Back pain - herniated intervertebral discs

Are you troubled by back pain or specifically by pain in the spine? Is your intervertebral disc pushing on the spinal cord, or on the nerve root, alternatively the nerve got inflamed as a result of the pressure? Did MRI or X-ray found degenerative changes on your spine? Did you go through rehabilitation but you still have remaining pain? Are you thinking about operation of the spine, but you would like to try something else?

PAIN MANIFESTATION

Back pain can be in the area of the spine or alongside it (local pain), the pain can shoot to the side or to the legs. It can trouble you only during certain specific activities (bowing forward, sitting for a long time, etc…), or it burdens your life constantly.

In this case we think about the pain appearing as a result of increased muscle tension that resulted from blocked lumbar spine, which was pushed by an incorrect movement and it is pushing on the nerve root. That is called disc herniation. The cause of the pain can be also resulting from pulled ligamentous system, arthrotic changes in the joints of the vertebrae, smaller damages in the intervertebral discs or osteophytes - bone spurs that irritate the soft tissues in the area of the spine.

HOW DOES THE DISC HERNIATION MANIFEST?

Typical manifestation for disc herniation is shooting pain (irritation) in the hips according to the affected segment of the spine. For example, if the intervertebral disc pushes on the nervous tissue between the fifth lumbar vertebra and the sacrum bone, the pain goes through the typical belt from buttocks to the sides, down through the inner side of the thigh to the calf and to the toes. In other movement segments, the pain goes through a different pathway.

Sometimes the pain goes only to the level of the hip, and in other cases it shoots all the way down to the knee or toes. The distance where the pain shoots is depending to the pressure of the disc on the nerve, simply said it depends on the degree of the mechanical damage. The more the discs is herniated, the more it pushes on the nerve, which shoots the pain further. When the pain backs up towards the spine (it gets centralized), we consider it to be a manifestation of healing, that means the disc is returning back to its original place.

If the intervertebral disc pushes just on one side, the affected person feels pain in the hip or leg of that side. In cases the disc creates pressure on both nerves, or on the center of the spinal cord, the pain appears in both sides.

CAN THE INTERVERTEBRAL DISC DAMAGE THE NERVE WITH THE PRESSURE?

Yes it can, because constant pressure on the nerve root causes its disappearance (so called pressure atrophy). It is manifested in less serious cases by lowered muscle strength in the leg, dropping knees, loss of sensitivity in the affected area, and in the more serious cases it can result even in disorder of the external sphincters and urethral sphincters (fecal and urinary incontinence), and loss of mobility and sensitivity. From the functional examination it can be decided how serious is the pressure on the nerve, and from that determine the treatment method. It is between the doctor, physiotherapist and patient, when would be operation optional or needed, and when the physiotherapy would be enough, alternatively which physiotherapeutic method will be exactly applied.

The pressure of the disc can cause even inflammation of the nerve (nerve root).

STANDARD TREATMENT

Neurologist will prescribe you pharmaceuticals to lower the muscle tensions and pain (analgesics). Drugs can be in form of creams, pills, intravenous therapy or through pumps.

On the rehabilitation you can go through electro treatment, magneto therapy, ultrasound, hydrotherapy and exercises. From personal reasons i would mostly recommend exercises according to physiotherapist from New Zealand Robin Anthony McKenzie, who primarily deals with incorrect position of the intervertebral discs and their pressure on the nerves. His method is therefore going straight against the source of the pain and treating the cause. At the same time it functions preventively against another damage of the intervertebral discs.

WHAT CAN YOU EXPECT BY US?

We offer the option of general treatment without the use of medicaments, based on rich experience from a clinical practice, but also knowledge from lectures and development from abroad. We combine the physiotherapeutic session with mobilization and manipulation, meaning: exercises and application of focused shock wave therapy. We developed and named this service Focus All-inclusive.

Improved condition is visible already after first hour. The pain fades away quickly by lighter damages, and if the patient keeps our advices and principles, the success can be long lasting or even permanent. With more serious damages the pain and incontinence (urinary) fades away a little slower. The success is also the fact that you can walk bigger distances without the need to take a break and rest, and also that you can manage the urinary incontinence, or maybe you have few moments where you don’t feel any pain at all.

Extension in a supinate positionExtension While Standing Extension with applied pressure



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Source: Clinical experience in physiotherapeutic field, FYZIOklinika

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