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Lumbar disc herniation happens when the discs between the vertebrae of the spine, which act as shock absorbers, are pressed and change shape or rupture, which can put pressure on the nerve roots near the spinal disc, causing symptoms such as pain, tingling or numbness in the legs.
Lumbar disc herniation is more common in the elderly due to the natural aging process, but it can also occur due to obesity, carrying excess weight or weakening of the abdominal and back muscles that support the spine.
It is important to consult an orthopedist when symptoms of lumbar hernia are identified so that the diagnosis can be made and, thus, the most appropriate treatment can be indicated, which can be done with medication, physiotherapy and, in more severe cases, surgery.
In most cases, lower back pain is the first symptom of a herniated disc. This pain can be constant or get worse with movement and last for a few days, then get better. Other symptoms of lumbar disc herniation can include:
- Back pain at the end of the spine, which can radiate to the buttocks or legs;
- Numbness or tingling sensation in the legs and/or feet;
- Weakness in legs and/or feet;
- Difficulty moving;
- Burning or tingling sensation in back or buttocks.
Also, in the most severe cases of compression of the pelvic nerves, the person may lose bladder and bowel control.
Although lumbar disc herniation is more often diagnosed due to the presence of low back pain, many cases are discovered in spinal imaging exams, without the person having symptoms.
How to confirm the diagnosis
In most cases, the diagnosis of lumbar disc herniation can be made based on the symptoms presented and clinical examination in which the orthopedist or neurosurgeon specialized in the spine, test the neurological reflexes, muscle strength and sensitivity of legs and feet and the ability to walk.
In addition, the doctor may order imaging tests such as spinal x-rays, MRIs, or CT scans to check the location, type of injury, and which nerves in the lower back are affected.
The most common cause of lumbar disc herniation is related to the natural aging of the body, in which there is a gradual wear and tear of the lumbar spine discs, because as the person ages, the discs become less flexible, can tear or break more easily. In addition, people who have very weak abdominal or back muscles, or who are overweight or obese, can develop lumbar disc herniation, due to overloading the back.
Other causes of lumbar disc herniation can be poor posture, using the back muscles instead of the leg and thigh muscles to lift heavy objects, or abruptly twisting or turning the back, for example. In addition, smoking is also related to the development of lumbar disc herniation by decreasing the amount of oxygen to the lumbar disc, causing it to decompose more quickly.
Rarely, lumbar disc herniation is caused by some trauma to the spine, such as a fall or some aggression to the back, such as a knock or blow.
How the treatment is done
Treatment for lumbar disc herniation should be indicated by the orthopedist or neurosurgeon with the aim of controlling and relieving pain and should include activity modification to avoid movements that cause pain, for example.
The main treatments for lumbar disc herniation include:
Treatment with medication prescribed by the doctor can be done with the use of oral anti-inflammatory pills such as ibuprofen or naproxen, analgesics such as paracetamol or codeine, or muscle relaxants to reduce the contraction of the lumbar muscles that can cause more pain.
In cases where the person does not have improvement of symptoms with the use of oral medication, the doctor may recommend injections of corticosteroids that can be applied in the area around the nerves of the lumbar spine.
Physiotherapy helps to relieve the symptoms caused by lumbar disc herniation and to recover movements, and can be performed daily, or at least 3 times a week, in case of acute pain.
The physical therapist should create a specific treatment program to speed recovery, including exercises to stretch and strengthen the muscles of the abdomen and lower back, or use devices to control pain and inflammation, as well as treatments to at home.In this way, physical therapy can help you return to normal activities and lifestyle.
The time it takes to cure the condition varies, but results can be achieved in 2 to 8 weeks or less when proper posture, pain reduction, stretching and strengthening program are implemented.
Depending on the person's he alth status, some pilates or global postural reeducation (RPG) exercises can be performed under the supervision of a physical therapist, but weight training exercises are contraindicated, in most cases, at least, during acute pain.
Watch the video with physical therapist Marcelle Pinheiro with physical therapy tips for lumbar disc herniation:
Surgery for a herniated lumbar disc may be indicated by a doctor when other forms of treatment have not been enough to improve symptoms after six weeks, especially if the person continues to have unremitting pain, weakness in the legs, or in the feet, difficulty standing or walking, or loss of bladder or bowel control.
Several techniques can be used for surgical treatment, such as using a laser or opening the spine to remove only the protruding part of the lumbar disc. Rarely, the entire disc must be removed, and in these cases, it may be necessary to join the vertebrae using a bone graft. Learn more about herniated disc surgery.
Lumbar hernia surgery is always the last treatment option and is directly related to the patient's quality of life, being performed when the quality of life becomes very bad. In the postoperative period, the person must remain at rest for the first few days, avoiding exertion and starting physical therapy usually starts after 15 to 20 days of surgery and can last for months.
Care during treatment
Some important measures during the treatment of lumbar disc herniation are:
- Take the medication at the correct times, as directed by the doctor;
- Do the exercises at home recommended by the physical therapist to strengthen the muscles of the back and abdomen;
- Applying cold compresses to the lower back for the first two days to relieve pain and inflammation;
- Apply warm compresses to the lower back after the first two days to relieve pain and discomfort;
- Avoid resting for too long as staying in bed can cause stiff joints and weak muscles, which can complicate your recovery
- Rest in a comfortable position for 30 minutes and then take a short walk;
- Avoid exerting that could make the pain worse such as carrying weights or squatting;
- Make slow, controlled movements, especially when bending forward or when lifting;
- Resume daily activities gradually, avoiding efforts that could cause the pain to reappear.
In addition, you should maintain good posture, keeping your back straight and aligned, especially when sitting, as it helps to reduce pressure on the spine and vertebral discs, and relieve low back pain and discomfort.
It is important to follow the doctor's instructions so that the pain improves and recovery can occur more smoothly.