Lumbar Herniated Disc (Herniated nucleus pulposis)
by Andrea Renshaw, M.P.T.
At any given time, over 31 million Americans have lower back pain. How can you know if it is muscular, arthritic or a herniated disc causing your pain? Does sciatica naturally mean you have a herniated disc? What causes the discs to herniate and what can you do to keep your spine healthy?
These are some of the most common questions asked about low back pain. This article serves to answer those questions and discuss the array of remedies and solutions to eliminate back pain naturally.
Over 80% of the disc herniations occur in the lumbar spine (lowest part of the back) between either the 4th and 5th lumbar vertebrae or the 5th lumbar vertebrae and the sacrum.
What Causes a Lumbar Herniated Disc?
The discs that lie between the vertebrae to absorb and allow for movement get damaged over time. The inner center of the disc is made of a gel-like substance, and the outer layer is more fibrous. With poor movement and alignment over the years, we create little microtraumas or small tears in the outer fibers of the disc.
Forward bending and rotation in combination are the most damaging to the disc. Handling baggage at the airport and getting in and out of your car incorrectly can increase your risk of low back pain and disc damage.
When you sit in poor posture, with a rounded low back, more pressure is placed on the front of the disc, sending the gel in the center towards the back of the disc - a bit like squashing a water-filled balloon between your hands.
Maintaining positions that damage the outer layer of the disc eventually cause it to break down, and cracks or fissures form, allowing a path for the gel on the inside to seep out. This break down is a long process of fissuring, bulging and eventual herniation.
You are no doubt familiar with the gradual creation of the Grand Canyon, where natural water flows eventually carved out a spectacular canyon through the rock. The gradual damage to the outer layer of your disc eventually allows the gel material in the center to find a pathway that leads to herniation of that inner material.
When the disc herniates into the small space in the spine, it presses on surrounding structures like nerves, ligaments and muscles. With disc herniations you can experience pain at the site of injury (back pain), or pain in the leg (sciatica) - or both.
Sciatica is a set of symptoms and not a diagnosis. These symptoms include pain, numbness, tingling, and weakness deep in the buttock and down the back of the leg to the foot, most often only on one side. Having sciatica does not naturally mean that you have a herniated disc.
Here's an example of how you can develop a herniated disc
You sit 6 - 8 hours a day at your desk, and also more at night. Your sitting position is with your lower back rounded and your head and shoulders forward. When you exercise, you go to the gym and do a lot of heavy weights and crunches. On weekends, you sometimes play a round of golf or an occasional softball game. You never stretch.
One day you notice some discomfort in your lower back, and it doesn't go away as quickly as usual. Your sleep gets disrupted because of the discomfort. You pop a few more Advil, and on Saturday afternoon, you go to the park to play a friendly game of softball, even though your back is still sore and you're tired. You take a few more Advil and don't warm up or stretch before the game.
In the last inning you're up. And you're determined to be the heroine (or hero). You wind up and tense your body, ready for the pitch and….as you swing with all your might you feel a sharp, agonizing pain in your lower back that brings you to your knees. And you strike out. You can't straighten up and your friends have to help you off the field.
After an MRI, your doctor tells you that you have a herniated disc at L4-L5. Do you think that one hit during a the softball game caused this?
The conditions of imbalance in your body that created the damage to your disc took years to develop and the softball game was merely the straw that broke the camel's back.
Common Remedies and Solutions
Anti-inflammatory medications like NSAIDs are often recommended to relieve symptoms. Muscle relaxants are sometimes given to decrease the muscle spasms.
Oral steroids and steroidal injections can also be used to decrease the inflammation.
Physical Therapy is also commonly prescribed. PT typically addresses immediate symptoms and gives you some basic reeducation for body mechanics, strengthening and stretching.
Natural remedies could include acupuncture, massage, relaxation techniques, and dietary changes to reduce inflammatory producing foods in your diet.
Sometimes surgery is indicated. The most common surgical procedure is the microdiscectomy. In this procedure, the involved nerve roots are decompressed by removing the piece of herniated disc that is compressing the nerve.
Surgery, however, cannot correct the poor posture and body mechanics or remedy faulty movement patterns. A comprehensive core stabilization and postural alignment program is a must, regardless of whether surgical intervention is required to decompress the nerve roots involved.
