Data about the condition
Lumbar disc herniation (HDL) is a common condition in the back. It is one of the most common diseases that causes back pain and / or pain in the lower limbs. The herniated disc is a movement of the disc material (the nucleus pulposus) beyond the space of the intervertebral disc. Damage to the disc ring is associated with complete flexion of the spine for a repeated or prolonged period of time. The fibrous rings lose their hydrostatic pressure and the nucleus pulposus is thrown out during the compression of the disc.
An intervertebral disc is composed of a complex series of fibrous rings and the nucleus pulposus (a gelatinous core containing collagen fibers, elastin fibers and a hydrated gel).
There are four types of herniated discs:
- Convex: extending the edge of the disc beyond the edges of adjacent end plates;
- Protrusion: the posterior longitudinal ligament remains intact, but the nucleus pulposus affects the fibrous rings;
- Extrusion: the nuclear material exits through the annular fibers, but the posterior longitudinal ligament remains intact;
- Extrusion: the nuclear material exits through the annular fibers, but the posterior longitudinal ligament remains intact.
Detection of solitary nerve injury caused by compression of the herniated disc in the lumbar spine.
- L1 nerve – pain and sensory loss are common in the groin region. Weakness of the hip flexion is rare and no stretching reflex is affected;
- L2-L3-L4 nerves – back pain radiating to the front thigh and lower leg; sensory loss of the anterior thigh and sometimes of the medial lower leg; weakness of hip flexion and adduction, weakness of knee extension decreased patellar reflex;
- L5 nerve – radiates in the buttocks, side thigh, side leg and dorsal leg, thumb; sensory loss in the side leg, back of the foot, the space between the first and second toe; weakness in hip abduction, knee flexion, dorsiflexion of the foot, extension and flexion of the toes, inversion of the foot and eversion; decreased semitendinosus / semimembranosus reflex;
- S1 nerve – radiates to the lateral or posterior thigh, hind leg, lateral or plantar leg; sensory losses in the hind leg, lateral or plantar; weakness in hip extension, knee flexion, plantar flexion of the foot; Achilles tendon; the median, perineal and perianal region; weakness may be minimal, with urinary and fecal incontinence, as well as sexual dysfunction;
- S2-S4 nerves – sacral or gluteal pain radiating to the posterior aspect of the leg or perineum; sensory deficit in the region of the medial, perineal and perianal buttocks.
- The most common cause of disc herniation is a degenerative process in which as the person gets older, the nucleus pulposus becomes less hydrated and weakens. This process will lead to a progressive disc herniation that can cause symptoms;
- The second most common cause of a herniated disc is trauma;
- Other causes include connective tissue disorders and congenital disorders, such as short pedicles.
Physical therapy is the key for most patients with HDL. The results depend on many factors, but those who exercise regularly and maintain a healthy body weight have better results than people who are sedentary.
The treatment of disc herniation has as objectives:
- Elimination of pain;
- Fight against muscle contraction;
- Cessation of the sensitive disorder in the limbs through which the affected nerve passes (paresthesias, numbness);
- The patient’s return to daily activities.
The objectives of the Recovery Program
The content of the Recovery Program
There are a number of exercise programs for the treatment of symptomatic disc herniation.
- Aerobic activity (walking, cycling)
- Directional preference (McKenzie approach)
- Flexibility exercises (yoga and stretching)
- Proprioception / coordination / balance (gymball and balance plate / inclined plate)
- Stretching exercises
- Motor control exercises.
THE WILLIAMS PROGRAM
Pelvic lifts P1 The patient is lying on his back with his knees bent and his feet pressed against the table. then he will raise his pelvis. The position must be maintained for 10 seconds. We repeat the movement 10 times.
Bringing a knee to the chest P2 the subject is lying on his back, with his knees bent and his feet glued to the table. One knee is gripped with the arms and brought to the chest maintaining the position for 10 s.
Bringing both knees to the chest-P3 movement is similar to the previous one only that both knees are held to the chest, the position is maintained for 10 s., 5 repetitions are done.
Half abdomen – P4 the subject lies on his back bent knees, feet pressed to the table, slightly raises his head and shoulders up to 45 degrees, without the help of the chin.
Knee flexion – P5 legs are parallel and slightly apart above the hips, making sure that the knees are facing forward. at the starting position repeating 10 times.
Fandari- P6 the subject takes a step forward and stretches the other leg backwards then leans slightly towards the ground, lowering the pelvis. Return to starting position and repeat 4-5 times.
Stretching the anterior muscles of the thighs – P7 the subject sits with his legs perfectly stretched and his fingertips facing the ceiling. Then the torso is lowered slightly, with outstretched hands and oriented towards the tip of the legs. The gaze is oriented forward and the knees will be kept stretched.
- The patient must do the exercises proposed by the Physiotherapist at home, and follow the schedule established by him.
- Exercises must be performed correctly, dosed, and carefully.
- Avoiding the risk factors that can recur the disease: cold, prolonged orthostatism, weight lifting, hot and cold air currents.
- The bed he sleeps on must be harder.
Did you know ?
- Disc herniation is the most common in the lumbar spine followed by the cervical spine. A high rate of disc herniation in the lumbar and cervical spine can be explained by an understanding of the biomechanical forces in the flexible part of the spine. The thoracic spine has a lower rate of herniated disc
- The incidence of disc herniation is about 5 to 20 cases per 1000 adults per year and is most common in people in the third to fifth decade of life, with a male to female ratio of 2: 1.
- In 95% of the lumbar disc herniation, the L4-L5 and L5-S1 discs are affected .
- Lumbar disc herniation occurs 15 times more than cervical disc herniation and is a major cause of lower back pain
- In people aged between 25 and 55 years, approximately 95% of herniated discs occur in the lower lumbar spine (level L4 / 5 and L5 / S1); Disc herniation above this level is more common in people over the age of 55.
- Kerr, Dana, Wenyan Zhao, and Jon D. Lurie. “What are long-term predictors of outcomes for lumbar disc herniation? A randomized and observational study.” Clinical Orthopaedics and Related Research® 473.6 (2015): 1920-1930. Level of evidence: 2B
- ↑Jump up to:0 2.1 Jordan, Jo, Kika Konstantinou, and John O’Dowd. “Herniated lumbar disc.” BMJ clinical evidence 2011 (2011). Level of evidence: 1A
- Jump up↑McGill, S. (2007). Low Back Disorders: Evidence Based Prevention and Rehabilitation, Second Edition. USA: Human Kinetics. Level of evidence: 3B
- ↑Jump up to:0 4.1 Olson K., Manual Physical Therapy of Spine, Saunders Elsevier, 2009, p114-116
- ↑Jump up to:0 5.1 Jioun Choi MS., Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation, J Phys Ther Sci. 2015 Feb; 27(2): 481–483. Level of evidence: 2B
- ↑Jump up to:0 6.1 Demir S., Effects of dynamic lumbar stabilization exercises following lumbar microdiscectomy on pain, mobility and return to work. Randomized controlled trial., Eur J Phys Rehabil Med. 2014 Dec;50(6):627-40. Epub 2014 Sep 9. Level of evidence: 2B
- ↑Jump up to:0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 Dulebohn SC, Massa RN, Mesfin FB. Disc Herniation.Available from:https://www.ncbi.nlm.nih.gov/books/NBK441822/ (last accessed 25.1.2020)
- Jump up↑Nucleus Medicine Lumbar disc injury Available from:https://www.youtube.com/watch?v=nV4ILsaVSXc&app=desktop (last accessed 25.1.2020)
Jump up↑ Musculoskeletal key Applied anatomy of the lumbar spine Available from:https://musculoskeletalkey.com/applied-anatomy-of-the-lumbar-spine/