Spinal disc herniation (herniated disc) is a common condition mainly in the lumbar spine but also the other degrees of the spine. At the same time it is and is the most common cause of pain in both the upper and lower extremities.
The intervertebral discs are located between the vertebrae and absorb the vibrations of the spine. Each disc is hard on the outside (fibrous ring) and contains a soft core inside, called the gel nucleus. Herniated disc occurs when the hard ring ruptures and the nucleus from the inside of the disc slides into the spinal canal and presses on a nerve.
A hernia can occur in any part of the spine, but the highest frequency is clearly seen in the lumbar spine, then in the cervical spine and much less frequently in the thoracic spine.
The risk factors for herniated disc are:
- Age: As we get older, our discs become damaged (corresponding to the deterioration of the skin and the appearance of wrinkles).
- Lifestyle: Lack of exercise, being overweight and smoking lead to poor intervertebral disc function.
- Poor posture: Poor posture and repeated weight lifting or waist turns cause stress on the discs.
This disease (disc disease) often occurs in young people, but also in middle and old age. Symptoms may include lower back pain (back pain) and leg pain (sciatica), and sometimes weakness (paralysis) and numbness of the leg.
The symptoms that appear vary depending on the severity of the hernia and its location.
Patients complain of acute or chronic low back pain (back pain), while in nerve root involvement there may be reported pain, numbness or paraesthesia in the lower extremities (sciatica).
Also often accompanied by muscle spasm, loss of lordosis in the waist and worsening of symptoms with coughing or sneezing. Sometimes analgesic scoliosis is created, ie distortion of the body, in the involuntary reaction of the person so that it does not hurt at the point where the root is pressed.
It should be mentioned here that in very serious situations, such as hippocampal syndrome, where there is weakness of the lower extremities, saddle type anesthesia, problems with urination, etc., immediate surgical treatment is required.
Diagnosis begins with a history and clinical examination of the lower back (lower back) and lower limbs. The diagnosis is then confirmed by magnetic resonance imaging.
The diagnosis of hernia is made accurately by magnetic resonance imaging (MRI), but plain X-ray is also useful in differentiating from other conditions, such as tumors, and stenosis of the intervertebral space on X-ray is an indication of possible hernia.
However, this does not mean that anyone with a hernia should necessarily be in pain or undergoing treatment, as a large percentage remain asymptomatic or the pain disappears over time.
Initial treatment of herniated disc should be conservative and focused on relieving pain and other symptoms. Research has shown that the vast majority of back pain is due to discogenic problems, with prominent projection or herniation of the intervertebral disc.
Drug analgesia, bed rest and conventional physical therapy using machines such as TENS, laser, diathermy and massage aim to reduce pain, but only provide a temporary relief and not a substantial treatment of the problem.
An appropriate program of exercises to strengthen the stabilizers and supporting muscles of the waist, seems to offer something more than the above means.
The McKenzie Method – Mechanical Diagnosis and Treatment (MDT) is a comprehensive system for the proper evaluation and treatment of back pain. An important advantage of the method, compared to the other approaches, is the prognosis from the first sessions, ie which incident will respond positively to treatment and which will not. This gives confidence and security to the sufferer and reduces the unnecessary waste of time and money on dubious treatments.
The other great advantage of the McKenzie method is that it is based on Self-Healing, through special individualized exercises that are designed based on the appropriate assessment that precedes, while no machines or drugs are used. Thus, little by little, the patient becomes completely independent of the therapist, as he is trained for a correct attitude in everyday life and eventually learns to manage his condition on his own, preventing any relapses in the future.
The McKenzie method has avoided a very large percentage of planned surgeries for herniated disc and now the method has gained the recognition of orthopedic surgeons and neurosurgeons. Thus, surgery is chosen only when a proper conservative treatment fails to reduce the patient’s symptoms or when there are severe neurological lesions with pressure on the nerves or spinal cord.
Kontzaelias DA, (2011). Physiotherapy in diseases of the musculoskeletal system, Publications: University Studio Press, Thessaloniki.