How to Avoid Lumbar Spine Pain
Pain in the herniated disc in the lumbar spine
What are herniated disc and sciatica?
In the case of a herniated disc (disc prolapse), an intervertebral disc between the vertebral bodies of the spine is damaged and has shifted in the direction of the spinal canal. This happens and is not always painful. A herniated disc can occur anywhere on the spine. However, the most common is the lower back, i. H. the lumbar spine is affected. If the intervertebral disc irritates or presses the spinal cord or the nerve roots, many sufferers feel pain in the back, which can also affect the leg. The best known is sciatica. This is a specific form of nerve root pain that is triggered when the intervertebral disc presses on the sciatic nerve (sciatic nerve). This leads to pain in the back that can radiate down to the foot. The pain follows the course of the sciatic nerve (sciatica or sciatica).
Lumbago, the popular "lumbago", on the other hand, is pure back pain without radiating to the legs. A combination of lumbago and sciatica is known as lumbar sciatica.
The pain of a herniated disc often occurs very suddenly, for example when lifting a heavy object. However, many sufferers feel pain and immobility in their back for a long time in advance, before the problems worsen acutely. The symptoms can vary significantly from person to person in both extent and severity, even if the herniated disc itself is equally severe. Sciatic pain often worsens when the leg is stretched out and the body is bent forward from the hip at the same time, or when one tries to lift the extended leg while lying on the back. Both maneuvers stretch the sciatic nerve, which increases the irritation of the nerve.
If the nerve is more strongly compressed or damaged, further symptoms can occur in addition to the pain:
- Disorders of touch perception / numbness in the area of the legs and feet,
- Abnormal sensations (tingling) in this area,
- Weakness of the muscles in the feet (walking on tiptoe becomes impossible).
A serious situation is when the patient experiences pain and a numb feeling on the inside of the thighs and buttocks combined with problems with urination and bowel movements (cone-cauda equina syndrome). These are signs of increased nerve damage and require immediate hospitalization and surgery. About 0.2–0.5% of the population in Germany complain of pain due to a herniated disc. However, only around half of the herniated discs cause symptoms, the others go unnoticed or are only recognized by chance.
The backbone consists of vertebral bodies, between which the intervertebral discs are located. The intervertebral discs act as shock absorbers. They allow the individual vertebral bodies to move in relation to one another, e.g. B. when the back is bent. Each disc consists of a firm outer ring with a soft, gelatinous core in the middle. The hard outer shell is often somewhat weaker at the back and can tear as a result of age-related wear and tear or under acute stress. Parts of the soft core can then escape and create a kind of bulge on the outside of the intervertebral disc. This bulge is known as a herniated disc.
If the herniated disc presses on one of the nerves that run in the canals between the vertebral bodies directly near the intervertebral discs, this can lead to pain and possible nerve damage.
In most people, slipped discs are the result of wear and tear. Over the years, the elasticity of the intervertebral discs decreases: they lose fluid, become brittle and cracked. Such changes are part of the normal aging process that begins in adolescence. However, the intervertebral discs do not age at the same rate in all people. Very rarely, an accident or a massive injury can damage the intervertebral disc and subsequently lead to a tissue prolapse. A herniated disc can also be caused by congenital diseases or changes in the vertebral bodies.
Several factors increase the risk of a herniated disc:
- Degenerative changes in the spine (wear and tear)
- Heavy weight sport
- Occupations with one-sided physical stress or work as a driver
Disc problems occur more frequently in the over 30 age group, but they are also possible in children.
A survey and a physical (neurological) examination by the specialist are usually sufficient to clarify acute back pain. The doctor can often determine which nerve is affected based on the exact location of numbness, muscle weakness and pain and special examinations. X-rays are not very suitable for diagnosing a herniated disc. Further examinations with other imaging methods such as magnetic resonance imaging or computed tomography are only necessary in rare cases, namely when
- paralysis occurs in one or both legs,
- the bladder or bowel function is disturbed,
- the pain is hardly bearable despite treatment,
- severe symptoms persist for weeks despite treatment or
- there is a suspicion that another disease is causing the pain, such as a tumor or
- in patients who have already been operated on.
The doctor probably has good reasons to be cautious about examinations at first: Imaging examinations can show a supposed cause of the back pain that actually has nothing to do with the symptoms. Such a misdiagnosis, in turn, can lead to unnecessary treatment, which may even be harmful.
Most people with a herniated disc are treated "conservatively", that is, without an operation. This mainly includes movement, relaxation and relief, pain reliever or local anesthetic medication, as well as manual and physical therapies.
Movement, relaxation and relief posture
It used to be common practice to give people with a herniated disc one to two weeks of bed rest. Today, on the contrary, people are often strongly advised to stay active. Because when you lie down for a long time, muscles and bones become weaker, which can lead to further problems.
It is also beneficial for the general mobility of the body to remain active instead of bed rest. As long as the pain allows it, it makes sense to continue doing normal activities. It has also been proven that exercise training can effectively prevent recurrence of symptoms. Relaxation exercises can also be worth trying for back pain. Because how someone feels pain and how well a person manages to cope with pain can be influenced by the psyche or a tense basic attitude.
For some patients, cold (e.g. cooling compresses), for others, warmth (e.g. fango pack) provides relief.
Medicines for ailments
Various medications can be used to relieve sciatic symptoms (sciatica) after a herniated disc. This includes primarily pain relievers, but also anti-spasmodic and anti-inflammatory agents. The most common low-dose medicines that are used over the counter are:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), for example diclofenac, ibuprofen and naproxen. They have an analgesic and anti-inflammatory effect. Since NSAIDs partially inhibit blood clotting, the drugs can cause bleeding. These can be mild, such as bleeding from the nose or gums, but sometimes more serious bleeding can occur, for example in the gastrointestinal tract. In some cases, NSAIDs can also cause stomach ulcers. NSAIDs can also affect the way the kidneys work. If you have asthma, cardiovascular disease or a stomach ulcer, it is best to ask your doctor first before using NSAIDs.
Paracetamol: Paracetamol is also a pain reliever, but it does not belong to the NSAID group. Paracetamol is well tolerated and can be an alternative, especially for people who cannot tolerate painkillers from the NSAID group. This includes people with stomach problems as well as some people with asthma. However, higher doses of paracetamol can damage the liver and kidneys. Therefore, adolescents and adults should not exceed the maximum daily amounts stated in the package inserts. In addition to the correct daily dose, a minimum time interval to the previous intake must be observed during use. Such a high dosage should only take place over a short period of time. Prescription drugs (only available by prescription) include:
Opioids: Strong pain relievers that may only be used under medical supervision. Opioids differ in their strength, some are also offered as patches. For example, morphine is a very powerful drug and tramadol is a weaker opioid. These drugs can have a number of side effects, some of them serious. These range from nausea, vomiting, and constipation to dizziness, breathing problems, and fluctuations in blood pressure. Long-term use can lead to habituation and physical dependence.
Anticonvulsants: These drugs are usually used for epilepsy, but some are also approved for treating nerve pain (neuralgia). Its side effects include drowsiness and fatigue. As a result, the medication can impair your ability to drive.
Antidepressants: They are usually used for depression. Some of these agents are also approved for treating pain. Possible side effects include nausea, dry mouth, low blood pressure, irregular heartbeat, and tiredness. As a rule, anticonvulsants and antidepressants are only used if the symptoms persist and the pain medication is inadequate.
Corticosteroids: Anti-inflammatory drugs. Should only be considered when other drug and non-drug treatments are inadequate.
Manual and physical therapies
Manual and physical therapies are also used in the treatment of sciatic symptoms after a herniated disc. Manual treatments include massages and certain hand movements designed to loosen tight muscles or blocked joints. Physical therapies use heat and cold to relieve pain. Frequently used treatments are:
- Massages: Various massage techniques are used to loosen muscles and relieve tension.
- Heat and cold applications: These include, for example, heat patches or packs, a hot bath, a sauna session or infrared radiation. Heat can be good for tense muscles. Cold packs, such as cold compresses or gel pillows, are also used for nerve irritation.
Overall, it has not yet been clearly proven that such treatments can accelerate recovery after a herniated disc or alleviate pain particularly well. However, many people find a massage or heat application pleasant and beneficial.
Syringes near the spine
In this injection treatment, anti-inflammatory drugs such as corticosteroids (cortisone) are injected into the immediate vicinity of the irritated nerve root.
During this treatment, an accompanying computed tomography or X-ray fluoroscopy of the spine ensures that the syringe is placed in the right place.
Injections near the spine can cause side effects such as bleeding, infections and nerve injuries. Long-term effectiveness has not been proven.
If the pain does not decrease within a few weeks / months, depending on the severity of the symptoms, surgical intervention may be necessary to relieve the affected nerve. Rapidly increasing symptoms of paralysis and long-lasting severe pain, which require analgesic treatment with narcotics (opiates), require rapid surgery, as does cauda equina syndrome (see above). Training and advice under physiotherapeutic supervision after the operation have proven to be very useful. Both muscles and stamina need to be trained.
For most of those affected, pain and restricted mobility as a result of a herniated disc subside after some time without surgery. Spontaneous healing often occurs.
If the symptoms persist for a long time despite therapy, it becomes increasingly unlikely that they will go away on their own or through non-surgical treatment. Often, even after the pain has improved, those affected suffer new symptoms after a while.
Most people with sciatica have had back pain before. Many continue to have symptoms after the sciatica episode. Most of those who have worked while they have their illness can return to work. People with particularly physically demanding work and persistent episodes of pain may benefit from retraining to less physically demanding activities.
Most people feel better after just a few weeks. Most of them are symptom-free after a few months. However, even after the symptoms have subsided, the actual herniated disc may persist. In a possible operation of the herniated disc, this is eliminated and the remains of the contents of the disc (disc) are removed. In most cases, the pain goes away right after the operation. However, the intervertebral disc becomes thinner and less elastic. In addition, the mobility in this back area is restricted. However, an operation does not guarantee freedom from symptoms - the symptoms can persist after an operation or even worsen again.
After an operation, the same guidelines for work and exertion apply as usual. Again, it is important to stay active. Targeted general strengthening of the muscles is essential to prevent another herniated disc. Here you can get advice from specialists and / or physiotherapists.
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