Last year, each one of our Chiropractors wrote up 10 different Diagnosis Sheets for our patients. That has given us about 40 different different Diagnosis Sheets ranging in topics. Below is an informational blog from Dr. Larry Masarsky on Lumbar Disc Herniations. Many patients deal with this condition and have no real answers to their pain. Feel free to contact us if you have any further questions on the topic.
Lumbar Disc Disorders
The
lumbar spine is made up of five bone segments called vertebrae. In between each
vertebrae are flexible intervertebral lumbar discs, which act as a shock
absorbers for the spine. The inter-vertebral discs are composed of two
components, a tough outer ring of fibrous tissue called the annulus fibrosis
and a jelly-like center inside the annulus fibrosis called the nucleus
pulposus. The structure is then held together by ligaments on the front and the
back of the vertebrae. Additional support is provided by muscles of the trunk.
In
most cases, lumbar disc disease is the result of of a normal aging process
called disc degeneration which causes structural changes in the normal disc. As
we age, the disc begins to lose fluid and become dried out causing the disc to
compress. This may lead to the break down and degeneration of tough outer ring
of the disc (annulus fibrosis) allowing the inner core (nucleus pulposus), to
bulge out. This is considered a bulging
disc. This puts pressure on the outer ring of the disc, which may cause low
back pain. As further degeneration of the disc continues, or with continued
stress on the lumbar spine, the inner jelly-like core may actually rupture out
from the outer ring causing a ruptured,
or herniated, disk. Once the inner nucleus herniates through the outer
ring, pain in the lower back may actually improve. However, the fragmented disc
material can inflame or put pressure on the spinal nerves leading to an
increase in sciatic leg pain, weakness, numbness, or changes in sensation in
one or both legs. Most disc herniations occur at the lower lumbar spine at
L4-L5 and L5-S1 levels. Occasionally, severe trauma can cause a normal disc to
herniate or may cause an already herniated disk to worsen.
Risk Factors of Lumbar Disc
Disorders
● Age and Gender - highest
incidence in men between the ages of 30 and 50.
● Obesity - being overweight
puts added stress on lumbar discs.
● Sedentary lifestyle - lack of
exercise and poor core body strength.
● Smoking - smoking decreases
oxygen supply to the discs causing more rapid degeneration.
● Improper lifting - using your
back muscles instead of your legs to lift heavy objects. Twisting while lifting
● Posture - hyperlordotic
lumbar curvature, anterior pelvic tilt (lower cross syndrome).
● Repetitive activities that
strain your spine - jobs that require constant lifting, pulling, bending, or
twisting.
● Frequent driving - staying
seated for long periods and the vibration from the car can put pressure on your
discs.
History and Symptoms of
Lumbar Disc Disorders
Lumbar
disc disorders may include one or a combination of the following symptoms:
intermittent or constant lower back pain and/or pain in the buttock, leg and/or
foot pain, numbness or a tingling sensation in the leg and/or foot, weakness in
the leg and/or foot, decreased reflexes in the knee or ankle, and changes in
bowel or bladder function. The symptoms will vary depending on if and where the
disc has herniated, and what spinal nerve root is affected. Leg pain is usually
greater than low back pain with disc herniations and nerve root involvement.
However, if there are only annular tears without herniation, pain will
generally be localized to the low back and buttock. The onset of pain can be
sudden or gradual after an injury. Pain may follow heavy lifting, twisting, or
straining activities or repetitive stress trauma. However, patients may not
recall a prior injury or a precises time the condition began because it is
often preceded by frequent episodes of less severe low back pain that usually
resolved. Pain is usually characterized as a sharp, shooting, or electrical
pain that may be aggravated with movement, changing positions, sneezing,
coughing, or prolonged sitting and standing. The pain is usually relieved with
rest and a recumbent position.
Treatment of Lumbar Disc
Disorders
Conservative
care should be your first course of treatment to manage lumbar disc disorders
but treatment will depend on the clinical presentation, your age, overall
health, and tolerance to therapies. With disc herniations, the first few days
of care will focus on centralizing (reducing) leg pain, decreasing
inflammation, and preventing further neurological loss by decompressing nerve
root impingement and reducing the disc herniation. Osseous mobilization and
manipulation, and soft tissue therapy may be administered as tolerated. Home
care will consist of pain-relief repetitive positional exercises and/or lumbar
stabilization exercises. We will also educate you on ways to protect your lower
back, positions to avoid, and how to manage activity. In most cases, bed rest
will not be recommend as the sooner you are up and moving, the better the
prognosis. Once pain and inflammation has decreased, we will continue working
on lumbar stabilization and progress into proprioceptive training. We will
evaluate muscle imbalances using posture and movement patterns with the goal of
restoring good biomechanics and core body strength. Your home care will
emphasize the progression of stabilization protocols and corrective exercises.
If you fail to respond to conservative treatment, or in cases of severe
neurological loss, a referral for a surgical consultation will be recommended.
