A herniated disc occurs when there is a problem with one of the cartilaginous shock absorbers, called intervertebral discs, that lie between the vertebrae.
The discs and vertebrae fit together to form the spinal column.
These discs are formed by a softer, more gelatinous center that is protected by a harder, cartilaginous outer ring.
Lumbar disc herniation occurs when the outer annulus tears and part of this gelatinous nucleus slips outward.
Disc herniation can occur anywhere in the spine, although it is much more common in the cervical and lumbar region. When the disc becomes displaced, it can irritate the nearby nerve outlet and cause pain, paresthesia or motor weakness in any of the extremities.
How can we know if we have a herniated disc?
For a patient to have a suspicion of suffering a herniated disc, the most frequent symptoms associated with this pathology are:
- Loss of strength in the limb, if the herniation is cervical in an arm, if the herniation is lumbar in a leg. It can also occur bilaterally, although it is less frequent.
- Paresthesias in the extremities, loss of sensibility, sensation of “numbness” or “cramping” of areas of the affected arm or leg.
- Cramping and/or pain in one area of the limb.
- Limitation of cervical or lumbar mobility with a sensation of “blockage”.
- Discomfort and sensations that are accentuated with sustained positions, such as standing, sitting or lying down. Movement usually improves symptoms.
What exercises should I avoid if I have a herniated disc?
The exercises to avoid for each case must be studied analytically and personalized, but there are some that should always be avoided, such as postures maintained especially in load, as they increase the disc inflammation and irritate the nerve output.
Standing without any movement, causes a specific load increase, irritating the affected area much more, also lying in bed for long periods or sitting in armchairs or sofas, in which the hip is below the knee, ie excessively soft.
On the other hand, what exercises would be good for me?
Walking, and neurodynamic exercises of the affected nerve, as well as soft joint mobilizations with movements that the physiotherapist should indicate to us, to give mobility to the affected joint or joints.
What treatments are performed in physiotherapy for herniated disc?
The physiotherapy treatment focuses on restoring the patient’s mobility to the area that was affected and in the vast majority of cases causes irradiation to a limb.
To achieve a good result we carry out several treatments:
- Distraction flexion stretcher: Through which, we get a disc pumping and a controlled and progressive traction of the affected area. The flexion-distraction stretcher facilitates the reduction of disc herniation and fights against intradiscal edema and nerve root ischemia, favoring the reabsorption of disc material by the force of gravity. Some of the beneficial effects of this therapy are the increase of the disc height by rehydration, decrease of protrusion and stenosis, opening of articular facets, reduction of posterior tension of the disc… and allows us to perform manual work at the same time that the flexion-distraction therapy with traction is applied.
- Echoguided electrolysis in articular facet and in the sciatic path: With it we manage to repair the affected tissue (macrophage call effect) and modify the structure and the mechanobiological behavior of the soft tissue.
- Neuromodulation of the sciatic nerve: This is an invasive but non-surgical therapy in which, through the insertion of ultrasound-guided needles in the area of the sciatic pathway, a low-intensity analgesic electric current is applied which helps to stimulate the nerve and to create new afferents and efferents.
- High intensity magnetotherapy: This treatment is able to act on cells, tissues, organs and even bones because the electromagnetic fields cross all physical barriers. This will achieve an effective treatment of pain in general and localized pain. Through high intensity magnetotherapy we can mobilize joints, heal fractures, neuromuscular stimulation and decrease spasticity.
- Exercise through lumbar motor control, postural reeducation and home mobilization of specific vertebral segments.
How long does it take for a herniated disc to disappear?
As for the time it takes for a herniated disc to disappear, it is very complicated to know, since each case is different, and each pathology within each patient as well.
We have had successful cases in which by means of MRI before the treatment and after 12 sessions in 3 months, we have achieved after a new MRI, to observe that the hernia had completely reabsorbed and our patient was completely asymptomatic. But in many occasions the treatment is based on making the symptoms disappear, orienting the treatment to “reposition” the hernia in an area of no radicular involvement, making the patient asymptomatic.
Can this pathology be prevented in any way?
Normally, a herniated lumbar disc occurs due to disc degeneration related to the passage of time, repetitive movements, dehydration, lack of muscle tone of the abdominal-lumbar-pelvic girdle, maintained postures and genetic predisposition.
It is difficult to determine the specific cause of the appearance of a herniated disc, however, there are certain factors that may increase the risk of lumbar disc herniation:
- Weight: When the patient is overweight, his discs are exposed to greater stress.
- Work: When the patient’s job requires him to carry a lot of weight or forced movements of the back, turning or twisting it repetitively.
- Genetics: There is a genetic factor and a predisposition to suffer from disc herniation can be inherited.
- Toxic habits: Hypoxia is created and favors the degeneration of your discs so they can deteriorate faster.
Avoiding these causes of origin of disc herniation, we can prevent or delay the onset of disc herniation.