General info
Summary

Data about the condition

Lumbar disc herniation is a condition with bipolar symptoms, which in most cases is pathognomonic for diagnosis, especially when the evolution is associated with periodicity, progressiveness and symptomatic variability; repeated low back pain, which may be associated with signs neurological and different mental reactions of the patient to pain.

Disc herniations are classified according to the direction of travel:

  1. Anterior disc herniation: rare, stopped by the anterior common longitudinal ligament , has no clinical expression, but may be the basis for the development of a future anterior osteophyte on the vertebral body.
  2. Lateral disc herniation: without clinical resonance at the lumbar level, unlike the cervical spine, where a compression of the vertebral artery or on a cervical root occurs.
  3. Posterior disc herniation: responsible for the production of algal functional symptoms such as root compresses.

Symptoms

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, in the lateral thigh, lateral 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 the extension of the hip, 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 on the region of the medial buttock and perineum.

Causes

  • 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.

Treatment

  • Medication treatment (Muscle relaxant, Anticonvulsant, Anti-inflammatory drugs);
  • Physiotherapy-If the pain does not subside in a few weeks, your doctor may recommend physiotherapy. The specialist can recommend positions and exercises designed to minimize pain in the herniated disc;
  • Surgery;
  • Physical Therapy;

Kinetotherapeutic objectives

  • Fighting pain;
  • Improving mobility;
  • Muscle rebalancing;
  • Muscle toning.

The recovery program

Breathing exercise – from supine position the patient puts one hand on the chest and the other on the abdomen, trying to breathe abdominally so that the hand on the abdomen moves. This exercise is done to raise awareness and relax the lumbar spine muscles during expiration.

Note: Take 5 deep breaths / 3 sets

Exercițiu de respirație

Dorsiflexion – from the same position with a bent knee, and with the extended one the patient performs left / right dorsiflexion.

Note: repeat the movement 10 times / 2 sets

Combination of dorsiflexion with plantar flexion – from the same position with the knees outstretched, the patient alternates dorsiflexion with plantar flexion for an ankle play.

Note: repeat the movement for 30 sec / 2 sets

Isometric contraction of the limbs – from the same position with both lower limbs outstretched, with a roller under the knee the patient performs an isometric contraction of the left / right limb.

Note: the contraction is maintained for 5-6 sec, 10 times / 2 sets

Pushing with the heel – from supine position, with the knees bent, the patient pushes with the left / right heel in bed.

Note: Isometric contraction is maintained for 5-6 sec, 10 times / 2 sets

Buttock muscle contraction – from the same position with the knees bent, the patient performs the contraction of the gluteal muscles.

Note: 10 repetitions / 2 sets

Anteduction of the pelvis – from the same position with the knees bent, the patient performs an anteduction of the pelvis thus contracting the abdominal muscles and at the level of the lumbar spine the arch disappears and sticks to the table.

Note: it is executed 10 times / 2 series

Flexion of the thigh on the pelvis – from the same position with the knees bent, the patient performs the flexion of the thigh on the pelvis at 90 left / right, as in the previous exercise, he keeps his back straight glued to the table

Note: 10 reps / 2 sets

Bring the limb extended to 45 degrees – from the same position with a bent knee, the patient brings the stretched limb to 45 and maintains the contraction 5-6 sec left / right.

Note: it is executed 10 times / 2 series

Flexion on the pelvis of the thigh with the left limb at 90 degrees – from the same position with both knees bent, the patient performs a pelvic flexion of the thigh with the left limb at 90 and holds, while with the other limb pushes the mass, then changes.

Note: hold for 5-6 sec, 10 repetitions / 2 sets

This set of exercises is performed during respiratory time.

Recommendations

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 that?

In 95% of the lumbar disc herniation, the L4-L5 and L5-S1 discs are affected [13].

Lumbar disc herniation occurs 15 times more than cervical disc herniation and is a major cause of lower back pain.

  1. 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
  2. Jump up to:01 Jordan, Jo, Kika Konstantinou, and John O’Dowd. “Herniated lumbar disc.” BMJ clinical evidence 2011 (2011). Level of evidence: 1A
  3. Jump up↑McGill, S. (2007). Low Back Disorders: Evidence Based Prevention and Rehabilitation, Second Edition. USA: Human Kinetics. Level of evidence: 3B
  4. Jump up to:01 Olson K., Manual Physical Therapy of Spine, Saunders Elsevier, 2009, p114-116
  5. Jump up to:01 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
  6. Jump up to:01 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
  7. Jump up to:01 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)

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