Your spine is made of 24 moveable bones called vertebrae. The lumbar (lower back) section of the spine bears most of the weight of the body. There are 5 lumbar vertebrae numbered L1 to L5. The vertebrae are separated by cushiony discs, which act as shock absorbers preventing the vertebrae from rubbing together. The outer ring of the disc is called the annulus. It has fibrous bands that attach between the bodies of each vertebra. Each disc has a gel-filled center called the nucleus.
A herniated disc occurs when the gel-like center of a disc ruptures through a weak area in the tough outer wall, similar to the filling being squeezed out of a jelly doughnut. Back or leg pain, numbness or tingling may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be recommended.
A herniated disk is most often the result of natural, age-related wear and tear on the spine. This process is called disk degeneration.
In children and young adults, disks have high water content. As people age, the water content in the disks decreases and the disks become less flexible.
The disks begin to shrink and the spaces between the vertebrae get narrower. This normal aging process makes the disks more prone to herniation. A traumatic event, such as a fall, can also cause a herniated disk.
Certain factors may increase your risk of a herniated disk. These include:
Gender. Men between the ages of 20 and 50 are most likely to have a herniated disk.
Improper lifting. Using your back muscles instead of your legs to lift heavy objects can cause a herniated disk. Twisting while you lift can also make your back vulnerable. Lifting with your legs, not your back, may protect your spine.
Weight. Being overweight puts added stress on the disks in your lower back.
Repetitive activities that strain your spine. Many jobs are physically demanding. Some require constant lifting, pulling, bending, or twisting. Using safe lifting and movement techniques can help protect your back.
Frequent driving. Staying seated for long periods, plus the vibration from the car engine, can put pressure on your spine and disks.
Sedentary lifestyle. Regular exercise is important in preventing many medical conditions, including a herniated disk.
Smoking. It is believed that smoking lessens the oxygen supply to the disk and causes more rapid degeneration.
In most cases, low back pain is the first symptom of a herniated disk. This pain may last for a few days, then improve. Other symptoms may include:
- Sciatica. This is a sharp, often shooting pain that extends from the buttock down the back of one leg. It is caused by pressure on the spinal nerve.
- Numbness or a tingling sensation in the leg and/or foot
- Weakness in the leg and/or foot
- Loss of bladder or bowel control. This is extremely rare and may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.
Medical History and Physical Examination
After discussing your symptoms and medical history, your doctor at westminster ortho med clinic, DHCC, Dubai will perform a physical examination. The exam may include the following tests:
- Neurological examination. A neurological examination will help your doctor determine if you have any muscle weakness or loss of sensation. During the exam, he or she will:
- Check muscle strength in your lower leg by assessing how you walk on both your heels and toes. Muscle strength in other parts of your body may also be tested.
- Detect loss of sensation by checking whether you can feel a light touch on your leg and foot.
- Test your reflexes at the knee and ankle. These may sometimes be absent if there is a compressed nerve root in your spine.
- Straight leg raise (SLR) test. This test is a very accurate predictor of a disk herniation in patients under the age of 35. During the test, you lie on your back and your doctor carefully lifts your affected leg. Your knee stays straight. If you feel pain down your leg and below the knee, it is a strong indication that you have a herniated disk.
Magnetic resonance imaging (MRI) scan. These studies provide clear images of the body’s soft tissues, including intervertebral disks. Your doctor may order an MRI scan to help confirm the diagnosis and to learn more about which spinal nerves are affected. If you are unable to tolerate an MRI, a computerized tomography (CT) scan, or a CT myelogram may be ordered instead.
For the majority of patients, a herniated lumbar disk will slowly improve over a period of several days to weeks. Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery.
Initial treatment for a herniated disk is usually nonsurgical in nature. Treatment focuses on providing pain relief.
Nonsurgical treatment may include:
Rest. One to 2 days of bed rest will usually help relieve back and leg pain. Do not stay off your feet for longer, however. When you resume activity, try to do the following:
- Take rest breaks throughout the day, but avoid sitting for long periods.
- Make all your physical activity slow and controlled, especially bending forward and lifting.
- Change your daily activities to avoid movements that can cause further pain.
Nonsteroidal anti-inflammatory medications (NSAIDs). Medications such as ibuprofen or naproxen can help relieve pain. (Speak to your doctor before taking any medications).
Physical therapy. The goal of physical therapy is to help you return to full activity as soon as possible and prevent re-injury. Physical therapists, Hadel Radwan, OR Anil Daniel at our clinic in Dubai can instruct you on proper posture, lifting, and walking techniques, and they’ll work with you to strengthen your lower back, leg, and stomach muscles. They’ll also encourage you to stretch and increase the flexibility of your spine and legs. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long fitness.
Epidural steroid injection. An injection of a cortisone-like drug into the space around the nerve may provide short-term pain relief by reducing inflammation.
There is good evidence that epidural injections can successfully relieve pain in many patients who have not been helped by 6 weeks or more of other nonsurgical care.
Only a small percentage of patients with lumbar disk herniation require surgery. Spine surgery is typically recommended only after a period of nonsurgical treatment has not relieved painful symptoms, or for patients who are experiencing the following symptoms:
- Muscle weakness
- Difficulty walking
- Loss of bladder or bowel control
Microdiskectomy. The most common procedure used to treat a single herniated disk is microdiskectomy. The procedure is done through a small incision at the level of the disk herniation and often involves the use of a microscope.
The herniated part of the disk is removed along with any additional fragments that are putting pressure on the spinal nerve.
A larger procedure may be required if there are disk herniations at more than one level.
Rehabilitation. Your doctor, Dr. Ishrat Khan, or a physical therapist, Hadel Radwan OR Anil Daniel may recommend a simple walking program (such as 30 minutes each day), along with specific exercises to help restore strength and flexibility to your back and legs.
To reduce the risk of repeat herniation, you may be prohibited from bending, lifting, and twisting for the first few weeks after surgery.
Recovery & prevention
Back pain affects 8 of 10 people at some time in their lives, and usually resolves within 6 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If your regular job cannot be done initially, it is in the patient’s best interest to return to some kind of modified (light or restricted) duty. Your physician can give prescriptions for such activity for limited periods of time.
The key to avoiding recurrence is prevention:
- Proper lifting techniques (see Self Care for Neck & Back Pain)
- Good posture during sitting, standing, moving, and sleeping
- Appropriate exercise program to strengthen weak abdominal muscles and prevent re-injury
- An ergonomic work area
- Healthy weight and lean body mass
- A positive attitude and stress management
- No smoking
- https://orthoinfo.aaos.org/ – Orthoinfo
- mayoclinic.org https://www.mayoclinic.org/
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