Lumbar disc herniation is a common disease seen by physiotherapists on day-to-day basis due to the amount of strain placed on the disc in adults.

Before we start, let’s look at the spine…

The spine is made up of 33 vertebrae bones, normally with 24 of them separated by inter-vertebral discs. This disc is like a jam-doughnut – the nucleus pulposus being the jam innermost part and the annulus fibrosus being the outer, firm doughnut. The inter-vertebral disc is subject to load and stresses which assists in mobility of the vertebrae segments and shock absorption with impacted movement.

What is disc herniation?

Disc herniation is a shift of disc material (centre jelly) beyond the inter-vertebral disc space.

Herniation begins from failure in the innermost jelly ring that progress outward to doughnut ring. The damage to the annulus of the disc appears to be associated with bending the spine for a repeated or prolonged period of time.

The nucleus loses its pressure and shape, the annulus bulges outward during disc compression, similar to when you squeeze a jelly doughnut and the jelly starts to ooze out.

lumbar disc herniation concept illustration

Disc herniation occurs often as a result of age-related degeneration of the annulus fibrosis, trauma, straining and lifting injuries are also involved. It may develop over a long period or with sudden trauma. It can occur in any disc in the spine, but lumbar disc herniation and cervical disc herniation are the two most common forms.

How can you tell if you may have a herniated disc?

Cervical disc herniation causing neck pain with radiating pain to head, face, shoulder blade, shoulder and down into hand and/or fingers. Lumbar disc herniation presents with lower back pain, buttocks, thighs, anal/genital region (via the Perineal nerve), and may radiate into the foot and/or toe once nerve has been affected. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica.

The different stages of damage.

There are four types of herniated disc:

  1. Bulging: with prolonged damage to the disc, the weakness of the disc walls develops which progresses to the disc margin pushing to the end field of the disc and the shape to change causing an impingement to the spinal canal / spinal nerves.
  2. Protrusion: the posterior longitudinal ligament remains intact but the jelly starts compressing on the doughnut edges (nucleus pulposus impinges on annulus).
  3. Extrusion: the nuclear material emerges through the annular fibres (jelly goes through the doughnut) but the posterior longitudinal ligament remains intact.
  4. Sequestration: the nuclear material emerges through the annular fibres and the posterior longitudinal ligament is disrupted (the jelly completely oozes out of the doughnut). A portion of the nucleus pulposus has protruded into the epidural space.

types of lumbar disc herniation

With a bulge disc herniation seen in the above picture, recovery is swift with physiotherapy treatment, and compliance from patients. When the disc bulge becomes sequestrated both physiotherapy and medical assistance is needed to get pain management and mobility back for patient to get back to daily life.

Physiotherapy treatment to disc herniation

Physiotherapy offers assistance with pain management and relief, decreases immobility and contributes to protecting the body to prevent further injury. Studies show that different treatments in combination assist with optimal therapy from disc herniation.

  • Manual therapy – joint mobilisation helps reduce acute pain and improves mobility.
  • Traction – helps reduce pain by reducing the irritation or impingement of the disc.
  • Exercise to assist with stability around neck/lower back.
  • Strengthening exercise programme to build the spine’s support system.
  • Myofascial release/deep tissue release, which assists with tension build-up that can, in turn, cause secondary problems.

This article was submitted by Jenilee Fortuin who practises at the Fourways branch of Lamberti Physiotherapy. If you have a recent sports injury, contact Jenilee by completing this appointment form to request an assessment and treatment.

References
1. Filiz M et al. The effectiveness of exercise programmes after lumbar disc surgery: a randomized controlled study (2005)
2. L. G. F. Giles, K. P. Singer. The Clinical Anatomy and Management of Back Pain. Butterworth-Heinemann, (2006)
3. Jordan, Jo, Kika Konstantinou, and John O’Dowd. “Herniated lumbar disc.” BMJ clinical evidence 2011 (2011)

Pictures
https://www.foundationsportspine.com/single-post/2015/01/31/How-To-Replace-Your-Abdominal-Exercises-With-Better-Ones-And-Why-You-Should (Herniated lumbar disc)

https://southfloridabackspineandscoliosis.com/disk-herniations  (Disc stages)