What is Lumbar Disc herniation and How It Causes Back Pain?

Blausen_0484_HerniatedLumbarDisc

Degenerative bone changes affect the integrity of bones, joints and ligaments to break the protective core of lumbar discs that leads to protrusion of nucleus pulposus (inner soft part) from damaged vertebral walls.

When degeneration process involves lumbar vertebrae, the disease process is referred to as lumbar disc herniation. The most common site of lumbar disc herniation is between L4-L5 and L5-S1.

What Are The Causes of Lumbar Disc Herniation?

The primary abnormality in the development of lumbar disc herniation includes:

  • Age related wear and tear changes that lead to damaged protective cushioning of lumbar vertebrae (inter-vertebral disc).  The presence of fluid in between the vertebrae and protective cushioning allow flexibility of movements and also acts as shock absorber.However, due to degenerative process, bones become weak and less capable of handling stress, strain and activity across joints. Loss of fluid further cause friction and leads to formation of bony spurs. Moreover, constant rub and friction makes the bone weak and leads to herniation of contents leading to inflammation and injury.

What Are Some Risk Factors That May Lead to Lumbar Disc Herniation?

The age related wear and tear damage is aggravated in following situations

  • Degenerative bone diseases and osteopenic bone disorders like osteoporosis. Osteopenia is a condition in which bone mineralization decreases. Mineral content of bone (Calcium and Phosphorous) give tensile strength and stability to bones; however aging and bone abnormalities like osteoporosis makes bone weak and vulnerable to injury.
  • Obesity increases the risk of lumbar disc herniation by speeding up the process of wear and tear. In a number of cases, weight loss helps in improvement of pain symptoms and range of motion.
  • Occupational injuries and strain on spine leads to mild to moderate damage and ongoing process of inflammation that damages the surrounding tissue and supporting matrix leading to herniation.
  • Traumatic injuries or history of fall make the bones / joints weak, speeding up the process of degenerative damage.
  • Poor posture is one of the strongest contributing factors.

What Are the Symptoms of Lumbar Disc Herniation?

  • Lumbar disc herniation presents as lower back pain in almost 80% of the cases
  • Sciatica or crampy leg pain is another common symptom reported in most untreated cases
  • Tingling sensation in the nerves affected by herniated disc
  • Weakness, numbness or loss of sensory or motor power in areas of body supplied by affected nerves
  • Involvement of L5 primarily may lead to foot drop and weakness in the area of foot, lower limbs and buttocks.
  • Involvement of S1 primarily leads to weakness of foot muscles and loss of sensations.
  • Bladder or bowel dysfunction is seen mostly in later stages of herniation.

When to see a Healthcare professional?

It is advised to see a healthcare provider to assess the degree and severity of spinal damage and to prevent complications.

Most Common Non-Surgical Treatment for lumbar disc herniation

Management of lumbar disc herniation involves:

  • Weight loss to decrease the stress and strain on the joints and to limit the degeneration process
  • Heat and/or ice therapy
  • Over the counter pain medications
  • Narcotics and nerve pain medications
  • Muscle relaxants can also be employed in cases of refractory pain, unresponsive to ordinary pain medications.

Physical therapy

is perhaps one of the major alternative therapies that aim at:

  • Relieving pressure on the spinal nerves
  • Strengthening spinal muscles to better handle the stress from damaged discs
  • Re-alignment and core strengthening exercises that helps in re-aligning spinal vertebrae.
  • Manual soft tissue therapy helps in detoxification of tissues that helps in eliminating inflammatory mediators that cause pain and interfere with tissue healing.

Chiropractic care

is helpful in managing cases that are inoperable. Different chiropractic therapies are available like

  • Manual manipulation of prolapsed disc to better align the intervertebral discs.
  • Massage therapies to relieve inflammation around the tissues and promote blood circulation for optimal healing.
  • Bio-Energetic Synchronization Technique that can alleviate the pressure from spinal nerves by application of precise pressure to prevent permanent nerve damage.
  • Logan technique to help in restoration of vertebral connection with the spine by application of pressure on prolapsed discs.

Surgery Should Be Your Last Option

Surgery is generally not the first choice of therapy and is mainly employed in the cases where no other treatment is helpful in controlling pain and disability. A variety of surgical treatments are available. Most popular being microdiscectomy that involves removal of the herniated part of spinal disc to relieve pressure and ensure healthy healing environment for spinal tissues and nerves.

Surgery does not provide an absolute cure and a recurrent herniation is reported in almost 10 to 15% of the cases within first post-operative year that can be managed by another microdiscectomy; however, other surgical options are also available to manage recurrent herniation by procedures like Lumbar Fusion Surgery (that involves removal of all herniated discs and lumbar fusion to prevent any activity or movement across lumbar joint).

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