As a physical therapist, it is quite likely that you will see many patients suffering from lumbar disc herniation; therefore, it is of the highest importance that you know how to help these individuals.

Man in pain with lumbar disc herniation

The discs within the spinal column play a highly crucial role in the functionality and comfort level of the lower back. As a practitioner, you know and understand that these components of the body act as shock absorbers for the regions in between the vertebrae.

They aid in supporting the upper region of the body and help in ensuring that the body is able to engage in a large assortment of movements in various directions. If damage occurs to one of the discs located in the lower back, a herniation may occur.

A lumbar disc herniation may then result in numerous complications for the sufferer.

The aim of the wise is not to secure pleasure, but to avoid pain…”Aristotle

Basic Anatomy

In order to effectively aid your patients with lumbar disc herniation, it is essential to have a solid understanding of the anatomy of the lower back region. In total, there are 5 bones in the lower back region, which are referred to as “vertebrae”. In between each of these is a type of padding that is tough, highly fibrous, and has the capability of absorbing shock.

These are called “discs”.

Blausen 0484 HerniatedLumbarDisc

 

Spinal disc herniation MRIEach of the vertebrae has a special type of plate that helps in ensuring the discs are held in place.

On the exterior region of the disc is a very tough band that is medically referred to as the “annulus fibrosus”. On the inside of each disc – behind the outer band – is a substance that resembles gel.

This is medically termed, “nucleus pulposus”.

A lumbar disc herniation occurs when the outer band develops a crack or breakage and the gel within the disc leaks. A lumbar disc herniation may also be called a “bulging disc”, a “herniated disc”, or a “ruptured disc”.

Risk Factors

Now that you have a solid understanding of the anatomy of the lumbar region of the back and know what happens when a patient experiences a lumbar disc herniation, it is now important to learn the risk factors associated with the development of this condition.

While there are many physical therapy steps that may be taken to help a patient with a lower back disc herniation, help may also be provided by educating patients on the risk factors and helping them reduce their risk factors, which include the following:

  • The first risk factor – as with most medical conditions and injuries – are the lifestyle choices that a patient makes. Those that elect to forego regular exercise, indulge in diets that are not considered to be nutritionally substantial, and indulge in activities that involve the use of tobacco and alcohol are at a much higher risk for developing a lumbar disc herniation.
  • The next risk factor associated with a lumbar disc herniation is poor posture. When a patient has poor posture, it is quite likely that they utilize poor body mechanics, too. Combined, these two factors result in the stress of the lower back region and its ability to function appropriately.
  • The final risk factor is the natural aging process. This results in many biological changes within the body. In the back, this biochemical process may result in the drying out of the discs in the back. As time progresses, this then reduces the resiliency and the strength of the discs, making them more susceptible to damage and herniation.

The Stages

The first and second technique to helping patients with lumbar disc herniation is to understand the anatomy of the lower back region and how a herniation develops and knowing which risk factors are associated with your patient. The third is to have a solid understanding of the stages associated with a lumbar disc herniation. This type of injury could happen in weeks, or it could happen over the course of several months. Regardless of how quickly it occurs, it always takes place within 4 different stages, which are:

  1. The first stage to a herniated disc is degeneration of that disc. In most instances, this is related to the chemical changes that result in complications of the disc.
  2. The next stage is the prolapse of the disc. In many instances, this is referred to as the “bulging disc” stage. It is during this time that the disc starts to result in some degree of impingement into either the surrounding nerves and/or the spinal canal.
  3. The third stage of lumbar disc herniation is when the inner gel of the disc experiences extrusion, or starts to break through the outer protective band of the disc.
  4. The final stage of a lower back herniation of the disc is referred to as the “Sequestration”. This is where the gel completely goes through the outer band and actually positions itself outside of the disc.

Helping Your Patients

Physical therapy is the ideal choice for patients seeking to recover from lumbar disc herniation. The strategies and methods that you go over with your patients offer relief to symptoms and help those patients to condition their body in such a way that future injuries may be prevented.

Passive and active treatments will work for your patients. The passive techniques that you may use for treatments include deep tissue massage, hot therapy, cold therapy, water therapy, the use of a TENS unit, and traction.

The active physical therapy treatments for patients with lumbar disc herniation include core stability exercises, hydrotherapy, encouraging exercises that aid in optimizing flexibility, and strengthening the muscles.

All patients should be provided with self-care methods that will help them cope effectively with their symptoms, without resorting to the use of medications and other medical treatments that could result in long-term effects. Ultimately, the goal of any physical therapist is to help a patient with lumbar disc herniation to live and to maintain a lifestyle that is naturally pain-free.

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Resources:
https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/
https://www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc-symptoms
https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095