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.
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
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)
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.
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.
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.
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.
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.
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.
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