Master of Physiotherapy ,MPTh. (Orthopedics), Certified Manual therapist, Bachelor of physiotherapy,BPTh
Herniated Intervertebral Disc Disease
The vertebral column (backbone) is made up of 33 vertebrae separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).
Between each vertebra is a fibrous disc with a jelly-like core. These cushions of cartilage allow the body to accept and dissipate load across multiple levels in the spine and still allow for the flexibility required for performing normal activities of daily living. As the body twists, bends, flexes and extends, the intervertebral discs are constantly changing their shape.
When discs degenerate, becoming less supple due to age or back strain, the disc may prolapse — squeezing out some of the soft core. This loss of cushioning may cause pressure on local nerves and cause back or neck pain, numbness or tingling in the arms, or searing pain down one or both legs. If the prolapse is severe it can damage the spinal cord. As a part of the aging process the discs lose their high water content and their ability to cushion the vertebrae. This is called degenerative disc disease. As the discs deteriorate, the spine can initially become less stable. Bony spurs can develop as a result of this instability and can cause pressure on nearby nerves leading to leg or arm pain. Narrowing of the neural canal by these bony spurs is known as degenerative spinal stenosis.
By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels. By the age of 60, greater than 90% of people will show evidence of disc degeneration at one or more levels on MRI. In some patients, this disc degeneration can be nearly asymptomatic; in others, disc degeneration can lead to intractable back pain.
The outer layer of the discs themselves can also tear. When this occurs, the inner, gelatinous layer can herniate out (a “herniated” or “ruptured” disc) and also cause pressure on an adjacent nerve. If the herniation occurs in the neck and causes pressure there, it can cause pain that radiates into the shoulder and arm; if it occurs in the lower back, the pain produced can radiate down into the hip and leg.
Patients with disc disease in the cervical, thoracic, or lumbar spine experience variable symptoms depending on where the disc has herniated and what nerve root it is pushing on. The following are the most common symptoms of lumbar disc disease:
Intermittent or continuous back pain (this may be made worse by movement, coughing, sneezing, or standing for long periods of time)Spasm of the back musclesSciatica — pain that starts near the back or buttock and travels down the leg to the calf or into the foot.Muscle weakness in the legsNumbness in the leg or footDecreased reflexes at the knee or ankleChanges in bladder or bowel function
The symptoms of lumbar disc disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
In rare cases, patients with large disc herniations may experience weakness in an extremity or signs of spinal cord compression such as difficulty with gait, in coordination, or loss of bowel/bladder control.
Treatment for disc disorders must be closely tailored to the patient, based on:
The history and severity of their pain whether or not they have had prior treatments for this problem and how effective they have been and whether or not there is any evidence of neurologic damage such as weakness of an extremity or the loss of reflexes
Some of the treatments used include
Activity modification patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disc)Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
Weight control medications (to control pain and/or to relax muscles)