John came into the clinic on crutches. He was unable to put any pressure on his left leg and clambered into the examination room with the help of a friend.
He was complaining of a sore, stiff low back and a sharp shooting pain down into his leg.
He also reported a sensation of pins and needles into his foot and was unable to get away from the extreme discomfort.
After much difficulty, he managed to get on the treatment table.
As I went through my orthopedic exam procedure I had little doubt in my mind of the diagnosis.
To be sure we needed an MRI.
Later the next day, John returned with his scan and there it was starring us in the face—the inescapable reality of a herniated lumbar disc.
This diagnosis is a reality all too familiar in my clinic.
I´m sure everyone has heard the words ¨herniated disc¨ perhaps from their doctor or a friend. But what exactly is a herniated disc? What causes it to form and why? And what is the most common age for someone to suffer from this problem?
… there are perhaps two very important questions:
How can I treat it? How do I treat it? And better still, what are some of the risk factors behind the condition?
These are some of the most common questions patients have every day in my clinic, and some of the answers may not be quite what you expect.
A herniated disc is one of the most common causes of lower back pain and refers to when there is a complication with one of the cushions between the individual bones which makes up the spine.
According to the Mayo Clinic a herniated disc can irritate nearby nerves and result in pain, numbness or weakness in the back and even arms and legs. Around 60% or 80% of people will experience some form of lower back pain at some point in their lives and a herniated disc likely causes this.
“those who are usually sedentary are most vulnerable”
However, most people who have a herniated disc don’t need surgery to correct the problem and feel much better with just a few weeks or months of non-surgical treatment.
Gradual wear and tear that accompanies age is an important factor to the degenerative process of the discs.
In addition, certain lifestyle indicators like improper lifting, smoking, frequent driving, pregnancy and most importantly, those who are usually sedentary are most vulnerable as inactivity can cause degeneration to the discs and soft tissues around the lower back.
A comprehensive physical examination can help determine the cause of your lower back pain. To test muscle weakness, the doctor may assess how you walk on your heels and toes. The examination may include a neurological examination to detect sensory loss or weakness.
Before surgical treatment is explored and unless there are significant neurological deficits such as muscle weakness or difficulty walking, conservative care is the first course of treatment.
The pain associated with a herniated disc is usually quite extreme, therefore, the initial focus for care is to provide pain relief.
What alternatives other than surgery are there for herniated discs?
A couple days of rest should calm severe back pain but the key is to avoid sitting for long periods of time. Take frequent breaks and ensure that movements are both slow and controlled. Taking steps to recognize daily activities that can cause further pain like lifting or bending forward are very important.
Over-the-counter (OTC) medicines like ibuprofen or naproxen may help relieve pain temporarily while others are available in prescription strength dosages.
Certain exercises can strengthen the lower back and abdominal muscles. Physical therapy can play a major role in herniated disc recovery and may not only provide immediate pain relief but can teach you and help condition your body from further injury.
It is important to note that these conservative or non-surgical treatments don’t guarantee immediate relief.
There usually is a process of trial and error that is often necessary to find what is most helpful for you and this may include a single or combination of treatment options at once.
For example, medication that focuses on pain relief may help in tolerating other treatments like physical therapy.
If conservative treatments are successful in reducing pain and discomfort, the patient may opt to continue but if they fail to improve symptoms after six weeks—numbness/weakness, difficulty standing or walking, or loss of bladder or bowel control—surgery can be considered as an option followed by rehabilitation.
In most cases, surgeons remove the portion of the disc that is protruding.
The most common surgical procedure for a herniated disc in the lower back is a “microdiscectomy”. This procedure involves removing the herniated part of the disk and any fragments that are putting pressure on the spinal cord.
Even if you’re not suffering from a herniated disc, there are small steps you can take daily to ensure you don’t develop the condition. The importance of prevention as well as the maintenance of low back pain and herniated discs (if developed) cannot be understated.
While methods of diagnosing and treating back pain differ among those in the medical community, most doctors generally agree that rehabilitation and exercise is crucial in helping patients recover from back pain and preventing or minimising future recurrences.
It is important to note that choosing the correct exercises and techniques and knowing how and when to do each of them can make all the difference.
If pain persists, this is typically a sign where your body is telling you that there are barriers to the healing process that need to be eliminated and exercise is an important part of the healing process. Contrary to popular belief too much rest and lack of activity actually makes the pain worse.
Indeed, pain often prevents us from incorporating physical activity into our day but a lack of exercise can actually worsen the pain by deconditioning and weakening the muscles.
Movement is necessary to keep your discs, muscles, and joints supple.
Regular exercise helps to strengthen muscles, which then helps to stabilize and support the spine. Key exercises when done properly can increase the strength of your big back muscles and will reduce pressure on the disc.
Exercise really is the only way to tell our body to heal but it needs to be done in a controlled and gradual manner as injections, medications, and other therapies cannot stimulate the healing process although they do help provide temporary pain relief.
As stated, active exercise is really the only stimulus for the healing process to begin. Exercising essentially means we are using our nervous system to tell the muscles how to behave but in order to achieve results you can see and feel, your dedication to a comprehensive rehabilitation and exercise program is needed.
This program should consist of a three activities: stretching, strengthening, and overall aerobic conditioning of the back. All three will be critical in your recovery.
Stretching is important because some form of stiffness usually accompanies inactivity and a proper stretch can provide meaningful and sustained back pain relief.
Strengthening exercises are important in order to prevent future occurrences of back pain and are important for long-term and lasting recovery.
Aerobic conditioning helps in the event when an episode does occur as they experience less pain.
In addition, these exercises if done regularly can help control one’s weight and keep it at healthy levels. Being overweight puts more pressure on the spine and discs making them more prone to herniation and regular physical activity can alleviate this.
When idle or sitting still it is important to take note of your posture. Poor posture can aggravate a herniated disc and you may be surprised to learn that something as simple as posture can play a role. Keeping the back straight especially when sitting for long periods helps to reduce pressure on the spine and discs.
People tend to slouch forward when they sit for a long time and this can overstretch spinal ligaments and strain your discs. Even if you have good posture, ensure that you are moving throughout the day with a good rule of them being to get out of your chair every 20 to 30 minutes for a good stretch.
Lastly, stay true to the old adage “lift with your legs, not your back”—lift objects properly to avoid having a potential episode. Avoid placing a large working load on your back and always practice correct lifting form. Lift within your limits—if a box feels too heavy, it probably is.