Herniated Lumbar Disc
What is a herniated lumbar disc?
The spine is made up of a number of individual bones called vertebrae. These are stacked to form the spinal column. Between every joint in the spine is a cushion called an intervertebral disc, and together, these act as shock absorbers. Each of these discs has a gel-like centre, which is called the nucleus pulposus, that is surrounded fibrous outer layer called the annulus.
A herniated disc is also referred to as a ruptured or slipped disc and occurs when pressure from above and below vertebrae force some of the nucleus pulposus through a torn part of the annulus. Pain results when the herniated nucleus pulposus presses on the nerve near the disc.
The lower part of the spine (lumbar spine) is where a herniated lumbar disc is most likely to occur, however they can also occur in the thoracic and cervical spine. Pain in the back and leg are the most likely to be the result of a lumbar lumbar herniated disc.
What are the symptoms of a herniated lumbar disc?
In most cases, there are no symptoms associated to a herniated disc. Although, symptoms of a herniated disc in the low back can include:
- Low back pain
- Muscle weakness
- Feet or legs experiencing tingling or numbness
- Pain in the buttocks, feet and legs
What causes a herniated lumbar disc?
A herniated lumbar disc is caused when the outer layer of the disc becomes weak, resulting in tearing. There are a number of risk factors that can contribute to this, including age, excessive weight, and strains caused from lifting something heavy or improper twisting.
How common are herniated lumbar discs?
Herniated discs are very common, especially in men, rather than women. People aged 35-55 years are most likely to experience a lumbar herniated disc.
How is a lumbar herniated disc diagnosed?
Diagnosis includes an evaluation of your medical history, symptoms and physical examination by an experienced chiropractor or physiotherapist. They may also perform a neurological exam that tests your muscle strength, sensation and reflexes. Other forms of diagnostic tests may also be performed to determine the severity of the herniated disc, these could include:
- Electromyelogram (EMG): An EMG involves a small needle being placed into numerous muscles to measure the electrical activity. This form of test is beneficial in identifying which nerves are being impacted by the herniated disc.
- X-rays: X-rays develop detailed images of the body to determine causes of neck and back pain.
- Myelogram: This test involves a dye being injected into the spinal canal to help determine the location and size of the herniated disc.
- Magnetic Resonance Imaging (MRI) scan and Computer Tomography (CT): An MRI and CT scan uses a magnet and computer to develop images of the inside of the body to show the narrowing of the spinal canal caused by the herniated disc.
How is a lumbar herniated disc treated?
In some cases, a herniated disc can heal on its own, though when treatment is required it involves anti-inflammatory medication, chiropractic and physical therapy. Ice or heat packs can be applied to the affected area to alleviate pain and muscle spasms in the back. If there is not improvement through these methods of conservative treatment, then surgery or spinal injections may be required.
The details of these treatment methods are listed below.
- Chiropractic: Chiropractic is recommended for any low back pain as a first port of call. Chiropractors are trained in the diagnosis and treatment of low back pain and offer a vast resource to improve low back pain from a lumbar disc herniation. The chiropractors at Sydney Spine & Sports Centre (S3C) have extensive experience in treating low back pain as a result of lumbar disc herniation. Our chiropractors use safe treatments that are based on the very latest research and evidence.
- Physiotherapy: Physiotherapy is recommended to improve and increase flexibility, core strength and endurance so that you can continue daily activities. Your physiotherapist at Sydney Spine & Sports Centre (S3C) will prescribe exercises that aim to relief pressure on your nerves and reduce pain and weakness. The exercise programs will often include stretching and aerobic exercises (for example, using a stationary bike). These exercises, which can be done at home, aim to see an improvement in your flexibility, circulation and endurance. Additional exercises may be prescribed to strengthen the muscles of your legs, abdomen and back.
- Medicine: Anti-inflammatory medication may be taken or recommended to help alleviate pain, stiffness and inflammation to allow for increased exercise and mobility. Muscle relaxants may also be prescribed to give relief to discomfort occurring because of severe muscle spasms and pain during the first stages of treatment.
- Spinal injections: This involves an injection, referred to as nerve blocks or epidurals, going into the lower back, that contain a cortisone-like medication. The goal of this injection is to alleviate inflammation and swelling of the nerve roots to make way for increased mobility.
- Surgery: While surgery is rare it may be required if a patient is showing little to no response from conservative treatments. If it is observed that symptoms have gotten worse then surgery may be considered. In rare cases, a large herniated lumbar disc might injure nerves to the bladder or bowel and this will result in the intervention of immediate surgery. Common surgeries include; foraminotomy , microdiscectomy (the process of using an operating microscope to perform a procedure to remove fragments of a herniated disc) or laminectomy (a procedure that is performed under general anesthesia to remove pressure on the nerve or spinal cord caused by tissue and lamina, which is the bone that covers and curves around the spinal cord. The recovery period of this procedure takes up to six weeks)
What complications are associated with a lumbar herniated disc?
If a herniated disc goes untreated, complications can include chronic and consistent leg and back pain, and loss or control or sensation of the feet and legs. Chronic lumbar disc herniation can become a medical emergency in order to preserve pelvis and leg function.
What is the outlook for people with lumbar herniated discs?
By taking cautious measures and adhering to recommended treatment, recovery and reduced pain can be evident within six weeks. In some cases, patients can recovery and also return to their normal daily activities within six weeks. However, some people will continue to experience back pain even after their treatment. In most cases people should expect a full recovery when given the correct chiropractic and physiotherapy treatments combined with self-management strategies.
Can anything be done to prevent a lumbar herniated disc?
While it is not always possible to prevent a herniated disc, there are numerous things that can be done to reduce the chance of a herniated disc. Our chiropractors and physiotherapists at Sydney Spine & Sports Centre (S3C) would suggests these:
- Quitting smoking
- Not wearing high heel shoes
- Regularly stretching while sitting for prolonged periods of time
- Consciously practicing good posture while sitting, standing, walking and sleeping. To help this, when standing up with your shoulders back, pull your abdomen in and keep the small of your back flat. When sitting, sit with your feet flat or elevated. When sleeping, sleep on a firm mattress to your side and not on your stomach
- Consciously practice proper lifting techniques. For example, when lifting do not bend at the waist, instead bend at your knees while and keep your back straight while using your leg muscles to help you support the weight
- Regularly exercise with a focus of keeping the muscles of your back, stomach and legs strong. When exercising, try to balance flexibility and strengthening
- Maintaining a healthy and well-balanced diet as excessive weight can put pressure on your back