Here’s another blog from a Mississauga Chiropractor…
A lumbar disc herniation is the external protrusion of the nucleus palposus of the intervertebral disc through the annular fibres potentially causing compression of the spinal nerve segments. In addition to the direct tissue damage, there is also potential chemical irritation from the release of inflammatory products & local edema. The most common spinal levels are at L4-L5 & L5-S1.
a) Age: 25-45 years old (when the nucleus palposus is most hydrated) – the highest incidence is at age 35-45 years old.
b) Gender: Male > Female (3:2)
a) Chronic overloading of the disc
b) Prior trauma (fall or motor vehicle accident)
c) Asymmetrical loading & twisting
d) Poor posture & muscle imbalances
e) Congential defects
a) Lack of exercise & poor core body strength
b) Weak abdominals, tight hamstrings, anterior pelvic tilt (lower cross syndrome)
c) Hyperlordotic lumbar curvature
d) Poor nutrition & general health.
Stage of Disc Herniation:
|Chemical changes associated with trauma; Repetitive stress or aging causes discs to weaken and the nucleus to shift without herniation|
|Form or position of the disc changes with slight impingement into the spinal canal; Also called a bulge or protrusion|
|Nucleus palposus breaks through the annulus fibrosus but remains within the disc|
|Nucleus palposus breaks through the annulus fibrosus & lies outside the disc in the spinal canal|
a) Sudden onset of low back pain & potential leg pain past the knee
b) Patient often has frequent episodes of previous low back pain
c) Leg pain is often greater than the back pain with herniations, however if there are only annular tears without herniations then the back pain will be greater
d) Pain may follow heavy lifting, twisting, or straining episode or repetitive stress trauma; may also be a history of intermittent low back pain that usually resolves.
e) Pain is described as sharp, shooting or electrical
f) Pain is exacerbated by increased disc pressure
- Weight bearing – standing, walking or sitting for prolonged periods
- Pressure increases with coughing, sneezing or straining (at stool)
- Positional changes (guarded moving from lying to sitting to standing or standing to sitting)
a) McKenzie Extension Exercises – decrease/centralize the pain with extension (Cobra, Sloppy Push-up, Camel extension exercises)
b) Avoid flexed positions (sitting with a flexed spine, lying on stomach or side).
c) Avoid lifting
d) Lumbar support when sitting to encourage extension
a) Prognosis is good for near complete recovery of functionality, although flare-ups may occur if the core remains to be weak. The sooner a patient is up and moving, the better the prognosis