Back Pain A Look at Lumbar Disc Herniation Causes, Symptoms and Treatment - National Sports Performance
Lumbar disc herniation is common among fit/athletic individuals as well as the general population, presumably because humans stand in the erect position. However, according to the journal "American Family Physician" there is more intradiscal pressure in the seated positions and bending postures, then in standing and recumbent positions. The most common vertebrae for a herniated disc are L4-5 and L5-S1. The intervertebral disc is responsible for the attachment of vertebral bodies to one another; providing flexibility, absorbing and distributing the loads applied to the spinal column . Arnheim states, "intervertebral pressure was decreased by 75% in the supine position and 25% in the side lying position. Pressure was increased by 33% while sitting, 33% while standing when slightly bent forward, 45% while sitting when slightly bent forward, 52% while standing when bent far forward, and 63% while sitting when bent far forward." Through degeneration, wear and tear, or trauma (as seen in many sports); the fibrous tissue (annulus fibrosus), containing the soft disc material (nucleus pulposus), may tear. This can result in protrusion of the disc which is termed, herniated disc.
With a lumbar disc herniation, the nucleus pulposus herniates through the annulus fibrosus and presses against the nerve root. When the nerve root is compressed, it will produce pain in the distribution of the nerve. The onset of symptoms are typically characterized by sharp, burning, stabbing pain radiating down the posterior or lateral aspect of the leg, to below the knee. For this reason, a herniated disc often resembles the condition, "sciatica". Pain is usually localized and superficial and associated with tingling and numbness. In advanced cases, motor deficit, diminished reflexes, or weakness may occur. A central herniated disc may compress nerve roots of the cauda equina resulting in difficult urination, bowel dysfunction, incontinence, or impotence. In such cases, immediate care is required for physical examination to prevent permanent loss of function .
A complete physical and neurological examination can reveal defects at specific levels. According to American Family Physician, the first assessment in the physical examination is searching for external manifestations of pain. Abnormal stance, posture and gait should be examined. Ligaments should be palpated for tenderness and range of motion should be evaluated. Motor, sensory, and reflex function should be assessed to determine the affected nerve root. This process is helpful in locating the source of the symptoms. Specific movements and positions that produce symptoms should be examined closer to determine the source of pain. If a health care provider suspects a lumbar disc herniation after examination, they may require to have one or more of the following procedures to verify diagnosis such as; a CT scan, MRI, Myelogram/CT, or EMG.
Most people, with a lumbar disc herniation, respond well to conservative treatment. Conservative treatment consists of limited bed rest, exercise, and in some cases injections. The optimal duration of bed rest is debatable but it is the common recommendation that 2-7 days is sufficient. Excessive bed rest can result in deconditioning and bone material loss. Exercise and massage techniques are used. Extension and isometric exercise are performed first. When strength is sufficient and pain relief is achieved, flexion exercises may be performed. Flexion exercises are delayed due to the load to the intervertebral disc it generates. Those who do not respond to conservative therapy after 4-6 weeks and have disabling pain, may be candidates for surgery.
Lumbar disc herniation is a common condition among the human population, occurring most in the L4-5 and L5-S1 vertebrae. Athletes watch your movements as some may be sharp twists and turns or in some cases a direct blow to the spinal region. Strengthening core muscles will reduce pain and can prevent some disc injuries if those muscles are strong. As you have always been told, always bend at the knees.
Sources: Arheim Daniel, D., Modern Principles of Athletic Training
"Clinical Evaluation and Treatment Options for Herniated Lumbar Disc," American Family Physician "Lumbar Disc Disease," NYU Dept. of Neurosurgery