and quality of life.
- A 2020 clinical trial compared massage plus traction vs traction alone in 60 patients with lumbar disc herniation. The massage group showed significantly greater improvements in pain and disability after 5 weeks.
However, systematic reviews note that overall evidence remains preliminary due to small sample sizes, lack of control groups, and variety of techniques used:
- A 2015 literature review concluded massage may provide short-term pain relief for acute lumbar disc herniations, but effects beyond 12 weeks are unknown.
- A 2020 review found massage has the potential to improve pain and function in various spinal conditions, but high quality studies are lacking.
More research is still needed to validate best practice massage protocols.
Precautions when using massage for a herniated disc
It is important to take precautions with massage for a herniated disc, including:
- Consulting the treating doctor – Only proceed if approved and no contraindications exist.
- Using a qualified massage therapist experienced in treating disc injuries.
- Avoiding massage directly over the disc bulge.
- Applying light pressure, within the client’s comfort zone.
- Adjusting body positioning to minimize pressure on affected discs.
- Providing adequate padding and support.
- Checking in frequently with the client regarding comfort level.
- Stopping immediately if symptoms significantly worsen.
With proper precautions, the risks of massage therapy for a herniated disc are low. However, clients should remain alert for any increase in symptoms and discuss any concerns promptly with their health professional.
Is self-massage helpful for a herniated disc?
Performing self-massage for a herniated disc is not generally recommended, for several reasons:
- It is difficult to access the affected spinal muscles and tissues effectively.
- Self-massage may inadvertently increase pressure on the injured disc.
- Overstretching and incorrect techniques can make symptoms worse.
- Not having a therapist guide treatment intensity and provide feedback.
Simple steps like applying heat packs, gentle stretches, and modifying activities may be helpful. However, it is best to avoid aggressive self-massage over the injured area. Consult a physical therapist or massage therapist to ensure techniques are appropriate.
How to complement massage therapy for a herniated disc
Massage works best when combined with other treatments for a herniated disc. Additional approaches may include:
- Rest and modification of activities – Avoid movements that aggravate symptoms.
- Ice and heat – Reduce inflammation and relax muscles.
- Medication – Use analgesic and anti-inflammatory drugs cautiously.
- Stretching and exercise – Stabilize the core and improve mobility under guidance.
- Physiotherapy – Specific strengthening and flexibility exercises.
- Education – Learning proper lifting, posture and movement techniques.
- Alternative therapies – Spinal manipulation, acupuncture, yoga.
- Healthy lifestyle – Nutritious diet, weight management, stress reduction.
A multifaceted program tailored to individual needs generally provides the best results. Massage can be a helpful addition, but should not replace conventional medical care.
When to see a doctor
It is important to consult a doctor for any new, persistent or worsening back or neck pain. Red flags indicating the need for prompt medical assessment include:
- Loss of bowel or bladder control
- Numbness in the groin or inner thigh
- Leg or arm weakness
- Fever or history of cancer
- Unexplained weight loss
- Pain at night or when lying down
Rarely, a herniated disc can press on the spinal cord or nerves in a way that requires emergency surgery. Cauda equina syndrome, with loss of function of the lower sacral nerves, is a medical emergency requiring immediate treatment.
For most patients, herniated discs can be managed conservatively. But it is still important to have your condition evaluated to determine the appropriate treatment options.
Conclusion
When applied cautiously, massage therapy may support reduced pain and healing for herniated disc injuries of the spine. Benefits are likely greatest when massage is incorporated as part of a comprehensive treatment plan including medical care, medication, physiotherapy exercises and education in proper movement patterns.
However, direct research evidence remains limited, and massage application requires an experienced therapist and avoidance of deep pressure techniques. Not all herniated discs are suitable for massage. It should only be considered for stable disc bulges without severe neurological symptoms or complications. As always, medical consultation is advised to determine whether massage is appropriate in individual cases.