Therapy of a herniated disc of the lumbar spine

introduction

A disc prolapse of the Lumbar spine (Lumbar spine) can be treated in different ways. The therapy depends on the patient's symptoms, the severity of the herniated disc and the age and general condition of the person affected.

Basically you can choose between conservative and surgical therapy can be distinguished. In most cases you can use long term conservative measures good results are achieved. A surgery is only carried out when absolutely urgent, as the complication and relapse rates are relatively high. Patients can benefit from a wide range of therapies - for example from physiotherapy, Pain therapy and Heat treatment. If conservative measures are unsuccessful, one can surgery be considered.

causes

At a Herniated disc of the lumbar spine a gelatinous mass emerges from a Intervertebral disc. The intervertebral discs consist of one kind Fiber ring, inside of which gelatinous substance is located. If this ring tears or if it leaks in one place, the inside of the intervertebral disc can bulge out and open to something that runs nearby annoy, or that Spinal cord to press. Depending on the localization, this then causes typical symptoms.

A herniated disc usually occurs when the person concerned makes a jerky movement or lifts heavy objects. The intervertebral disc is often already through fine cracks pre-damaged and then tears from the abrupt movement. Through today's Sedentary lifestyle, one weak back muscles and Obesity herniated discs are favored. The intervertebral discs between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and the first sacral vertebra are most frequently affected.

Symptoms

The symptoms caused by a lumbar disc prolapse caused vary depending on the location of the incident.

If the herniated disc presses the center of the Spinal cord, localized back pain can occur, especially when Prevent increase.

If the gelatinous core occurs Intervertebral disc sideways, so he often presses on the Nerve rootsbetween the Whirl leak from the spinal cord. If such a nerve is squeezed, pain occurs, which radiates into the supply area of ​​the respective nerve. In case of Lumbar spine therefore, pain often occurs that extends into leg pull. Numbness, tingle and others Paresthesia can also occur.

Large herniated discs can also be too Paralysis to lead. The worst case occurs when a so-called Mass prolapse (a very large herniated disc) Spinal canal almost completely relocated. The affected patients then lose the ability to bladder and Intestines to control, suffer from paralysis and often severe pain. In such a case, an operation must be performed as soon as possible.

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A herniated disc is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

Therefore, treating a herniated disc requires a lot of experience.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Diagnosis

To a herniated disc the Lumbar spine to diagnose, the clinical symptoms of the patient are groundbreaking. A neurologist raises the Symptoms of the patient, followed by an in-depth physical exam. If the findings suggest that it could be a herniated disc, imaging procedures are also used. in the Magnetic resonance imaging of the lumbar spine (MRI) is the one protruding from the intervertebral disc gelatinous mass visible. The doctor can determine how and where they are at Spinal cord or Spinal nerves presses. Also by means of Computed Tomography (CT) a herniated disc can be made visible. Ultimately, however, the images created and the extent of the herniated disc visible there must always be interpreted in connection with the patient's complaints. Not infrequently, incidental findings are discovered in the MRI of the lumbar spine or CT in which one Intervertebral disc presumably presses on the spinal cord, but the patient has no symptoms. Then you don't have to therapy respectively.

therapy

There are many therapeutic options for one Herniated disc of the lumbar spine to treat. Basically, between conservative and surgical therapy distinguished. About 90% the herniated disc can be successful without surgery be treated. The herniated disc regresses over time and the symptoms improve. Conservative therapy, in turn, is divided into various sub-areas that can help the patient recover.

Heat treatment

Warmth improves blood flow to the muscles. A hot water bottle in your back or a warming patch, such as ThermaCare® help to soften the muscles and relieve tension. Pain is often due to cramping and poor posture in the musculoskeletal system. Patients with herniated discs often report an alleviation of their symptoms with regular use of heat.

Read more on the topic: ThermaCare - heating patches

Positioning and posture

Postures that are gentle on the back are very important in order to get the symptoms of a herniated disc under control. In addition, it should prevent new herniated discs. The so-called Step storage is considered to be particularly relieving for the Spine and is usually very comfortable for patients with herniated discs. To do this, the patient lies on his back and puts his legs up at right angles.

physiotherapy

Patients with a herniated disc Lumbar spine should be early with physiotherapy start and not keep yourself physically calm. Lack of exercise stiffens the muscleswho have favourited pain lead to a Relieving posture and this in turn increases the pain even more. If you just lie down with a herniated disc for a long time, your clinical picture is likely to worsen. This vicious circle can be counteracted by means of physiotherapy. The patients perform specific exercises that the Back muscles should strengthen. This improves the Spine stability and prevents further herniated discs. In addition, the spine is relieved by strengthened muscles. Sports in which the spine is spared can also be used in the therapy of a herniated disc - for example Aqua aerobics. Sports that strain the back and that Lifting heavy objects should absolutely refrain become.

Read a lot more information at: Physiotherapy for a herniated disc and Exercises after a herniated disc of the lumbar spine

Manual therapy

In the manual therapy These are procedures that are used in the case of a herniated disc Mobilization of the spine serve the patient and Eliminate tension should. This includes Massages, Osteopathy and Chiropractic. In principle, manual therapy can be used sensibly as a supplementary measure in treatment, but it is not suitable for every patient with a herniated disc. This should therefore be discussed in advance with a doctor.

Medical therapy

In the drug therapy a herniated disc the Lumbar spine Adequate pain therapy is crucial. The so-called WHO level schemes.

Depending on the severity of the complaints are of different strengths Painkiller used.
On the first stage become non-opioid pain relievers administered, for example Paracetamol or Ibuprofen.
Stage II avails itself weak opioids, for example Tramadol and Tilidinethat are combined with the first-stage pain relievers.
If this does not bring any improvement either, it follows Stage III, on the strong opioids be applied, for example Morphine or Fentanyl.

After all, the painful nerves also directly anesthetized locally become. You can do this directly to the pain reliever Spinal joints, the neuroforamen or directly to the disc prolapse be injected. This procedure is called periradicular therapy.

Read more detailed information on this topic at: drug therapy of the herniated disc

Operation of a herniated disc in the lumbar spine

An operation on one Herniated disc of the lumbar spine is only made for certain indications, for example severe paralysis and the Loss of bladder and bowel control.

The The complication rate of the procedure is relatively highwhy first conservative therapeutic measures should be exhausted. During the operation, the surgeon gains access to the damaged one Intervertebral disc and removes the jelly that has leaked out. If the intervertebral disc is severely impaired, it may have to completely removed and by one artificial disc be replaced. This is followed by follow-up care of about six weeks, which is the goal Strengthening the back muscles, the Mobilization of the spine and the Learn back-friendly postures and movements Has.

Further treatment options and what else you can do with a herniated disc

• Treatment of the herniated disc
• Herniated Disc - What Can You Do?

Exercises

To the Back muscles to strengthen and to relieve the spine after a herniated disc, or to prevent herniated discs, can also at home various exercises are performed. These should if possible Every day to be completed.

Below is a small selection of exercises that may be useful to help you with that Lumbar spine to mobilize or to strengthen.

• To mobilize the lumbar spine, lie on your back and lie down Arms and legs relaxed from. Then the one Hips towards feet, the other Towards shoulders pull. Hold this position for a few seconds before returning to the starting position. Then switch sides.
• Lie on your stomach, extend your arms straight forward. Then for a few seconds Lift your arms, legs and head off the floor. This strengthens the entire back muscles. Let go again before the next round follows.
• Lie on your back with your arms next to your body and your legs bent at about hip width in front of your pelvis. Well that Pull in your belly button while pressing the lumbar spine on the mat. Hold this position for a few seconds. Then make a slight hollow back and stretch your navel upwards. Hold again for a few seconds. Always do this alternately.
• in the Quadruped alternately that left leg and right arm, or that right leg and left arm stretch out forwards / backwards parallel to the floor. Hold this position for a few seconds and then return to the starting position. Switch sides. This exercise strengthens the back muscles very well.
• Lay that on your back Bend your legs and pull them towards your stomach. Grasp both knees with one hand. In this position, perform small rocking movements from left to right or up and down. This exercise relaxes you lower back.

You can find many other exercises for or against a herniated disc under our topic: Exercises for a herniated disc

Duration of therapy

Conservative therapeutic measures be about about 6-8 weeks carried out. If there is no improvement in the symptoms during this period, you must have one surgical intervention to be thought about. In principle, it can take longer before the original functional level is achieved again after a herniated disc. One closes even after an operation Follow-up care over several weeks on.
Following therapy should continue back-friendly sports to prevent further herniated discs.

Please also read our topic: How can I best prevent a herniated disc?

forecast

Overall, a herniated disc of the lumbar spine has one with adequate therapy good prognosis. Of course, the prognosis depends on the severity of the incident and the impairment of the patient. It comes within 6-8 weeks of conservative therapy if there is no improvement, the prognosis is worse. Often a surgical procedure must then be carried out.

prophylaxis

To prevent a herniated disc of the lumbar spine, the Strengthening the back muscles particularly important. By Sports will the Improves the stability of the spinewhat a total of one discharge the spine leads.

Sports like Swimming, cycling, horse riding, running and dancing are particularly useful if you want to train in a way that is easy on the back. Heavy objects should always be lifted in a way that is easy on the back, i.e. not from the back, but rather out of the legs. In everyday life and especially at work you should focus on one good posture be respected. When working in the office, ergonomic seating to adopt a back-friendly posture.