Low back pain is one of the most common and complained problems in our society. Physical Therapy and Rehabilitation Specialist Associate Professor Ahmet İnanır gave important information about herniated disc. What is a herniated disc, and with what findings does it occur? How is hernia diagnosed? What non-surgical treatments are used for herniated disc? When is Surgery Necessary in Lumbar Hernia?
What is a herniated disc, and with what findings does it occur?
Lumbar hernia is a condition in which the jelly-like soft part, which is located between the vertebrae and acts as a suspension, protrudes beyond the hard outer capsule and causes pain, numbness, tingling or loss of strength by applying pressure or pressure to the nerves. The pain increases with coughing, straining and laughing. Standing, sitting, and leaning forward increase the pain. Herniation occurs when there is weakening or tearing of the outer ring of the disc due to factors such as excessive weight, a sudden tension caused by lifting heavy loads, aging and degeneration. Especially sudden onset hernias are caused by heavy lifting, trauma or sudden movement. In some patients, on the other hand, attacks of painful low back pain, which pass spontaneously in a short period of time, are seen. Most of the time, patients do not care about this as they recover, but in the end, severe low back pain and pain may begin in these patients, and even serious hernias may develop. These complaints become life-threatening to the patients. In midline lumbar hernia, the patient usually feels the pain in the lower back. On the other hand, in hernias that go to the side, the pain usually manifests itself by spreading to one leg. Numbness in the leg, loss of strength, loss of reflexes and balance may occur with pain. The patient may also have difficulty sitting and walking. lumbar disc herniation may not cause any symptoms.
Here it is necessary to explain the expression of ruptured hernia. In a second degree hernia (protrusion), it is the posterior herniation of the disc through a partial defect in the annulus fibrosus. Grade 2 (Extruded disc) is the posterior herniation of the disc through a complete defect in the annulus fibrosus. If the full solid is passing, the expression of bursting into this situation is used incorrectly.
How is it diagnosed?
Diagnosing lumbar hernia, especially its treatment, requires the skill of a specialist in hernia. After excluding other causes of low back or leg pain, the diagnosis of hernia is definitely made by a specialist examination who has a full knowledge of the hernia subject, and the spinal cord or nerve relationship caused by the hernia is detected with high-resolution diagnostic devices such as x-ray, MR, CT or CT scan to assist the diagnosis. is done. In addition, with the EMG device, it can be determined which nerve root or roots of the patient are affected by the hernia. We would like to point out that it is an extremely wrong behavior to diagnose hernia with only MRI. Although studies say that hernia is 4-5% of the causes of low back pain, since pain in the waist region can originate from all anatomical structures, it cannot be well localized by both the doctor and the patient. It must be evaluated in detail by a very experienced Physiotherapy and Rehabilitation specialist. Clinical studies show that the source of low back pain is related to intervertebral disc pathologies up to 39%. Considering the subgroups of intervertebral disc pathologies, lumbar disc herniation and degenerative disc disease are the leading ones. In people who do not have any complaints, a hernia is seen as a picture in Magnetic Resonance Imaging at a rate of 22-40% and does not give any symptoms. For this reason, when a hernia is seen in the MRI of the patient with low back pain, it is a serious mistake to directly attribute it to the hernia.
What non-surgical treatments are used in lumbar hernia? When is Surgery Necessary in Lumbar Hernia?
Rest can help heal a hernia or other low back pain by reducing intra-disc pressure and loading on the soft tissues around the vertebrae. The mattress should be neither hard nor soft enough to collapse. The patient can lie on his back, right or left side position. You should rest as much as your doctor recommends. The most important thing is to find a qualified specialist doctor who can distinguish the factors causing hernia and low back pain and to continue our life under his supervision. I had a method applied and treated, and now the thought that everything will go well is wrong. It is very important to apply multiple methods. Neither manual therapy, nor Prolotherapy, nor Neural Therapy, nor dry needling, nor stem cell applications are solutions alone. Methods such as cortisone, laser, ozone, hydrotherapy, and radiofrequency cannot produce a definitive solution for hernia. Leech, cupping (can be used as an adjunct) and creams applied from the surface do not have a solution-producing effect. The surgery is only required in 1-2% of the cases, and stool and It is considered in cases of urinary incontinence, deterioration in sexual functions, and progressive loss of strength despite all kinds of medical treatment and prevention (not the only method). and flexibility to certain degrees and may render the patient mildly or severely disabled. Whether the surgery is endoscopic or microsurgery is attractive, but it does not prevent damage to the disc because it reduces the volume like open surgery.
What Should Those Who Have Back Hernia Pay Attention?
- Sudden movements should be avoided
- Do not lift heavy, pay attention to the weight of the lifted objects
- Light sports should be done, avoid forcing the waist
- Do not stay in the same position for a long time
- While bending, care should be taken to bend the knees and bend the waist straight.
- Do not do any movements that will force or injure the spine.
- Should not gain weight, those who are overweight should definitely return to normal
- Light backpacks should be preferred over handbags.
- Do not stand too long
- It is preferable to sleep on your back or side
- Sit upright and support the back