Lumbar Disc (Disc Herniation)

Written by Esther Lok

The spinal discs, also called intervertebral discs, are located between each vertebra from the lumbar, and thoracic to the cervical spine. They act as shock absorbers and tough connective tissue to hold the vertebrae together. At the same time, they are cartilage joints that provide joint stability and allow some range of movement in the spine.

The lumbar discs are the disc within the lumbar spine area. They are built to take the pressure and physical load during daily activities. At a younger age, disks contain high water content. However, degenerative changes like the normal ageing process may cause the disc to lose fluid and become compressed by the vertebra. At this stage, overpressure may cause irritation, strain, or even push the content out of place. It is known as disc herniation.

Signs and symptoms that may happen with a lumbar herniated disc include:

• Lower back pain
• Sciatica is a general term that refers to nerve irritation and people suffering from neuro symptoms. In this case, it means an affected disc pressed on a nerve that causes pain.
• Pain radiates from the lower back or buttock down the leg. Normally it feels like shooting pain.
• Pain aggravated after prolonged standing or sitting.
• Numbness or Pins & Needles that occur in the affected leg caused by nerve root compression.
• Weakness in the leg or foot due to the muscles that are served by the affected nerve, it may cause you to stumble.
• Some people can lose bowel or bladder control due to cauda equina. It is an extremely rare condition where multiple lumbar and sacral nerve roots are compressed and affected.

Most lumbar disc herniation is often gradual onset. Disc wear and tear is a common condition when people grow older. While the firm outer layer of the disc gets dehydrated over time, it develops a crack. When the disc becomes less flexible, the inner jelly-like layer is more prone to push through the crack with even a minor twist or a load. As a result, it causes the disc to herniate.

Besides gradual onset, disc herniation can also result from a traumatic event such as lifting a large and heavy object, a fall incident or a direct blow to the back.

Moreover, several risk factors may contribute to increasing the risk of disc herniation. First, excess body weight can increase the pressure in the lower back, causing extra stress to accumulate in the lumbar spine area. Thus, increasing the risk of disc herniation.

Also, repetitive movements such as pulling, lifting, bending or twisting with or without load are very demanding for the lower back joints and muscles. The nature of occupation will certainly impact people with back problems.

Other than that, disc herniation can be hereditary. If you have a family history of disc herniation, you are likely to have it too.

Smoking can decrease the oxygen supply to the disc, causing it to dehydrate and damage more quickly.

Long-duration sitting positions, plus the vibration from the car engine can increase pressure in the lower back area. Thus, frequent long hours of driving is another risk factor.

Last but not least, people with a sedentary lifestyle are prone to develop a herniated disc due to general weakness and poor support in the lower back area.

To understand if you have a herniated disc, you can see a medical professional or a GP. A herniated disc will be suspected if you have lower back pain with radiated leg symptoms. In addition to a complete discussion about your signs & symptoms and the medical history with the professional, you may undergo a physical examination and imaging studies.

A neurological examination will be completed by a medical professional The exam will test your muscle strength, sensation, reflex and upper motor neuron sign. Some specific tests such as straight leg raises will be helpful to indicate nerve irritation.

For diagnostic imaging, the most common use scans are Magnetic Resonance Imaging (MRI), X-ray, Myelogram, Computed tomography scan (CT scan) and Electromyography (EMG).
X-ray is a scan that shows bones, while an MRI shows organs and soft tissues, including intervertebral disks. MRI is the best imaging study to support the diagnosis of a herniated disc.

The Myelogram uses a contrast dye injection to look for problems in the spinal canal. The CT scan uses x-ray and computer technology to scan the body from multiple directions. It can show bones, fat and organs. EMG uses nerve stimulation techniques to measure muscle responses and electrical activities. These techniques are only used when the health care professional thinks MRI is inconclusive and other conditions may be indicated.

For the majority of cases, a herniated lumbar disc will gradually improve over 4 to 8 weeks. Most patients are pain-free after 4 months. Although some patients still experience pain during their recovery period, initial herniated disc treatments are non-surgical treatments.

• Resting at the first onset will usually help relieve back and radiated leg symptoms. However, try to resume activities as pain tolerate because a decreased activity level may lead to muscle loss and aggravated symptoms. Here are some suggestions below:
• You may spread out your daily task and rest in between activities.
• Prevent sitting for long periods.
• Make sure you break down your task and do not overdo it.
• Keep your physical activities low-intensity and controlled.
• Avoid any aggravating factors.

1. Manual Therapy

• A medical professional may provide exercises to strengthen the back and abdominal muscles, as a result, give extra support to the lower back.

2. Nonsteroidal anti-inflammatory (NSAIDs)

• Anti-inflammatory medication can help pain control.

3. Steroid injection

• A steroid injection is an effective way to reduce inflammation. It provides short-term pain relief by injecting the medicine around the nerve. There is good evidence that it benefits people who suffer from disc herniation for more than 6 weeks.

4. Surgical treatment

• Surgical treatment is only advisable if all the conservative treatments are not working and symptoms are persistent.
  Microdiscectomy is a commonly used procedure to treat disc herniation. It only involves a small incision at the herniated level. The herniated part that compresses against the nerve will be removed.

To prevent disc herniation, maintaining a healthy lifestyle is important. You may engage in regular exercise, maintain a healthy weight and work in a good posture can lower the risk of lumbar disc injury.

Exercise that benefits disc herniation recovery includes strengthening the core, lower back and hip muscles. Pilates is a good tool to reactivate our weak muscles but not too aggressively at the same time. Pilates focus on posture, flexibility, mobility and core control. It improves your strength, breathing and body conditioning. While it is a slow and controlled movement activity, it is relatively safer than other sports.

You should contact your healthcare provider if:

• The pain increase in the lower back
• Leg pain worsens than lower back pain
• Start to develop numbness or tingling in both legs
• Loss of bowel or bladder control
• New onset of constipation
• Sudden change in sexual function