Health - Conditions
By: - at June 24, 2013

Herniated Disc: Symptoms and Treatments

Woman with back painThe backbone has two important functions. First, it is part of the skeleton: the frame of bones that gives the body its shape. Lastly, it supports and protects the spinal cord from damage by external forces. The spinal cord is part of the delicate nervous system that relays messages from the brain to other parts of the body. These important functions have earned the backbone three other names: vertebral column, spinal column, and spine. Twenty-four separate small bones build up the backbone. It stretches from the skull to the pelvic bone. The hollow in the bones forms the spinal canal through which the spinal cord passes. Circular pads of cartilage, usually called intervertebral discs, separate the ends of neighboring bones. They prevent the ends of the bones from rubbing against each other. Therefore, they protect the bones from fast wear and tear. Furthermore, they cushion the backbone from shock. The outer cover of the disc is a thin tough cartilage whereas the inner part consists of a jelly like substance. If you engage in activities that subject the disc to high pressure, the cartilage can rupture and enable the jelly to protrude into the spinal canal. A herniated disc is a disc with a ruptured cartilage and protruding inner substance. This article describes herniated discs: symptoms, causes, diagnosis, treatment, and prevention.

Symptoms of Herniated Disc
A herniated disc causes symptoms if its protrusion compresses the spinal cord or a nerve root. The symptoms depend on its location, how large the protrusion is, and the nerve root it compresses. It can compress no nerve, a single nerve root, or the entire spinal cord. First, there can be little or no discomfort if the protrusion is small and it does not affect any nerve. Second, a slight compression on a nerve root can cause numbness, tingling, and muscle weakness along the areas it innervates.

Third, a large protrusion can subject a nerve root or the spinal to very high compression and cause persistent unbearable pain and paralysis in the lower back, neck and areas the affected nerves innervate.

Fourth, a herniated disc in the lumber region can affect the sciatic nerve, which innervates the buttocks and legs. Consequently, the patient can experience the symptoms in the buttocks, a condition called scartica. Furthermore, if the herniated disc is the one that separates the lumber vertebrae L3 and L4 or L4 and L5, a male patient can suffer erectile dysfunction.

Lastly, the patient usually experiences the symptoms on one side of the body. However, a high compression of the spinal cord or the cauda equina nerve can cause the symptoms in both sides of the body. The cauda equina nerve is in the lumbar region. High compression on this nerve can permanently damage it and cause paralysis: cauda equina syndrome.

Causes of Herniated Disc
The main causes of herniated discs are shock and wear and tear. First, a sudden shock on the backbone can cause disc rupture. For instance, the backbone can be subjected to sudden shock in a motor vehicle accident or fall on the stairs. Furthermore, lifting heavy objects can cause a herniated disc.

Second, activities that subject people to constant squatting or sitting cause most cases of herniated discs. With time, these activities cause high wear and tear on the outer cover of the discs. Worn out discs easily rupture when subjected to trauma such as when lifting a heavy object. Chronic back tiredness and minor back pain are symptoms of general wear and tear of the discs.

The internal pressure on the disc is even when you are lying down or standing. However, the disc internal pressure is disproportionate when you are bending: the side of the disc that faces the stomach gets higher compression than the opposite side. This pressure can build up to very high values: up to 300 psi. Therefore, disc rupture usually occurs on the side facing the stomach. Such a rupture usually occurs when bending forward or sitting. The rupture occurs when high pressure from bending bears on the outer cartilage already thinned from wear and tear. Lastly, some people inherit the risk of developing herniated discs.

Location of a Herniated Disc
spinal x-ray of neckThe backbone has three distinct sections. Each section comprises individual bones called vertebrae. First, the cervical spine is the neck section. It has seven vertebrae designated as C1 to C7. C1 is the vertebra attached to the skull. Second, the thoracic spine is the section in the thorax. It has twelve vertebrae designated as T1 to T12. T1 is the top one attached to C7. Lastly, the lumbar spine is the section in the lower back. It has five vertebrae designated as L1 to L5. L1 is the top one attached to T12. Furthermore, part of the pelvic bone called the sacrum is below the lumber. It has five individual bones fused together and usually designated as S1 to S5. S1 is the top one attached to L5.

Most cases of herniated discs involve discs in the lumbar region: ninety five percent of cases. They usually involve the discs between L5-S1 and L4-L5. A herniation of either or both of these discs causes the symptoms in the toe, genital area, anal area, thigh, buttocks, and lower back. It usually affects the sciatic nerve and can lead to a condition called sciatica. Furthermore, it can affect the perineal nerve, which innervates the genital and anal areas. Besides, it can affect the femoral nerve and cause pain, burning sensation, tingling, and/or numbness in one or both feet, legs, and hips.

The second most common cases involve discs in the cervical region especially those between C5-C6 and C6-C7. A herniation of either or both of these discs can cause the symptoms in the hand, arm, shoulder, scapula, shoulder girdle, neck, and skull. It usually affects the brachial plexus and cervical plexus nerves. Cases of herniated disc in the thorax region are few: only about four percent.

Diagnosis of Herniated Disc
It can take some time before doctors diagnose a herniated disc because initially the patient complains of pain in remote areas of the body such as feet, knees, or thighs. Apart from pain, the patient can experience weak reflexes, numbness, paresthesia, tingling, paralysis, and muscle weakness.

The doctor can perform physical examination to diagnose a herniated disc. The type of examination he performs depends on the symptoms and health history of the patient. Furthermore, he can perform tests to confirm herniated disc and rule out other health problems with similar symptoms. The tests can also determine the best treatment option. The doctor can use one or a combination of the following seven physical examination methods.

First, the Straight Leg Raise (SLR) is a simple test for herniated disc. However, it is a very sensitive test to confirm or rule out herniated disc, sciatica and low back pain. The patient lies on the back and raises one leg without bending the knee. If the patient feels pain, the doctor repeats the test while flexing the leg about the pelvis. The test is positive if the leg raise with flexing does not cause pain. A positive SLR confirms the presence of herniated disc, sciatica or low back pain. .

Second, x-ray cannot produce images of soft tissues such as nerves, muscles, and discs. However, it can show fractures, infections, and tumors. Therefore, it is an inexpensive method to begin with because it helps rule out these problems and strengthen suspicion for herniated disc.

Third, Computed Tomography scan (CT or CAT scan) uses the computer to interpret x-ray images. It can show the size and shape of the spinal canal, the spine, and objects around the spine including soft tissues. However, it cannot confirm a herniated disc. It helps rule out other problems.

Fourth, Magnetic Resonance Imaging (MRI) uses computer technology and powerful magnets to produce three-dimensional images. It produces clearer images of soft tissues than CAT. It can show nerve roots and their vicinity, tumors, and spinal cord. Therefore, doctors use it confirm the presence of a herniated disc especially if the magnetic field used has high strength. T2-weighted images can produce a clear image of the jelly substance from the disc protruding in the spinal canal.

Fifth, Myelogram consists of taking x-ray images after injecting a contrast material into the spinal canal. Doctors use it together with CT scan. It can clearly show a herniated disc and other structures such as bone spurs and tumors. Sixth, Electromyogram and Nerve Conduction Studies (EMG/NCS) measures electrical impulse in muscle tissues, peripheral nerves, and nerve roots. The test can show nerve damage, healing nerves, and compressed nerves. The doctor can use it to confirm the location of a herniated disc.

Lastly, Transcranial Magnetic Stimulation (TMS) test can show if and where the spinal cord is compressed. Furthermore, it can show how severe the compression is. It consists of measuring the time a nerve impulse takes to travel from brain to the end of lumbar, thoracic, or cervical spinal cord. To perform the test, the doctor stimulates the impulse in the brain with a high-intensity magnetic field. He passes the magnetic field into the brain very briefly. Therefore, it is noninvasive. TMS can enable the doctor to confirm spinal cord compression, location of the compression, progress of treatment, and cause of the compression.

Treatment of Herniated Disc
Back pain therapyIf given time, herniated discs usually heal without much intervention. However, the patient should avoid activities that can aggravate the herniation. Therefore, doctors usually recommend rest. During the period of rest, the doctor can prescribe painkillers and anti inflammation drugs to help manage the pain. Furthermore, he can recommend non-medical approaches such as gentle exercise, rehabilitation, anti-depressants, and physical therapy.

This period of rest usually frustrates patients because of the persistent unbearable pain, taking a lot of pain management medicine, inability to perform normal duties and feeling of neglect. The doctor monitors the healing progress during the rest period that may take up to six months. If these conservative measures do not relieve pain, the doctor can perform surgery to correct the herniated disc, as a last resort.

The doctor can recommend conservative treatment methods depending on the condition of the patient. They usually consider severity of both the pain and injury. The severity of the injury can be minor and result in minor discomfort. However, a major injury can cause unbearable pain and restrict movement. An MRI test can show the severity of the injury.

You can use the following five conservative treatment methods if diagnosed with a herniated disc. Your doctor can advise which methods can work for your case. First, spend most of your time lying down: avoid sitting and bending. Lying down gives your body the best opportunity to heal. However, avoid the bed and couch. Instead, use a duvet on the floor because it offers maximum support for your body. You should lie on your back most of the time to keep your spine straight. When lying on your back, you should bend your knees to raise your legs slightly to reduce pressure on your spine. Therefore, place some pillows under your knees.

Furthermore, you can lie on your side with pillows between your legs. However, avoid lying on your stomach because it makes the joints stiffen. Second, you should perform gentle exercises. Inactivity can make the joints accumulate fluid and expand. This makes them become more painful. Take a stroll several times during the day. You can also perform slow push-ups. Furthermore, you can swim. Swimming provides gentle exercise because the water supports your body.

Third, do not use the bath: use a shower instead. In the bath, you cannot keep your backbone straight. Therefore, the bath helps aggravate the pain. Fourth, try to keep your mind off the pain, which seems to intensify during the day. You can read or watch movies while lying on your back. The pain will become unbearable if you idle about feeling sorry for yourself. Lastly, use the pain management drugs prescribed by the doctor and report to him if they do not work for you. A combination of painkillers and anti-inflammatory can help manage the pain. For instance, you can take ibuprofen and tramadol. If the pain persists for more than six months, the doctor can decide to perform surgery.

Surgery - Doctors resort to surgery when the conservative methods of treatment fail, for an emergency case such as cauda equina syndrome, or when the patient has significant impaired functionality of the nervous system. The doctor can perform the surgery to remove part of the disc and release the compressed nerve.

Prevention of Herniated Disc
Squating 135 lbs of weightIndividuals and health authorities can take the following measures to help prevent cases of herniated discs. First, authorities should educate the public and create awareness on the problems and prevention of herniated disc. Second, you should avoid lifting heavy weights. Do not lift weights beyond your capability.

Third, you should maintain proper alignment and posture of the backbone to avoid degradation of the discs. Poor posture causes wear and tear on the discs. Bending increases the risk of herniated disc. Furthermore, if your work involves long hours of sitting, then you should use a proper seat and perform exercises that help firm your back muscles.

Fourth, you should avoid overworking yourself. Furthermore, you should give your body some rest after a strenuous activity. Do not work until you feel fatigued. Symptoms of fatigue include loss of the deep stomach muscles, shaking, burning sensation in the muscles and poor coordination. If you engage in activities that subject the body to high stress, such as weightlifting, you should use barbells to strengthen the muscles. Furthermore, you should use lumbar sacral support belts to confine movement of the backbone during lifting.

Lastly, you should perform exercises that help firm your back muscles. Such exercises include floor bridges, transverse abdominal bracing, and prone press-ups. Abdominal bracing exercises can help prevent disc and joint injury.





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