- Hernia of the spine - how does the disc work?
- Hernia of the spine - symptoms
- Hernia of the spine - treatment
- Spinal hernia - causes
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VERIFIED CONTENTConsultation: Jakub Placzki, physiotherapist from Carolina Medical Center, clinic of orthopedics, spine surgery and rehabilitation
Spine hernia is a concept shrouded in many myths. One of them is the colloquial phrase: disk loss. The hernia of the spine is a problem that affects younger and younger people. Is it dangerous to our he alth? What are the causes and symptoms of a spinal hernia? How is her treatment going?
Spinal herniais the protrusion of the nucleus pulposus of the intervertebral disc and the disruption of the fibers surrounding the nucleus of the fibrous ring. This may result in local inflammation in the form of pain, and sometimes also irritation of the peripheral nerves emerging in a given segment.
If this happens, it can manifest as sciatica pain. We also speak colloquially about a disc herniation: disc prolapse, but physiologically nothing falls out in this place and - more importantly, it cannot be adjusted!
The hernia of the spine may appear in a single intervertebral disc or in several segments. In 80% of cases, it affects the lumbar region - the most overloaded part of the spine. Research shows that 30% of 20-year-olds and 40% of 60-year-olds have a hernia in the lumbar spine, but what is worth adding - they are often asymptomatic. 20% of spinal hernias occur in the cervical region. It also happens occasionally in the thoracic region.
Hernia of the spine - how does the disc work?
The intervertebral disc, colloquially known as a disc, is a type of flexible element that separates the consecutive vertebrae of the spine and absorbs the loads that the spine is subjected to. It is made of an internally located nucleus pulposus, which changes its shape depending on our movements and the load on the spine.
The nucleus pulposus is surrounded by a multi-layer fibrous ring woven from collagen fibers, which gives the shape of the disc. The intervertebral disc should sit between the vertebrae, be properly hydrated and subjected to regular movement without excessive strain in order to fulfill its functions.
During the day, when we sit or walk, the forces acting on the disk squeeze water out of it. At nightthanks to the diffusion mechanism, the disk absorbs water and swells. This is why you are taller in the morning than in the evening.
Injury of the intervertebral disc, usually due to sudden movement or the summation of microtraumas, has its causes much earlier in the form of long-term adoption of a static position (standing position loads the spine 4x more than lying, and sitting 6 times more), which leads to dehydration of the discs, impairment of their functions stabilization and atrophy of unused muscles that control micromovements of individual segments of the spine.
This micro-instability leads to the degeneration of the fibers of the fibrous ring, the subsequent layers of which are damaged and lead to further destabilization of the segment. A vicious circle forms.
The situation in which we carry something heavy, bend down, go for a run or sit in the car for a long time is only the last event that exceeds the strength of the tissue and results in the displacement of the nucleus pulposus into the area of the broken ring.
According to an expert
Jakub Placzki, physiotherapist from the Carolina Medical Center, clinic of orthopedics, spine surgery and rehabilitationJakub Placzki, physiotherapist from the Carolina Medical Center, clinic of orthopedics, spine surgery and rehabilitation
Why is the disk not falling out and why does it not need to be adjusted?
This is due to its construction. The very name "disk" leads us to misunderstanding. The disk is actually quite a rugged and compact structure.
Our unsanitary life sometimes causes the nucleus pulposus of the disc to break the fibers of the surrounding ring and penetrate between them. The fibers of the ring will heal partially and the disc may continue to function if slightly damaged. In case of severe damage, the contents of the nucleus may escape beyond the disc area and detach irretrievably. Then there is a chance that the body … will absorb the detached structure!
What about the tuning?
The popular manipulation of the spine is an action on the intervertebral joints located back from the disc, and the achieved therapeutic effect is probably achieved by a reflex mechanism that causes muscle relaxation and analgesic effect.
After an episode of pain in the spine, we are afraid to bend down for a long time and sometimes forever, for fear of recurrence of pain. This is a mistake! In order to learn to bend down correctly, to activate the necessary muscles, go to a physiotherapist for advice.
Please see how rice pickers work on Asian crops, people working with a shovel, an ax and other manual workers. They are not the most common patients in the clinicsphysiotherapeutic. Everyone needs movement including - full spine flexion.
One of the recommended activities in chronic back pain is swimming. Are you sure? Yes, but in moderation! It is not the relief of the spine in the aquatic environment that is the benefit, but the repetitive movement of high frequency. Should you go swimming then? Yes! 1-2 times a week for 30 minutes.
Hernia of the spine - symptoms
Pain is a symptom that accompanies an acute disc incident in all episodes. But its severity and other symptoms vary from episode to episode.
- Lumbar spinal herniacauses severe pain when bending or trying to straighten in the place where it occurs, that is, most often in the lower lumbar region. This pain can cut the legs, is sharp and sometimes makes it difficult to move. It can also radiate through the buttock to the leg. Colloquial "sciatica" may be a symptom of a hernia in the lumbar region. However, in practice, these symptoms often have their origins elsewhere. In addition, there may be numbness, tingling in the legs, sensory disturbances, muscle weakness and even paresis. These symptoms should not be taken lightly and consult a doctor as soon as possible.
- The cervical spine herniamanifests itself more secretly. Initially, it is just a slight pain and stiffness in the neck and difficulty making free head movements. Then you start to feel tingling and stiffness in your hands. Common symptoms of a cervical spine hernia are headaches and dizziness.
Hernia of the spine - treatment
In the first - acute phase, it is worth leading a sparing lifestyle, looking for a position that gives relief from pain (often lying on the back with bent but supported legs). It is worth visiting an experienced physiotherapist who will help relieve local swelling, which is a natural effect of inflammation, will alleviate the discomfort of the stiffened and sensitized tissues surrounding the injury site, and show the first safe movements.
In case of severe pain, doctors (orthopedists or neurologists) also recommend anti-inflammatory drugs, painkillers or muscle relaxants. Recurring pain episodes should be diagnosed to confirm the diagnosis, assess the degree of injury, and exclude possible other pathologies. The first examination of choice should be X-ray, and often additionally also MRI.
When the pain has subsided, it is worth returning to your normal lifestyle as soon as possible, avoiding exerting yourself and long standing and sitting. Our spine likesrepeated movement without heavy loads, hence activities such as walking, swimming, pilates or properly conducted physical exercises will nourish the healing area and return to fitness. These activities should be implemented gradually under the supervision of an experienced physiotherapist.
Properly selected exercises and forms of movement agreed with the physiotherapist should also be practiced after a pain incident to avoid its recurrence.
In cases of serious complications such as foot drop, muscle weakness, urinary incontinence or faecal incontinence, or limb sensation disorders, spinal hernia surgery may be required.
In this situation, you should immediately consult a neurosurgeon who, after an appropriate examination, will qualify and perform the procedure. After the procedure, you should also start the spine, strengthen the muscles and learn safe movement thanks to the support of a physiotherapist.
See also: Exercises for discopathy - which will help and which should be avoided?
Spinal hernia - causes
It may be the result of an injury, e.g. when lifting a load, but this injury is often affected by the structure of the fibrous ring, which has been damaged over the years. This is caused by the progressive dehydration of the discs with age, as well as dehydration and the load on the spine associated with a sedentary lifestyle.
This sitting is interspersed with spontaneous activity, often without preparation, without proper warm-up, without rational load management, and this is when microdamages arise in the weakened structure, which add up to an injury.
The weakening of the trunk muscles, which occurs due to a sedentary lifestyle, plays a very important role in the formation of a spinal hernia. It is the lack of proper muscular stabilization and movement control that makes us unable to bend down, which results in injuries during this movement.
The best spinal hernia prophylaxis is a movement appropriate to age and physical fitness, which does not overload the spine. The recommended ones include marches, Nordic walking, pilates, tai-chi, some forms of yoga, and swimming (in reasonable amounts).
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