Prolapsed Disc Lumbar
1. Between each vertebra there lies a vertebral disc, a prolapsed disk occurs when the disk material is displaced beyond the intervertebral disc space.
2. This can result in neural structures becoming impinged causing pain however, a large percentage of herniations are asymptomatic.
3. This can be associated with fully flexing the spine repeatedly or for a prolonged period of time, trauma or lifting in a flexed position can also be a cause.
4. Additionally, a prolapsed disc can be a result of age related degeneration.
5. Prolapsed discs are most common in the lower back or neck although can occur at any level in the spine.
2. This can result in neural structures becoming impinged causing pain however, a large percentage of herniations are asymptomatic.
3. This can be associated with fully flexing the spine repeatedly or for a prolonged period of time, trauma or lifting in a flexed position can also be a cause.
4. Additionally, a prolapsed disc can be a result of age related degeneration.
5. Prolapsed discs are most common in the lower back or neck although can occur at any level in the spine.
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1. A disc prolapse in a lumbar disc may cause pain across the lower back2. Pain may also radiate into the buttocks, thigh, genital region and lower leg.
3. A prolapsed disc can cause sciatica which often feels like a sharp pain in the buttocks/ leg with associated numbness, tingling or muscle weakness in the leg
4. Short walks can be relieving while long walks, extended standing or sitting can worsen symptoms
5. Symptoms can be present in one leg or both legs
Treatments
1. Stabilisation / core exercises are effective at strengthening the abdominal muscles, relieving the pressure on the back muscles, resulting in a reduction of pain [8][6]2. Spinal manipulation treatment can be effective at alleviating pain and improving function [8][9]
3. Extension based exercises can help encourage the disc back into the intervertebral space [2][3]
4. Acupuncture can reduce sciatic related pain [7][10]
5. On rare occasions if physiotherapy does not alleviate symptoms, surgical intervention may be considered however evidence suggests that intensive physiotherapy provides better long term outcomes [11]
References
2.https://journals.lww.com/spinejournal/Abstract/2004/12010/Does_it_Matter_Which_Exercise___A_Randomized.2.aspx Long, A., Donelson, R. and Fung, T., 2004. Does it matter which exercise?: A randomized control trial of exercise for low back pain. Spine, 29(23), pp.2593-2602.3. https://www.ncbi.nlm.nih.gov/books/NBK539720/ Mann, S.J. and Singh, P., 2019. McKenzie Back Exercises. In StatPearls [Internet]. StatPearls Publishing.
6. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052082 Wang, X.Q., Zheng, J.J., Yu, 7. https://www.hindawi.com/journals/ecam/2015/192808/abs/ Ji, M., Wang, X., Chen, M., Shen, Y., Zhang, X. and Yang, J., 2015. The efficacy of acupuncture for the treatment of sciatica: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2015.
8.https://journals.lww.com/spinejournal/Abstract/2010/05150/Conservative_Management_of_Lumbar_Disc_Herniation.23.aspx Hahne, A.J., Ford, J.J. and McMeeken, J.M., 2010. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine, 35(11), pp.E488-E504.
9. https://www.sciencedirect.com/science/article/pii/S0161475417303147 Mo, Z., Zhang, R., Chen, J., Shu, X. and Shujie, T., 2018. Comparison Between Oblique Pulling Spinal Manipulation and Other Treatments for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Journal of manipulative and physiological therapeutics, 41(9), pp.771-779.
10. https://journals.sagepub.com/doi/abs/10.1136/acupmed-2016-011332 Tang, S., Mo, Z. and Zhang, R., 2018. Acupuncture for lumbar disc herniation: A systematic review and meta-Analysis. Acupuncture in Medicine, 36(2), pp.62-70.
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573846/ Abou-Elroos, D.A., El-Toukhy, M.A.E.H., Nageeb, G.S., Dawood, E.A. and Abouhashem, S., 2017. Prolonged physiotherapy versus early surgical intervention in patients with lumbar disk herniation: short-term outcomes of clinical randomized trial. Asian spine journal, 11(4), p.531.