Herniated disc

A herniated disc (or prolapse) is a protrusion in the back wall of the disc or extrusion of its contents, which persists even in the absence of pressure.

It is necessary to explain the causes of this disease, since many years it was believed that all the troubles with the back are caused by the herniated intervertebral disc. In the 1930s, discs were declared the main cause of back pain, and this concept dominated almost to our days.

[1], [2], [3], [4], [5]

How does a herniated intervertebral disc appear?

When something unexpected happens with the back, it is believed that this disc has shifted relative to the general line of the spine - like a saucer jumps out of a pile - and seized a nearby nerve. When the pain is weak and generalized, it is possible that the diagnosis is the destruction or complete depletion of the disc (osteochondrosis). (Arthritis arcuate joints only recently came to the fore.)

Fibrous ring is sometimes bulging, but, according to modern studies, this is only 5% of cases is the cause of problems with the back. A true herniated intervertebral disc is characterized by the fact that the ring protrudes in one place, when the nucleus in the process of general destruction has degenerated, disintegrated and squeezed out of the center. The pain does not come so much from the disk (the disk looks like a fingernail, there are almost no nerves in it), but rather from pain-sensitive structures, the affected hernias.

When the disc loses its properties, in the place where the rear wall is opposed to the load, a herniated intervertebral disc may form

If a herniated disc is formed on the back of the fibrous ring, it can cause compression of the horse's tail, the symptoms of which are deep back pain, impotence, intestinal and excretory disorders, and loss of sensitivity in the sciatic region. If the disc protrudes in the posterolateral direction, it can cause compression of the spinal nerves, and there will be pain that radiates to the leg, as well as numbness, tingling and general muscle weakness in the shin or foot.

Herniated disc does not occur suddenly - it is always a natural result of various changes in the disk. Hernia is only part of the overall picture, and the disc wall is destroyed for a long time. This simply can not happen while the segment is healthy. (Laboratory studies have shown that with increasing load, bone is destroyed much faster than the disk.)

Because of one awkward movement, the disc never moves, turning a person into a cripple. In a healthy state, the discs are surprisingly strong, they can not be displaced by a poorly designed movement. These are unusually flexible links between the vertebrae.

Sometimes the arcuate joint may slightly dislocate, but the wall of the disc simply protrudes (this is called a protrusion), and in some cases prolapse breaks, releasing the contents-the pathologically altered nucleus-into the spinal column where it either drifts or wraps around the nerve root to form a sequestrum. It sounds terrible, but in reality the substance of the nucleus is eventually absorbed in the blood, although if it degenerates, the body can respond with an autoimmune reaction that will irritate the nerve roots.

Perhaps the expressiveness of the word "fallout", which was often used as a synonym for a hernia, damaged the wall of the disk, so astounded the imagination of both patients and specialists that this led to some kind of understatement in relation to this problem. When you experience severe pain in your back, the very word is causing you bad associations, as if something fell out and blocked the whole system, although the mechanism of the spine's back action is too complicated for anything to happen so primitive. It's just amazing how many "sins" were attributed to such an unlikely reason, and as a result, this rare disease has become the most widely known.

In fact, the herniation of the intervertebral disc happens often, but extremely rarely are the culprits of human suffering. This was proved only recently, with the advent of magnetic resonance imaging. Wide research was conducted among those who did not have a backache (without the risk of radiation exposure, which is unavoidable in X-ray myelography) to see what the most common back is like from the inside. To the general amazement it was found out that at every fifth among subjects under the age of 60 years there was a hernia of the intervertebral disc, and people did not even suspect anything. In elderly people, the figure was no less impressive: the disk was damaged in every third, also without any symptoms. Almost 80% of the subjects showed a herniated intervertebral disc. It became quite obvious that the herniation of the intervertebral disc is not at all the main source of trouble, as was always thought.

A hernia of the intervertebral disc is formed when, due to other disorders in the motor segment, muscle spasm begins. The structures around the disc are very sensitive to pain, and if they become inflamed, they can easily incorporate muscular protection. When the defensive reaction continues for too long, the segment contracts, and the disc wall eventually deforms. Tonic vertical muscle contraction, especially at the problem level, gradually squeezes out fluid from the disc, and the swelling in it begins to play its fatal role.

With healthy disks, this never happens. They briefly expand for a couple of millimeters, assuming the load, but this does not at all resemble a clamped segment when the fibrous ring deforms in a weak spot. Healthy disks are extremely elastic and never suddenly deformed, not torn. Stories about how the disc slipped with an awkward movement and there was a sudden pain down his leg - these are not stories about the disc herniation. There was always an initial disorder, even if it was invisible and did not cause any symptoms. Sciatica, caused by changes in the disc, usually "ripens" for several years, initially manifesting itself in the form of harassing pain in the lower back, as with limiting the mobility of the vertebral segment. In the end, everything moves from a dead center, and the initial pain is replaced by a new one, giving in the leg.

What causes a herniated intervertebral disc?

• Long-term disorder qualitatively changes the core and weakens the wall of the disc.
• The wall of the disc is torn due to the bending of the back and lifting weights.

Long-term disorder qualitatively changes the core and weakens the wall of the disk

The discs are designed to absorb shock, so they must be volumetric. In a healthy state, the thickness of each of them increases imperceptibly when we transfer weight from foot to foot in normal daily activities. When the pressure passes down the spine, the core distributes the load in all directions. Due to the effect of the hydraulic bag, the compression is converted into a springing pushing force, which gives the connecting links of the spine their elasticity and protects the entire vertebral column from vibration when we step on the ground.

When flexing and unbending the spine during movements, a synchronous energy exchange takes place. First, the core is deformed, and a moment later the fibers of the disc wall are pulled, when it takes a load on itself. When the wall is stretched almost to the limit, it gently pushes the "energy" back to the core, because of what it swells. Thanks to such an excellent dynamics, the disc damages shocks, and our gait becomes springy.

The exchange of energy works perfectly when both the nucleus of the disc and the fibrous ring are healthy. While the core maintains a normal consistency, and the ring - its elasticity, the disk can endlessly absorb the pressure. But the damage to either the articular joint or the disc - as well as too much muscle spasm - can change everything. Restriction of mobility in the anterior segment of the segment and arthritis of the arch of the arch in the back can eventually lead to the formation of a herniated disc and thus to destroy its viability.

Often it all starts with a muscle spasm; even a minor disorder can become chronic if the defensive reaction of the muscles does not pass. Segment as if clamped in a vice, because of what the dynamics of energy exchange is hampered. When muscle spasms and constriction persist, the disc begins to bulge along the entire circumference. This is still an insignificant and easily removable flattening, but eventually the disk can fail.

As the disc is dehydrated, the core becomes more viscous and prone to deformation. It no longer resembles a tight ball with a liquid inside, it deforms and spreads under pressure. When the nucleus is squeezed out in different directions during the movements of the spine, it encounters the inner layers of the fibrous ring - and this is the only thing that limits it. Over time, constant attacks injure the wall of the disc, and it begins to break down.

Actions that increase the pressure inside the disc only accelerate its death. For example, with tilts that are almost always accompanied by rotational movements, the load falls on the back of the fibrous ring.

The wall of the disc is torn due to bending of the back and lifting weights

With the tension of the body, associated with lifting weights, numerous fiber breaks in one section of the fibrous ring can turn into a small crack, into which the core rushes.

When the nucleus moves, frequent flexing of the back can lead to the most serious consequences. The pressure inside the disc when tilted increases. If the inclination is accompanied by a rotation (albeit insignificant), the pressure rises even more, because the muscular effort compresses the disc. When the rotation occurs all the time in the same direction, the core layer by layer destroys the same portion of the fibrous ring until it breaks through.

The last drop can be an effort to lift the gravity. It exposes the spine, and especially the lower discs, to enormous loads. The pressure inside the disc becomes simply unbelievable, more fibers are torn in the same place, and eventually the wall breaks from the inside. Gradually, the nucleus is squeezed out into the formed crack and expands it on its way outward. As a result, the entire wall can burst, and the nucleus enters the spinal canal, a herniated disc is formed.

Additional risk factors for herniation of the intervertebral disc

The rupture of the disc wall will occur faster if the lifted cargo is held at a distance from the body or if it is something very heavy. In both cases, the pressure inside the disc is increased. The rupture is also easy to evoke if the body is rotated. When the segment is mixed forward, the arcuate joints diverge, making the disc more vulnerable; alternating layers of the wall tend to separate, which causes peripheral ruptures in the outer layers. If there is an obvious internal malfunction in the discs in the form of the kidney in the places of greatest curvature, the rupture can meet with the peripheral one, and the core will be squeezed through different parts of the wall.

The combination of the pressure of the core from the inside with the external tension of the wall during rotation leads to the fact that the disk most often breaks through in those places which, if compared with the dial, approximately correspond to 5 and 7 hours. This explains why the posterolateral hernia of the intervertebral disk predominates. Most often, the posterolateral herniation of the intervertebral disc occurs on the right (and not on the left), which may be due to the fact that there are more right-handed people. The muscles of the right side of the trunk and right arm exert additional pressure on the disc.

Here's to you a perfect example, illustrating the law of Murphy: it is these areas of the greatest rounding of the disk that are the place where the sciatic nerve roots exit from the spinal canal. They go down the canal in the form of numerous filaments, and then come out at the appropriate level through the intervertebral foramen. The protrusion of the disc in the posterior direction can squeeze the nerve root inside the spinal canal, while in the posterolateral canal irritates the nerve in the intervertebral foramen. The opening of the site is much smaller than in the spinal canal, so the nerve suffers doubly. It can be simultaneously pressed against the back wall, and stretched along the contour of the protrusion (approximately so we have to squeeze to the exit by the fat lady in the bus).

Not surprisingly, a herniated disc is often caused by heavy physical work. The worst option is lifting weights with a turn of the hull: for example, digging the ground with a shovel with a long handle or constantly tilting when removing boxes to the floor from the same height. Very often, nurses suffer from back problems, although these problems are not always associated with discs. Unsuccessful lifting of weights can weaken the wall of the disc, but in order for the core to protrude, the disk must already be damaged.

[6], [7], [8], [9], [10], [11], [12]

What happens to the back?

Sharp herniation of the intervertebral disc

A few days after the trauma of the spine, pain in the leg gradually appears. Usually a person can accurately remember exactly what he did when the pain arose, but very rarely the back was involved. Perhaps she was slightly tense, and she felt a sharp pain, which quickly passed. Maybe you hurt your spine, unsuccessfully picking up something not the heaviest, but very uncomfortable. Perhaps you dragged the couch in one armrest, and his corner caught something for something. Your battle with the couch can be the last straw that overflowed the cup, and in the back, there will be acute tension. The next few days the back remains painful and tense, and then the pain begins to give in the leg.

Painful tension is felt deep in the buttock and is transmitted down the leg, and then develops into an unbearable convulsive pain. At first it seems that in the leg just stretched the muscle or ligament. The pain usually begins in the buttock and descends into the thigh, and then, having passed the knee, again appears in the calf. If you deeply probe the buttocks with your fingertips, you can find the source of the pain, and, strangely enough, the pressure on this point calms the pain in the leg.

The nerve can become inflamed and become so sensitive to tension that you can not even lower your heel to the floor. The spine is usually forced to bend to the side (this is a scoliosis with sciatic neuralgia) in order to ease the tension of the nerve root. Behind the spine looks completely twisted and weak. Sometimes not only lateral curvature is observed, but in the lumbar region a hump appears instead of the cavity. The buttock on the affected side can become flat and flabby. Both deformations of the spine are protective mechanisms, minimizing the tension of the inflamed nerve root.

When you stand, then lean on the fingers of a sore leg and bend it at the knee so as not to stretch the nerve; The leg is often trembling uncontrollably. When you walk, you feel sorry for yourself. Each step causes the most painful pain in the leg, almost to loss of consciousness, as if a sharp, red-hot spear is stuck into it (usually it is described as shooting pain in the leg). Slope forward is almost impossible. When you try to bend, a great pain arises in your leg, and the spine is even more bent, like from the wind, to avoid stretching.

With an acute disc hernia, you look awful: standing, you can not put the heel on the floor, and walking turns into a helpless waddling, because you can not pull the nerve to push the leg forward.

Sitting is usually simply impossible, since compression of the spine increases the pressure on the disc, and therefore, on the nerve. Literally after a few seconds of sitting, the pain can become so strong that you have to get up and lean on something to free your leg. The same unbearable pain can be after several minutes spent in a standing position, when the pressure on the disc gradually strengthens convulsive pain. The most comfortable position is lying on one side in the embryo pose with a pillow between the knees.

What causes acute pain with a herniated disc?

Perhaps the back pain that occurs in a condition such as an acute herniated disc is caused by stretching its wall. The pressure on the local protrusion stimulates the mechanoreceptors between the fibers, which is manifested in deep back pain, which does not weaken when exposed to a sore spot by hand.

The disk itself is almost insensitive to pain. Only the outer layers of its wall are innervated, and this explains why minor protrusions are painless. The inner layers of the fibrous ring withstand the main pressure shifting toward the core and protect the sensitive outer layers from direct contact with it.

The destroyed core moves and, like a wedge, penetrates into small cracks in the inner layers of the wall and expands them when moving outward. When there are only a few layers restraining it, the tension of the disc wall becomes maximum, moreover, it is additionally strengthened by muscular spasm. (This can explain why the problem disk often explodes with a loud pop when the scalpel of the surgeon cuts it, and the core flies across the operating room a few meters.)

As your condition worsens, the tension of the nerve causes more pain than compression, the usual back pain disappears, but pain in the leg appears. The reason for this can be a spontaneously broken through the outer wall of the nucleus. Pressure on the wall due to this decreases, but new problems arise. By this time, the kernel can acquire a brownish hue (this means that it degenerated and became toxic), and now it irritates the nerve root chemically.

It is believed that the tension of the nerve root causes more anxiety than its compression. All of us have often had to lean on the condyles of the humerus at the elbow, and we know that nerves are not bad enough to bear the pressure. They may temporarily lose conductivity, and the hand numb; it is unpleasant, and when the hand starts to move away, it will give goose bumps, but this does not cause severe pain. Tightly pulling the nerve, and therefore subjecting it not only to stretching, but also to friction, we are much more annoying of it. Therefore, a slight protrusion, in which the nerve does not stretch, will be painless.

The first thing that happens to the nerve, when it is squeezed (and stretched), - it breaks blood circulation. Fresh blood does not enter the affected area, and blocked stagnant blood is unable to withdraw the metabolic products. Both of these irritate the free nerve endings in the nearby tissues, and you feel more and more discomfort in the problem area.

Remember that the inflammatory reaction is not peculiar to the disc, because it is devoid of blood supply. It arises in other tissues around the disc, reddened, swollen and thereby intensifying the overall squeezing. Muscle spasm around the segment because of this increases, the pressure increases, and still swells more - including the disc. In a confined space, all structures are even more inflamed and even more closely in contact with each other.

When the nerve is both compressed and stretched, friction arises between the tightly stretched nerve and its own protective shell. The physical friction of the two hyperemic (overcrowded) surfaces causes more and more severe pain, as the inflammation of the nerve becomes aggravated. From the damaged and inflamed surfaces, a clear liquid is released, the same as when burned, and the pain becomes simply unbearable.

If you could look inside, you would see an unreal red and swollen nerve, and around it - drowning in liquid tissues. It is with this state of metabolism that painful pain in the leg arises; cure it conservatively is very difficult.

The disk, like the least blooded part of the segment, is really the best object for surgical removal when the process has gone so far. If everything is blocked by irreversible stagnant edema, it is the disc, strongly compressed, but inert component, which is easiest to separate and cut out. This is the fastest and most effective way to relieve tension from the segment, when all conservative methods have not helped, despite the adverse effects it may have on the entire vertebra in the future.

Chronic herniated intervertebral disc

By this time, protrusion is not too noticeable, although the disk still hurts you. In the chronic phase, the internal structures of the segment struggle with residual inflammation, and pain can occur for several reasons. For example, there may be symptoms of chronic limitation of the mobility of the vertebral segment and arthropathy of the articular joints, as well as chronic fibrosis of the once inflamed nerve root. As a consequence of the previous acute inflammation, the liquid that has accumulated from the nerve gradually hardens, forming scar tissue. This mass glues the nerve with its membrane and with other nearby structures, including the walls of the intervertebral foramen. The whole segment permeates dry whitish scars, creating a peculiar collar, which gradually compresses the nerve. This is the so-called fibrosis of the nerve root membrane.

Such a collar fixes the nerve and does not allow it to move freely through the bone orifice during movements. A dense network of adhesions dictates its laws, a nerve often attached to the back of the disc. From prolonged squeezing it is considerably thinner. The leg appears to be a continuation of the back. It is impossible to flex freely in the hip, neither to sit down, nor to step forward, the back always moves with it - that's why you have a characteristic lameness. The back is compressed, all actions are accompanied by a variety of pains, pain in the leg then appears, then disappears, depending on the degree of nerve tension.

Sometimes the spinal cord is attached by scar tissue to the inner wall of the canal. When sitting, the back can not bend, and in it there is a feeling of tension that spreads up the spine and down, into the buttock and thigh. This is called the fixation of the spinal cord to the hard shell. When sitting, the spinal cord stretches and tries to break the adhesion, which causes deep pain, from which it catches its breath and which can spread to the shoulder blades. Sometimes you almost feel how the spine is pulled from the inside when tilted.

If only the nerve root in the intervertebral foramen is fixed, most of the symptoms will appear in the leg. During sitting, the buttocks tend to move forward to reduce the angle at which the hips are lifted; When trying to straighten the leg, the knee automatically bends. Over time, when sitting, other symptoms may appear, for example, numbness of the heel or pain in the foot. But worst of all, the stupid pulling pain in the thigh, because when bending the back, the nerve root is stretched in the place where it is attached to the intervertebral foramen. And for a long time after all the other symptoms have disappeared, a long trip to the car or air travel can cause pain that you have not felt for several years.

In addition to poorly functioning legs and difficulties during sitting, there are more subtle signs of nerve damage. On the affected side, the muscles may be slightly depleted. The buttock becomes flat and flabby, as does the caviar, where the muscle tone decreases. Symptoms may be less obvious, for example, a flattening of the arch of the foot, because of which the front part of the foot expands, and you begin to feel that the leg is too large for the shoe. You may notice that it became difficult for you to perform any specific actions: climbing on tiptoe or pushing something off with a foot. When walking, the feet seem too heavy, they are harder to control and you have to pull them up to take a step.

[13], [14], [15], [16]

What causes chronic pain with a herniated disc?

Sudden stretching of the nerve, for example, when struck on a football, can cause a local inflammatory reaction in the place where the nerve is attached to the hole. The nerve can not come off, like boiled spaghetti stuck to the pan, it can barely move. A sharp movement can damage several adhesions and cause mild bleeding in the scar tissue, and then new scars will appear on this site, and the situation will worsen. At this time, the familiar pain in the leg becomes worse, as the nerve is irritated by the local inflammatory reaction.

Active expansion of the adhesions can ultimately lead to narrowing of the spinal canal, since the intrinsic blood supply of the nerve is hampered by the overgrowth of the intervertebral foramen. In this condition, the legs are always hurt, with any movement. Walking even a short distance, you are forced to sit down and rest, especially difficult to climb the mountain or the stairs.

Normally, when the leg muscles actively work as a pump, moving the body, the nerve sucks in the blood and thus maintains its ability to transmit impulses to the brain. When all is convulsively compressed, the nerve can not absorb blood. He suffers from a lack of oxygen, and his legs are getting heavier, until the strongest convulsive pain blocks them completely - then you have to stop. You need to rest - bend over or squat, which expands the diameter of the spinal canal, letting in more blood, and therefore brings relief. Narrowing of the spinal canal can also be observed with arthropathy of the arbor: the swelling of the joint affects the nerve in approximately the same way.

After a few minutes, the pain wanes and you feel better. However, after renewing walking, you will feel the pain already faster, and you will have to stop for rest earlier than last time. Each time you will pass more and more short distances before the legs become painful and heavy, forcing you to stop. At the end of the walk you will have to stop, just starting to walk. (It is the reduction of the time between stops that is the hallmark of pain in stenosis of the spinal canal from convulsive pain caused by circulatory problems.)

Although the legs are refused for quite obvious organic reasons, it's just incredible how their condition changes day by day. Sometimes you can walk a whole block, and the next day you will hardly overcome the path to the sidewalk. In this equation, a variable amount is spasm of the back muscles. Even with minimal spasm, the segment is compressed more strongly, and it is even more difficult for the blood to pass through it. An important role is also played by anxiety and psychological stress, because they directly affect the muscle tone. When you are very tired or worried, the legs move worse, and the familiar feeling that you are moving in dense molasses appears at the shortest distance. On other days, it would seem, for no apparent reason, you literally soar in the air.

How is the herniated disc?

It was always difficult to say anything about discs with complete certainty, because they are difficult to see. The substance of the disk is transparent to X-rays, so it is impossible to get a clear image on the roentgenogram. To determine whether the herniated disc is affected by the spinal cord (through the spinal canal) or the spinal nerve (in the intervertebral foramen) is pinched, a contrast agent was injected into the spinal canal; The patient then leaned in different directions, so that the paint seeped around the disc. Then the roentgenogram was taken, showing its outlines. This entire procedure is called a myelogram.

Fortunately, this very unpleasant procedure (after which the patient often suffered from headaches for several days, and in more serious cases he could begin arachnoiditis - inflammation of the spinal cord) was completely replaced by X-ray computed tomography and then magnetic resonance imaging. Although the latter is expensive, it gives very distinct, almost three-dimensional images of both soft tissues and bones, clarifying the situation in all vertebral structures.

The physiotherapist can not touch the discs with his hands, because they are located in the anterior complex of the spine. One can only find out the general state of the spine, palpating it through the spinous processes. Although with a strong protrusion of the disc, palpation can reveal a characteristic "connectivity" of the spine, it is very difficult to catch. Sometimes a slight pressure on hands irritates the disc and causes pain in the distant part of the body, perhaps because its deformed wall acts on the nerve root. If, with minimal pressure, there is a convulsive pain in the leg, this indicates that the nerve is very irritated, although it is necessary to exclude the arthropathy of the articular joint. For this it is necessary to feel the back in 1-2 cm away from the central furrow.

Since the disc itself can not be palpated, one must rely on objective symptoms indicating that the nerve root is squeezed. These are the so-called neurological symptoms of a herniated disc, they talk about how much the nerve is irritated and how much it has lost its functions. One of the tests is to lift the straightened leg at an angle of 90 degrees. By increasing the tension of the nerve roots, you can find out if one of them is inflamed. When the nerve is inflamed, a sharp pain appears, as soon as you tear your foot off the bed. Other neurologic symptoms are a decrease or lack of reflexes (in the area of the ankle and under the knee), numbness of the skin on the leg and loss of muscle strength. However, almost the same symptoms are also characteristic of acute inflammation of the arcuate joints. It seems to me that it is possible to conclude that this is a herniated intervertebral disk, if there are also disorders in the work of the intestine and bladder (the cause of which the arcuate joint can not be).

Absolutely sure that this is a hernia of the intervertebral disc, you can only be when the arcuate joints are all right. Too often, patients appear in the clinic with a sentence: "the operation on the disk" is shown, while all the symptoms indicate a pinched nerve. As a result, the most superficial work with the hands with the arcuate joint at the same level saves him from the problem in a few days.

Herniated disc is very difficult to eliminate by conservative treatment, but it is possible. When the nucleus has shifted, it is very difficult to bring it back; this can be compared with stuffing the toothpaste back into the tube. The only clue is to make the entire segment moveable to eliminate compression. Relaxation removes the load from the disk and allows it to retain more fluid, and also improves blood circulation in the entire area, and therefore removes the inflammation caused by swelling of the structures inside the segment (the disc is just one of them).

Even when a herniated disc is diagnosed with computer or magnetic resonance imaging, it is perfectly treatable. If the damaged segment is forced to move normally along with the entire spine, you can eliminate even the most severe pain in the leg. However, after severe inflammation, the nerve root for many months or even years will remain supersensitive and vulnerable, especially after a long sitting. Even with mild muscle spasms or with circulatory disorders, the familiar pain in the leg can resume.

What if you have a herniated intervertebral disc?

In the acute phase, the most important thing is to open the back of the lumbar vertebrae to relieve pressure from the protrusion. This can be achieved by pulling the knees to the chest, but the improvement will be short-lived unless the muscle spasm is removed. And this will not happen until the inflammation of the soft tissues is cured. In any case, you need to take the medicine prescribed to you by your doctor (non-steroidal anti-inflammatory drugs and muscle relaxants). Remove muscle spasm will help you and pulling the knees to the chin, even with acute sciatica.

When the tumor began to subside, and the inflammation of the nerve subsided, it is important to achieve disengagement of the segments. It is here that exercises with a block for the back and squatting are important, causing fluid to enter the discs. At the same time, requiring a lot of effort, the leans forward from the prone position raise the intra-abdominal pressure, which also relieves the load from the discs.

Herniated disc in the chronic stage should be treated on the basis of stabilization and stretching. Sometimes the instability of the segment is not far off, it can cause a decrease in pressure inside the disc and weakening of its wall. Tilting with the touch of the toes, including diagonal ones, contribute to the flow of liquid into the discs and to strengthen the deep muscles that connect the segments. Diagonal inclinations with the touch of the toes and diagonal twisting eliminate the adhesions in the intervertebral openings, which could remain from the inflammations. The nerve root can be attached to other structures, and rhythmic stretches and nerve cuts with tilts help to gently release it. At this stage, rotational movements of the spine relax the fibers of the disc wall, so that it absorbs water more freely.

Typical treatment of acute herniation of the intervertebral disc

Purpose: to weaken the muscle spasm, to open the back complex of the spine in order to relieve pressure from the damaged disc.

• Pulling your knees to your chest (60 seconds)
• Relaxation (with a pillow under the lower leg) (30 seconds)
• Pulling your knees to your chest
• Relaxation
• Pulling your knees to your chest
• Relaxation
• Pulling your knees to your chest
• Relaxation
• Pulling your knees to your chest
• Relaxation
• Pulling your knees to your chest
• Relaxation

Take medication prescribed by your doctor. Most of the time, lie in bed, putting your feet on a stool or pillows, so that the hips and shins form a right angle. Repeat lifting of the knees to the chest and chin at least every half hour.

Duration. Go to the regimen for the subacute phase, if the pain in the leg is no longer permanent.

Typical treatment of a herniated disc in the subacute phase of a herniated disc

Purpose: to relieve muscle spasm; relax your back to increase fluid flow into the disc; strengthen the abdominal muscles to relieve the load from the disc.

• Pulling your knees to your chest (60 seconds)
• Rides on the back (15-30 seconds)
• Pulling the knees to the chin (5 times)
• Squatting (30 seconds)
• Pulling your knees to your chest
• Rounds on the back
• Pulling the knees to the chin
• Squatting
• Exercise with the block for the back (60 seconds)
• Pulling your knees to your chest (30 seconds)
• Pulling the knees to the chin (15 times)
• Squatting (30 seconds)

Exercise should be done early in the morning or in the afternoon, and then relax for 20 minutes, putting a pillow or a bench under the lower leg. When you are doing your own business, avoid prolonged stay in one position; try to walk at least 2 times a day (no more than 15 minutes).

Typical treatment of a herniated intervertebral disk with chronic hernial disc

Purpose: to remove the compression of the base of the spine, to stretch the adhesions, to restore the coordination of the muscles of the abdomen and back.

• Squatting (30 seconds)
• Exercise with the block for the back (60 seconds)
• Pulling your knees to your chest (60 seconds)
• Tilting forward from the prone position (15 times)
• Squatting
• Exercise with a block for the back
• Pulling your knees to your chest
• Tilting forward from the prone position
• Squatting
• Diagonal twisting in a prone position (2 times in the sore side, 1 time in a healthy one)
• Squatting
• Diagonal twisting in the supine position
• Diagonal inclinations with the touch of the toes (4 times in the sore side, once in a healthy one - repeat three times)
• Squatting
• Squatting
• Exercise with a block for the back
• Pulling your knees to your chest
• Tilting forward from the prone position
• Repeat the whole complex 3 times a week.

If you are bent forward from the prone position, your leg hurts, replace them by pulling your knees to your chin. Pain in the leg may appear after prolonged sitting or traveling. In this case, you need to return to the sub-phase phase.

Surgical treatment of a herniated intervertebral disc

Removal of the herniated disc by surgery is usually not successful, since a metabolic disorder within the inflamed segment contributes to the irritation of the nerve root. According to some estimates, the condition of 50% of patients operated on for a herniated disc does not improve, and sometimes even worsens. Removing a disk does not always solve the problem, and in many cases only aggravates it. When both the disc and the denture joint were swollen, the unstable pain in the leg most likely comes from the arcuate joint. The rich blood supply of the arch of the arbor makes it more susceptible
Indeed the main source of pain - the arcuate joints, the removal of the disc shortens the segment and causes these joints to take on a heavy load. After the operation, the pain in the leg is amplified - and this so depresses the patient, especially after all that he had to endure. As soon as you get up, all the symptoms manifest themselves again in all their glory. Sometimes you hear about a second operation after 2-3 weeks, already on a different level.

Nevertheless, many operations on the spine are successful. Earlier, a more radical operation was performed, a laminectomy, at which the disk was completely removed (it was removed in parts with a scalpel and forceps - this is approximately the same as pulling the nail off by pieces), and then a part of the bony arch of the vertebra above and below the nerve. Sometimes vertebral segments were connected during the same operation to prevent instability as a result of the destruction of the fibrous binder. To do this, either fill the empty space in place of the disk with bone fragments (usually taken from the iliac crest), or insert two large bolts into the arcuate joints. Recently, spinal surgery has become less radical (and not so much disrupting the entire spine mechanics when it again has to move).

The microectomy of the disc is a much finer operation: through a tiny cut in the skin, the smallest part of the disc is removed (practically only the herniated disc). The wound is small and there are few incisions, so the scar is almost invisible. The best surgeons do not only what is needed, but also restore the cut lumbosacral fascia, before suturing the wound. Due to this, vertical fixation of vertebral segments is preserved (and this ultimately avoids instability). It is also very important during the operation to minimize blood loss. Many doctors recommend the patient to return to normal motor activity as soon as possible after removal of the herniated disc. Movement prevents stagnation in the tissues of blood and lymph, so there are fewer adhesions that prevent all moving structures of the spine from starting to work again.

More selective surgeons are guided by the strictest criteria, in which case the herniated disc is operated only if neurological symptoms in the sciatic region are observed and the legs can not function normally. The pain itself is not an excuse to open your back and remove the disc. This is too subjective. In addition, pain can be caused by many other disorders. Imagine how terrible it is when the disc is removed and the pain is left - and it happens very often.