Lumbar Disc Herniation

Written By Preya Ramdass

What is an Intervertebral Disc (IVD/Disc)?

Apart from the first two vertebrae, the disc is present between each vertebra. These discs are round, like small pillows, with a tough, outer layer (annulus) that surrounds the nucleus and contains a vertebral end plate. Located between each of the vertebrae in the spinal column, discs act as shock absorbers for the spinal bones. Main functions of the IVDs:

  • To allow vertebral movements (Spinal movements)

  • To act like a shock-absorbing cushion

  • To hold the vertebrae together by working as a ligamentMeniscus Lesion/injury:

What is lumbar disc herniation?

There are various terms used related to disc herniation like, disc protrusion, slipped disc, bulging disc, and ruptured or prolapsed disc. These all terms signify the displacement of disc material beyond the intervertebral disc space. 

The lumbar spine is most prone to disc herniation followed by the cervical spine due to their biomechanical forces. In the lumbar spine, L4/L5 and L5/S1 levels are most common as in 95% for getting disc herniation.

 

Some Common Causes and Risk Factors of Herniated Disc:

  • Disc degeneration with age and wear and tear

  • Spinal over-loading (From prolonged sitting, flexion/extension, side bending, torsional and compressional loading)

  • Spinal trauma (From MVA, Fall)

  • Age: 30-50 years

  • Male: Female ratio – 2:1

  • Smoking

  • Weight-bearing sports

  • Occupation (Like prolonged vibration from driving/operating machines)

  • Exposure to repetitive loads

 

Signs & Symptoms:

Lumbar Disc Herniation is not always symptomatic, Research says that herniated discs can be found in 20-30% of people who are asymptomatic. Though disc herniation is the major contributor to 60-80% of incidences of low back pain in the general population. Here are a few signs and symptoms when pain is a complaint with a herniated disc:

Low back pain

  • Intermittent, localized pain that increases under strain and axial loading

  • Pain worsens with prolonged sitting, coughing, and sneezing

Radicular Pain/ Pain radiating away from the low back

  • Irritation of a spinal nerve causing radiation of pain along its pathway

  • Not related to sensory or motor loss

  • Lumbar disc herniation is among the most common cause of nerve root irritation.

 

Neurological deficits:

  • Happens with progressive nerve root compression.

  • Impaired reflexes

  • Motor weakness

  • Sensory disturbances

 

Most common levels of disc herniations are L4/L5 and L5/S1, signs & symptoms listed below are specific to herniation levels:

  • Pain radiating into the buttock, outside of thigh, calf, and foot

  • Weak Quadriceps

  • Difficulty in knee extension

  • Tingling, Numbness in the lateral thigh to inner leg and great toe

  • Hip flexion and adduction weakness, knee extension weakness; decreased patellar reflex.

  • Ankle drop

  • Abnormal gait pattern/ pain with walking

  • Difficulty in extending great toe

  • Tingling, numbness in the Lateral leg and toes

How Can Physiotherapy with Lumbar Disc Hernation?

The current recommendation of treatment is conservative management before considering surgery.

           Our Physiotherapists can help with conservative treatment protocol based on individual assessment which usually includes the following protocols:

  • Patient Education which includes returning to activities safely

  • Aerobic activities

  • Flexibility and strength exercise program

  • Motor Control Exercises (MCEs)

  • Spinal manipulations & mobilizations

  • Spinal traction

Our Physiotherapist has advanced training in manual and manipulative physiotherapy and is able to provide you with a treatment plan that is specific to your findings and helps you get back to your everyday life as quickly as possible.

REFERENCES:

https://www.physio-pedia.com/Disc_Herniation

Advanced Integrated Musculoskeletal Physiotherapy program. Theory resource.

Integrative Physiotherapy is a Barrie-based clinic that believes in a one-on-one patient-centered, manual therapy (hands-on) approach to physiotherapy. We aim to empower our patients by providing quality care that is personalized to each patient in an interactive and friendly manner. Through the use of the best available treatment techniques, we aim to provide exceptional care so that each patient feels engaged and motivated.

Our therapists are continually upgrading their skills and taking time to provide comprehensive assessment and treatment techniques that are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  

Our therapists would be happy to help you to achieve your goals, get in touch to schedule your appointment.  Don’t let pain ruin your day!

 

Integrative Physiotherapy, Empowering Patients with Personalized Care.

Preya Ramdass
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