As much as 13% of medical consultations involve back pain, spine specialist Jonas Lenzi, from Hospital VITA, said in an interview with SEGS that only 15% of lumbar spine pain is related to herniated discs .
Types of herniated discs
Protrusions
It occurs when one disc becomes wider than the others, due to the destruction of some fibers of the fibrous ring, causing its dilation. The gelatinous liquid inside the discs remains in this disc, but because it is wider, its walls touch sensitive regions, causing the pain of the herniated disc.
Extrusions
It is due to the even greater wear of the fibrous ring, which causes the rupture of its last fiber, overflowing the gelatinous content that exists inside the discs.
Kidnapped
It happens when the wall of the disc breaks and the gelatinous liquid seeps into the spinal canal, up and down. This causes chemical pain, as the gelatinous liquid in the disc has acidic chemical properties, causing inflammation and continuous compression.
Causes of herniated discs
Posture
Every movement we make during the day requires a correct posture. Even when we are standing still, we need a posture. The spine asks for a correct posture, because it is she who structures our body, balances us and distributes forces and gestures. Thus, poor posture is one of the causes of herniated discs.
Disc wear
This wear and tear usually happens with people who carry excessive weight on the back muscle, as in the case of masons, who lift and carry a lot of weight. Wear, in itself, is a major cause of herniated discs.
Sedentary lifestyle
The absence of physical activities atrophy the muscles, cause sagging of the trunk and shorten the muscle fibers, changing the pressure on the disc joints.
Risk factors
Age
As the herniated disc is a degenerative disease, that is, the aging of the discs, advancing age is also one of its causes. It usually occurs between the ages of 30 and 55, on the discs in the lower part of the spine, which are the ones that work the most.
Genetic predisposition
The study “Genetic influence on intervertebral disc degeneration”, published in The Scientific Electronic Library Online (SciELO), proves that the genetic factor is present in this disease.
When studying the participation of some genes in the disc formation process, it was found that the family history of hernia is related to cases of disc state change in young people under 21 years old.
Smoking
Also according to the study “Genetic influence on intervertebral disc degeneration”, there is evidence that smoking increases low back pain , directly affecting the disc. What’s more, smoking causes chronic pain .
In one study, people who were separated into a group of smokers who reported back pain and did not stop smoking during treatment did not experience reported pain improvement, unlike those who stopped smoking during treatment.
Obesity
Once the spine supports the body weight, the more overweight the patient is, the more weight the spine supports, so the discs are damaged by overweight. The largest group of people characterized with herniated discs suffer from obesity.
Psychological and psychosocial factors
Studies have already shown that those who have a depressive tendency suffer twice as much from back pain. In this study, patients with constant spinal pain also complained a lot about psychological problems.
The anxiety and stress come here. Another psychological factor that triggers herniated discs is work overload, not necessarily physical, but as self-punishment for not reaching your goals.
Wearing high heels
The use of high heels causes postural changes when stepping, in addition to leaving the woman in tiptoe position. Thus, the heel region makes no effort and the chance of forcing the spine is immense. Therefore, this effort that the spine makes can affect the herniated disc.
Herniated Disc Symptoms
The main symptom of herniated discs is pain in the spinal region , but there are many cases in which the lesion is asymptomatic. In addition, depending on the affected disc, the pain can spread to other locations. Know more:
- Lesion in the cervical vertebrae: Characterized by pain in the neck, shoulders, arms, elbows and hands;
- Injury to the lumbar vertebrae: Pain in the lower part of the spine, which radiates to the legs and feet.
In general, the pain is only passed to other parts of the body when the hernia touches the nerve structures that cross the spine. It can occur in stages and the tendency is to get worse if left untreated.
Other sensations that may appear in the upper or lower limbs include:
- Tingling;
- Numbness;
- Weakness;
- Cramps;
- Crashes;
- Pain along the path of the sciatic nerve (spine, buttock, thigh and leg).
In most cases, the pain is more intense at night and worsens when performing movements (flexion of the lumbar spine, moving the neck, among others). As for the duration, some people report that it can disappear on its own, others that it is constant. There are also reports in which the pain returns at unexpected times.
In rare cases, the hernia can be between the last lumbar vertebra (L5) and the sacrum bone, which causes nerve compression in the area and can result in loss of urine control and bowel movement.
How is herniated disc diagnosed?
As a first step in the diagnosis, the doctor will listen to everything the patient has to say about this pain, seeking to learn more about the routine of the patient’s body and whether the report corresponds to the symptoms of the herniated disc.
Then, a physical examination is done, assessing the sites of pain. To assist in the diagnosis, the doctor may order additional tests such as X-rays, tomography, magnetic resonance and electromyography. Know more:
- Electroneuromyography: Identifies the nerve root and tests the nerve conduction speed, in order to diagnose any radiculopathy (compression of the spinal nerve roots);
- Magnetic resonance or computed tomography: Helps to visualize the lesion and the height of the compression of the nerve root;
- Spine radiography: Usually done to exclude other possible causes of pain, such as spine fractures;
- Myelogram: Invasive examination used to determine the size and location of the hernia when in doubt after an MRI scan.
Differential diagnoses
Back pain is not always caused by a herniated disc, so doctors can look for other causes of these pains. Some different diagnoses with similar symptoms include:
- Compression and / or inflammation of the sciatic nerve (citalgia);
- Myofascial Pain Syndrome;
- Spondylosis;
- Ostearthrosis;
- Piriformis syndrome.
Is there a cure for herniated discs? What is the treatment?
The herniated disc is curable , which occurs when the pulpy fluid is reabsorbed by the disc and a scar tissue takes the place of the destroyed fibers. For this, it is necessary to carry out the appropriate treatment and adopt measures that prevent further damage to the disc. In some cases, even without the total reabsorption of the pulmonary fluid, patients no longer feel the pain.
Treatment is done through physical therapy, weight training , pilates or surgery.
Physiotherapy
The patient who treats the herniated disc with physiotherapy maintains the sessions until the pain, discomfort and local inflammation end. The number of sessions varies from case to case and after this treatment a posture re-education and even pilates and hydrotherapy are advised.
In each case, the physiotherapist chooses which physiotherapy technique will be most appropriate, but, in general, techniques that help are those of manual physiotherapy, which are:
- Osteopathy: Physiotherapy technique that treats diseases through a palpatory approach at the site of pain and around it, manipulating the musculoskeletal system (bones, muscles and joints).
- Maitland: Technique that uses mobilizations that restore joint movements in five degrees, starting from the lightest and going to the heaviest. But the main focus of this treatment is on meticulous clinical evaluation.
- Mulligan: Repairs flaws in the position, also by means of joint mobilization. It is painless, therefore considered one of the most comfortable for patients. Some of the maneuvers of this technique are: mobilization of the spine with movements of the arms, natural sliding of the apophysis and mobilization of the spine with movement of the upper limbs.
- Articular mobilizations: Technique based on restoring joint movements and stretching, with the purpose of relaxing the muscles;
- Global postural reeducation (RPG): This is a technique that helps to relieve pain through movements that stretch the muscles potentially damaged by herniated discs, in addition to correcting the patient’s general posture.
In some cases, such as protruding hernias (without damage to the ligaments), the flexor -extensor bed can be used , since the extension of the ligaments of the spine can help to bring the hernia into the disc again.
Bodybuilding
Weight training is recommended due to its function of strengthening the muscles. One of the most common exercises in this case is the isometric exercises that develop tension in the muscle without changing its external length, basically as when we carry purchases: the muscles are under tension, but static.
When treating herniated discs with weight training, the movements in the hips, torso and spine should be lighter, so as not to aggravate the case. If there are crises, training should be suspended and the doctor should be sought. Exercises should never be done at home or without the help of a physical education professional.
Pilates
Like weight training, pilates strengthens muscles. The difference is that with pilates the patient needs to do the exercises recommended by the professional outside of classes as well. The most suitable for this practice is to work on the lumbar condition, strengthening and stretching the muscles.
Acupuncture
Acupuncture is an alternative technique based on oriental medicine that consists of applying pressure (through needles) at specific points to promote pain relief.
Although the scientific community has yet to prove its effectiveness, several published studies suggest that acupuncture is able to help in cases of chronic pain, but not for long. Therefore, it is worth mentioning that the practice does not dispense with physiotherapeutic treatment.
Steroid injections
In some cases, in patients with spasms and pain that do not respond to another type of treatment, steroid injections may be performed periodically. These injections, when applied directly to the spine, are able to control the pain for months.
It is important to remember that the prolonged use of steroids can have unpleasant and limiting consequences, this being one of the last alternatives to try.
Surgery
Surgery comes as a last resort, when the disease is already severe and none of the other techniques have had results. Some data state that only 5% of cases of herniated discs require surgery.
In case of surgery, the disc is removed and a similar material is placed, or an artificial disc, for the correct functioning of the rest of the discs.
Medicines for herniated discs
The drug treatment of herniated discs is usually based on analgesics and anti-inflammatory drugs, for pain relief. In addition, some doctors may also prescribe muscle relaxants and opioids.
It is important to remember that these medications are only part of the treatment , and are not the complete treatment itself. If medications are taken, but physiotherapeutic treatment is not done, the patient will return to pain in a short time.
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Living together
Living with a herniated disc can be challenging, but there are some tips that can help you recover from the injury. Are they:
- Take the medication as recommended by the doctor, always following his instructions;
- Make compresses with hot water or ice, as they help to relieve pain and inflammation in the area;
- Move around, as complete rest can cause problems for the joints and muscles;
- Perform stretches for muscle relaxation;
- Avoid physical efforts beyond limits, such as carrying heavy objects.
Herniated disc as a cause of retirement
Back pain occupies the second place in the ranking of the main reason for Brazilians to take leave of absence and herniated discs is in 3rd place in the ranking of causes of early retirement .
For Social Security, the impossibility of carrying out the work due to herniated discs is considered labor incapacity . Continuing to work aggravates the disease, leads to functional limitations that can disrupt brain signals and puts the patient at risk for life.
Complications
The spinal cord, nerve tissue that is found inside the spine, goes to the lumbar vertebrae, where it divides into a structure called “cauda equina”, because it resembles a horse’s tail. In the absence of treatment, the herniated disc can compress the entire cauda equina, causing the so-called cauda equina syndrome .
In such cases, emergency surgery can be performed to prevent permanent paralysis of the lower limbs. This syndrome also causes decreased bladder and bowel control, in addition to loss of sexual sensation.
How to prevent herniated discs
It is not always possible to prevent herniated discs, since it is a progressive degeneration of the intervertebral discs. This degeneration occurs naturally as the spine ages as a whole. However, it is possible to prevent wear and tear from occurring too quickly, which helps to keep the discs healthy for a longer time.
Some tips are:
- Correct posture;
- Use appropriate weight-lifting techniques;
- Do physical exercises or stretches frequently, preferably with professional monitoring;
- Avoid smoking;
- Control the weight;
- Adopt a healthy lifestyle with a balanced diet;
- Drink fluids frequently, preferably water, to avoid dehydration of the disc.
How to prevent already in childhood
Poor posture is one of the main factors that lead to herniated discs, so correcting children’s posture from an early age is essential for this prevention. Excess weight in backpacks also means that children can develop herniated discs later on, as they are making a greater effort than recommended.
Parents should encourage the child to have an active life from an early age, by practicing physical activities in the family. One should be alert to injuries that are annoying and also childhood obesity .
Herniated disc in pregnancy
The increase in weight during pregnancy makes back pain in pregnant women normal, since many need to lean back, increasing the lumbar curvature, to establish balance due to the weight of the belly.
To prevent herniated discs during pregnancy, one must take care of the posture and strengthen the muscles with pilates or weight training. The ideal is to talk to an obstetrician to make sure which exercises are indicated according to the period of pregnancy.
How to correct the posture?
To correct posture, you need to be aware of the way in which the weight is distributed throughout the body. This is because, to avoid spinal problems, it is necessary to distribute it evenly across all vertebrae. This distribution must be done in all activities of the day, even during rest!
Some tips for correcting posture and distributing weights more evenly are:
- When doing household chores, one should avoid leaning forward;
- Use a table high enough so that there is no need for inclination at work, both domestic and formal;
- To put on your shoes, the ideal is to sit and support one foot on the other knee, to be able to reach your feet without tilting your back;
- When carrying heavy objects, one must bend down, flexing the knees, and not bend over the object;
- It is preferable to use trolleys and other transport instruments to carry heavy objects;
- At bedtime, the mattress should be semi-rigid or foam, as these types help to distribute the weight better at night;
- One should avoid sleeping on his stomach, however, if necessary, it is recommended to use a pillow under the belly, to decrease the lumbar curvature;
- When sitting, the spine should be erect and forming a 90º angle with the thighs;
- If the chair has a back, the entire spine must be supported on the back, and not just the upper part (thoracic and cervical vertebrae).
