Lumbar disc herniation

What is the intervertebral disc?

The intervertebral disc is like a cushion between the vertebrae of the back. The disc mainly serves to absorb shocks and allow the vertebrae to move properly.

The disc is composed of two parts:

• The nucleus (in the center)
• The annulus (which surrounds the nucleus)

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What is a lumbar herniated disc?

This occurs when part of the disc's nucleus shifts, putting pressure on its ring. This pressure causes the ring to crack, and part of the nucleus may end up outside the ring.

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The stages of cervical disc herniation formation

A bulging disc is the beginning of a disc herniation. The nucleus pushes on the disc's ring and slightly deforms it.

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A protrusion occurs when the nucleus extends beyond the ring to the outside of the disc. This overflow of the nucleus is the herniation.

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An extrusion occurs when there is a tear in the disc's ring, and the herniation protrudes even further outwards.

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Sequestration is when a fragment of the herniated disc breaks off and moves independently.

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What are the causes of a lumbar disc herniation?

A lumbar disc herniation can develop gradually over several years or suddenly due to trauma.

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Disc herniation that develops gradually is caused by the wear-and-tear process of the disc over the years. The disc's ring becomes less solid over time, and small tears can form in it. The nucleus of the disc can put pressure on this tear and eventually cause a herniation.

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A 'traumatic' disc herniation is caused by a specific event such as trauma or a sudden movement involving a load. At that precise moment, a tear in the disc's ring may occur, and the nucleus will overflow through this tear.

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What are the symptoms of a lumbar disc herniation?

The main symptoms are:

• Gradual or sudden lower back pain
• Back muscle spasms
• Pain increased by:
  
  • Getting up after sitting
  • Getting out of the car
  • Bending forward, often worse when straightening up
  • Coughing or sneezing
  • Straining during bowel movements

If you also experience pain, numbness, or tingling that radiates down your legs, the disc herniation may be irritating one or more nerves. This is called radiculopathy, visit this section to learn more.

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What are the serious symptoms of a lumbar disc herniation to watch out for?

The presence of certain signs and symptoms should prompt you to seek prompt medical attention at the emergency room or from a doctor.

These include:

• Severe weakness or paralysis of one or both legs
• Significant or even complete loss of sensation in one or both legs
• Recent loss of balance when walking
• Significant and new incoordination
• New difficulties with bladder or bowel control
• Loss of sensation in the genital area or when wiping after a bowel movement

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Serious symptoms are only present in less than 1% of lower back pain cases. Most of the time, although the pain can be very unpleasant, the condition improves.

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How is a lumbar disc herniation diagnosed?

Diagnosis is made based on a review of your symptoms and a clinical examination.

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In some rarer cases, radiological exams (X-rays, MRI, EMG) are necessary to determine the severity of the disc herniation or to see if it is compressing a nerve in the back.

"It is important to know that what is seen on X-rays or other types of imaging is not always relevant. Did you know that 25% of healthy young adults aged 20-22 have a visible disc herniation on MRI without any pain?"

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Please note that it is not possible to see a disc herniation on an X-ray.

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When to consult a physiotherapist for a lumbar disc herniation?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for a lumbar disc herniation?

Your physiotherapist will perform an assessment to determine your limitations by evaluating the following elements:

• The mobility of your spine
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Will mobilize the joints in your back and your nerves to reduce pain and improve movement.
• Will give you specific exercises to do at home to address the cause of the problem and reduce pain.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your postural habits and movements

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What to do at home for a lumbar disc herniation?

Temporarily stop doing the movements that cause too much pain, and then gradually start doing them again.
Do not remain completely still for long periods, as you will be stiffer and experience more pain afterward.

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Here are some other tips that may help:

• Limit the time spent sitting (get up every 20 minutes to walk a little).
• When you are sitting, straighten your lower back a little by sticking your buttocks out. Place a rolled-up towel in your lower back to remind you to sit up straighter.
• Go for frequent walks for a duration that is comfortable. Running might even be good for you (it depends on the person).
• When driving, sit well back in the seat and tilt the backrest slightly backwards. Move the seat slightly closer to the steering wheel.
• Stick your buttocks out slightly to lean forward.
• If you have pain, spend a few minutes lying on your stomach or back with your legs extended. This should give you some relief. If not, try lying on your side with a pillow between your knees.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Did you know?

• Approximately 95% of herniated discs occur at the L4-L5 or L5-S1 level. So it's very common to have a herniated disc at one of these levels.
• 90% of lower back pain episodes heal in 6 to 12 weeks
• 50% of lower back pain episodes heal in 1-2 weeks

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To learn more...

You can listen to the podcast "Parle-moi de santé" produced by one of our physiotherapists, Alexis Gougeon. Episode #7 discusses the topic of lower back pain.

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Episode #7 lower back pain

Find the episode on YouTube :

Click below to listen to episodes on podcast platforms:

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Sources

• Alexander CE, Varacallo M. Lumbosacral Radiculopathy InStatPearls [Internet] 2019 Mar 23. StatPearls Publishing.
• Al Qaraghli MI, De Jesus O. Lumbar Disc Herniation. StatPearls [Internet]. 2020 Aug 10.
• Takatalo J, Karppinen J, Niinimäki J, Taimela S, Näyhä S, Järvelin MR, Kyllönen E, Tervonen O. Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine. 2009 Jul 15;34(16):1716-21.

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