Discus Herniation

Cause of discus herniation

The blood supply of the discus decreases already at the age of 20 years.This natural aging process ensures that less and less waste products can be removed from the core of the discus and that the discus must obtain its nutrients elsewhere by means of osmosis.

As a result, the number of proteoglycans in the discus decreases. These play a role
in the circulation of disc fluid, the amount of swelling and the compressive properties of the disc. As the number of proteoglycans decreases, so does the water concentration in the nucleus of the disc. At birth, the disc consists of 88% water and this drops to approximately 65-70% at the age of 75. There is also an increase in collagen and a decrease in elastin, so that the disc becomes more fibrous and less resilient, i.e. stiffer. This causes calcification in the space between the vertebrae and discs.

Due to dehydration and calcification, the disc needs more time to return to its original position. This translates into a clinically reduced mobility in the spine. As a result, the suction force of fluid in the disc will decrease. This can lead to morning stiffness since during the night - when there is no pressure on the disc - it does not fill up sufficiently.

Other important factors that can contribute to disc problems are lack of exercise, a poorly balanced diet, obesity and nicotine use.The resulting reduced flexibility of the disc will reduce the likelihood of deformation. Larger cracks may develop in the outer layer of the disc. If, due to numerous tears, the inner layer bulges into the outer layer, we speak of a disc prolapse. However, if the tear is so large that the inner layer is completely torn by the outer layer, we are dealing with a disc hernia.

Evolution of the clinical picture

Disc herniation can occur progressively as a result of the degenerative process. We see this, for example, in patients who have a static, sedentary job and systematically develop more complaints. In addition, a sudden heavy load on the lower back can lead to an acute herniated disc.

Furthermore, an inflammatory reaction will also take place, causing an accumulation of fluid around this fissure. This can lead to local pressure on the nerve root, which will no longer function optimally. As a result, symptoms will develop in the nerve root affected areas.

Articular

Patients often cannot bend their back, or only to a limited extent, and certainly not in a loaded position (standing / sitting). Sometimes, but not always, morning stiffness is present due to limited mobility in the joint.

Neurologic

If the nerve root experiences too much pressure, there will be radiating pain to the pelvis and/or legs. This can be a shooting pain that may or may not be accompanied by loss of feeling and/or strength.

Muscular

The muscles around the herniated disc are often excessively tense. This is a protective strategy of the body. Because of this, the muscles become overtired and radiate pain into the lower back and the mobility of the back is often limited.

Other symptoms

Pain on coughing, sneezing or pushing. The patient chooses an antalgic (pain-avoiding) posture.

Physiotherapeutic examination

First of all, an interview will give direction in order to exclude certain illnesses and to determine the cause. During the physiotherapeutic examination, the mobility of the lower back and pelvis will be checked passively and actively, as well as the involvement of nerve structures. This will allow to determine the seriousness and to exclude other pathologies. After all, there are other complaints that can cause a similar pattern of symptoms. It is therefore extremely important not to act hastily.

Education

The physiotherapist will explain to you which activities put an incorrect strain on your back. People often think that only heavy weights are a problem and that you have to bend your knees. Unfortunately, this is too simplistic and that is why it is crucial that you understand how to strain your back correctly in your daily life.

Manual physiotherapy

If there are restrictions on certain vertebrae or joints (e.g. pelvis), manual therapy can help to relieve the level that has been overburdened.

Physiotherapeutic treatment

For the treatment of disc pathology, relative rest is recommended in the first place. This means that you should remain active and not carry heavy loads or do (heavy) efforts that put a strain on the back.

Pain control

Physiotherapeutic techniques such as soft tissue massage, stretching exercises, mobilisations, manipulations and exercise therapy have a pain-relieving effect, which in turn increases mobility and nourishes the disc.

Physical therapy

Before or as a result of the herniated disc, a deviant movement pattern usually develops. Coordination exercises to load the back correctly play an important role. The myth that you must have strong muscles is therefore not true: you must have smart muscles that know when to do what, and if so, what load.

Short term

Most of the pain disappears between 5 days and 6 weeks, depending on the severity of the tear and the patient's history. In more than 80% of cases, a natural recovery process occurs whereby the patient is free of symptoms relatively quickly.

Long term

If back hygiene is adapted and integrated into daily life, the risk of relapse is small. If there is no adjustment in the patient's back hygiene, there is a risk of relapse: avoiding prolonged static loads or sudden heavy loads in combination with back bending and twisting remains important.