Herniated Lumbar Discs
- August 18, 2016
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Dr Lucia Corriette Physiotherapist
Background
The human spine is made up of 24 bones or vertebrae, positioned on top of one another. These vertebrae form a canal that protects the spinal cord. In the lower back there are five vertebral bodies. This area is called the lumbar spine.
Nerves run from the spinal cord to muscles and other structures in the body, carrying messages to and from the brain. Between the vertebral bodies are the discs which are flat and round. These discs serve as shock absorbers during walking, running and other actions.
A herniated disc, also known as a prolapsed or slipped disc, can occur at any point along the spine. However, it is most common in the lumbar spine or lower back. It is one of the most common causes of low back pain.
A herniation occurs when there is a tear in the outer fibres of the disc. This tear allows the gel-like substance in the middle of the disc (nucleus pulposus) to ooze towards the outer fibres (annulus fibrosus), creating a bulge in the disc. This bulge may cause low back pain. If the gel-like substance oozes out of the disc, it can compress spinal nerves and this may lead to pain, numbness, or weakness in one or both legs.
Causes
Disc herniations may be due to a number of factors including:
- Gradual wear and tear that comes with aging
- Gender – men are most likely to have a herniated disc
- Improper lifting
- Being overweight – causes increased pressure on the discs
- Repetitive activities that place added stress on the low back
- Driving – the vibration of the engine and staying seated for long periods increase stress on the discs
- Sedentary lifestyle
- Smoking – causes the disc to degenerate faster
Symptoms
These may include:
- 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)
Medical Management
Those who experience one or more of these symptoms should visit a physician. The doctor will perform an examination and may suggest further tests such as x-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI). On confirmation of a diagnosis of a herniated disc, the doctor may suggest conservative or nonsurgical treatment. This treatment includes rest, anti-inflammatory medications, physiotherapy and epidural steroid injections. Most people recover well with conservative treatment.
Physiotherapy Management
Disc herniations can be treated with the use of electrical modalities for pain relief along with specific exercises (e.g. McKenzie exercises), traction and manual therapy techniques.
Ultrasound
McKenzie extension exercises
Advice on proper posture and good lifting techniques is also useful.
Kinesiotaping can also be used to help control low back pain.
Surgical treatment
Surgery is needed in a small percentage of cases. One possible procedure is called a lumbar microdiscectomy in which the herniated part of the disk and any fragments that are putting pressure on the spinal nerve are removed.
Microdiscectomy
Another option is laminectomy. In this surgical procedure part or all of the lamina is removed. The lamina is the thin part of the vertebra that helps to protect the back of the spinal cord.
Laminectomy
Lumbar disc herniations are a fairly common condition and are often seen in the physiotherapy clinic. In most cases, the condition resolves well with physiotherapy treatment. Awareness and use of proper posture and good lifting techniques, along with a maintenance program of exercises help to ensure effective control of this condition following physiotherapy.
References
- Back pain help today: Secrets of a pain free back
http://www.backpainhelptoday.com/herniated-disc/ Accessed August 10, 2016
- Proper lifting
http://www.gopixpic.com/510/proper-lifting/http:%7C%7Cwww*spinenevada*com%7Cassets%7Cimages%7Clifting_properly*jpg/ Accessed August 10, 2016
- How to lift a heavy object
http://zestzfulness.blogspot.com/2011/01/how-to-lift-heavy-object.html Accessed August 10, 2016
http://spinalfusionsurgerytoday.blogspot.com/2013_03_01_archive.html Accessed August 10, 2016
- American Academy of Orthopedic Surgeons. Herniated disk in the lower back.
http://orthoinfo.aaos.org/topic.cfm?topic=A00534 Accessed August 10, 2016
- Cedars-Sinai. Herniated or ruptured disc. https://www.cedars-sinai.edu/Patients/Health-Conditions/Herniated-or-Ruptured-Disc.aspx Accessed August 10, 2016
- American Academy of Orthopedic Surgeons. Herniated disc. http://orthoinfo.aaos.org/topic.cfm?topic=A00334
- Humphreys, S.C, & Eck, J.C. Clinical Evaluation and Treatment Options for Herniated Lumbar Disc. Am Fam Physician.1999 Feb 1;59(3):575-582.
- Physiopedia. Lumbar Traction. http://www.physio-pedia.com/Lumbar_Traction Accessed August 10, 2016
- WebMD. Lumbar Herniated Disc – Surgery. http://www.webmd.com/back-pain/tc/herniated-disc-surgery Accessed August 10, 2016
- My Experience with Lumbar Spinal Surgery – Microdiscectomy.
http://cadebe.info/2011/09/27/my-experience-with-lumbar-spinal-surgery-microdiscectomy/ Accessed August 13, 2016
12. Herniated Disk. http://www.novaorthospine.com/herniateddisk.html Accessed August 13, 2016
Massage Practitioners are frequently concerned about whether or not it is appropriate to work on clients with herniated discs. Unfortunately, there is a great deal of misinformation about this condition.
Disc herniations are sometimes blamed for back pain when they are not actually the cause. It is important to understand the anatomy and symptoms of disc herniation to make proper clinical decisions. Massage can be an effective adjunct treatment for clients with this condition.
TREATMENT
A key question for massage therapists is whether or not it is appropriate to work on somebody with a herniated disc. Massage therapy can be a valuable means of helping to reduce the aggravating factors that perpetuate lumbar disc herniation and the subsequent pain and dysfunction that result. As with other potentially serious medical conditions, it is a good idea to obtain a doctor’s clearance before treating the client.
Many of the muscles in the lumbar region, and especially those attaching directly to the lumbar vertebra, increase compressive loads on the intervertebral disc when they are tight. Consequently, reducing tightness in the lumbar muscles helps decrease compressive stress on the intervertebral disc, thus relieving symptoms. Massage will not reverse the process of disc herniation that has already occurred, but it can help reduce compressive forces that can further deform the disc.
A common concern expressed by massage therapists is whether or not working in the lumbar region will press the protruding disc against the adjacent nerve roots. the transverse processes of lumbar vertebra and the nerve roots. The transverse processes prevent direct pressure on the nerve root. While the specific massage techniques will not directly compress the disc against the nerve roots, it is possible to aggravate pain from a disc herniation with massage in the lumbar region indirectly by moving the vertebral bodies.
Because the disc does not always protrude in the same direction in relation to the nerve root there is no way to know for sure which motions or positions will aggravate nerve root compression. A good general rule of thumb is that IF ANY MOTION OR POSITION or technique further aggravates the client’s symptoms, it should be immediately stopped. However, relieving muscular tension in the lumbar region is an important step to reducing disc compression
Great article.