Lumbar Herniated Disc

Between each vertebrae of the spine contains a disc that separates each vertebrae. (with the exception of the first 2 levels of the cervical spine) Each disc acts like a jelly donut. When you bend forward the “jelly” will push posteriorly and when you bend backwards the “jelly” will push anteriorly. These “jelly donuts” act as a cushion and help allow for movement in the spine.

If the disc becomes inflamed, damage, or begins to degenerate you may experience a variety of symptoms. These symptoms are: back to the center of the back, loss of motion with bending/turning, pain, numbness or tingling into the leg, weakness and muscle spasm. The levels most susceptible to injury in the lumbar spine are L4-L5 and L5-S1.

What exactly is a disc herniation?
A disc herniation happens when the walls of the disc became torn and the “jelly” can push out and place pressure on nearby structures. When this happens the “jelly” is usually pushing out in a posterior and lateral direction. This direction is where the spinal nerves also exit out into the body. The further the “jelly” of the disc pushes out the more severe the symptoms can be.

What causes a disc herniation?
Wear and tear of the spine
Prolonged sitting or bending (this causes the spine to flex pushing the contents of the disc posteriorly”
Sudden fall or trauma
Repetitive bending and twisting motions (as in construction or any job that allows for constant lifting)
Smokers are also more susceptible to disc degeneration

What are the symptoms of a disc herniation?
Pain in the back (right or left side, or across entire back)
Pain into the right or left buttocks
Pain into the right or left leg
Feeling of numbness, tingling or burning into the back, buttock, or leg
Muscle spasm
Changes in posture (severe herniation’s can cause a visible shift)
Loss of motion (usually loss of ability to bend forward)
Reduction in reflexes

How to treat a disc herniation?
Treatment will vary depending on if the issue is acute or chronic and if the herniation is mild or severe. Treatment options range from: rest, medication, ice, lumbar brace, or exercise regimen designed by a physical therapist. Some MDs recommend spinal injections. The worst option is surgery if all other conservative options fail. Of course an x-ray, MRI, or CT scan may be performed. You may also undergo an EMG to check for any nerve involvement.

When to consider surgery?
Surgery is usually considered if the disc is not responding to conservative care. Signs of a worsening or non-responsive disc are: increase in radicular pain, development of further weakness into the leg, loss of control in bowel and bladder, or an increase in numbness.

How can Physical Therapy help?
During your first visit you can expect your therapist to put you through a series of motions to try to determine the cause of the pain. There will also be an assessment of strength to check for any muscular imbalances. You will also have an assessment of flexibility because shortened muscles can lead to imbalances putting you at more of a risk of susceptibility to disc problems or low back pain in general. Your physical therapist will also assess your posture and get an idea of your day-to-day activity to try to determine if any repetitive stresses may have led to your problem. After the initial assessment your therapist will come with a treatment plan including manual therapy and therapeutic exercise to address and impairments and functional limitations found during the initial exam. Physical therapy treatment can range from 4-12 weeks followed by a home exercise program. It is very important to follow-up and maintain your home exercise program after discharge from physical therapy.

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