“INTERVERTEBRAL DISC IS THE MOST IMPORTANT PART OF HUMAN SPINE, THUS THE MAIN SOURCE OF PAIN.”
Many patients complain of pain in lower back along with tingling/numbness/heaviness in entire lower extremity. On reviewing the history of such patients, it was noted that their profession involved prolonged sitting. Frequent travelling and lifting of heavy weights are also some of the reasons. Patient faces immense pain while changing posture and are not even able to walk or stand properly even for a few minutes. Such symptoms indicate sheer case of slipped disc resulting into sciatica.
Let’s us understand the spine first.
The spine is made up of many bones called vertebrae. There are 33 vertebrae in human spine: cervical 7, dorsal 12, lumbar 5 & sacrococcygeal 9. Each bone (vertebra) is roughly the shape of a flattened cylinder and between each vertebra is an intervertebral disc. Disc has a stronger fibrous outer part – annulus fibrosus and a softer jelly-like part in the centre called the nucleus pulposus. Disc is important for shock absorption in the spine.
The spinal cord contains the nerves that come from the brain. It is protected by the spine. Nerves from the spinal cord come out from in between the vertebrae to relay messages to and from various parts of the body. The nerves coming out from the cervical region supplies to both arms and from the lumbar region supplies to both legs. Sciatic nerve is the longest nerve of the human body running from buttock to thigh to calf & foot.
Strong ligaments attached to the vertebrae give extra support and strength to the spine. Various muscles also go around, and are attached to, various parts of the spine.
What is Slipped Disc?
When the outer ring – annulus fibrosis becomes weak or torn and allows the inner portion jelly – nucleus pulpous to bulge out, it is called as Slipped Disc.
What causes slipped disc?
Various things may trigger the inner softer part of the disc to squeeze out through the weakened outer part of the disc. For example, sneezing, awkward bending, or heavy lifting in an awkward position may cause some extra pressure on the disc. In people with a weakness in a disc, this may be sufficient to cause a prolapse. Factors that may increase the risk of developing a prolapsed disc include:
1.Prolonged sitting in wrong posture
2.Repeated forward bending
3.Heavy weight lifting in wrong posture
4.Turning, twisting, rotation & torsion on spine in an abnormal manner
5.Prolonged travelling in wrong posture
6.Occupation or house hold work with lower back in forward bent/rotated posture
- Increasing age
What happens to the patient?
1.Back pain
2. Nerve root pain (Sciatica IN CASE OF LUMBAR DISC INVOLVEMENT)
Although the problem starts in the back, patient will feel pain anywhere along the course of the sciatic nerve from buttock to thigh to calf and foot in the form of heaviness, tingling, numbness & burning.
3. Pain in lower back along with heaviness/tingling/numbness in the leg while standing/walking
4. Weakness in lower extremities muscles in severely affected cases
- bowel/bladder disturbances in severe cases
How is the diagnosis done?
Detailed clinical history & thorough clinical examination are important to conclude the diagnosis.
An MRI of LUMBAR SPINE is useful to determine the exact location & severity of the slipped disc problem.
How is slipped disc and sciatica treated?
Ergonomics:
•Change posture frequently, if possible, every 30 minutes
•Sit straight & supported
•Ideal lifting & shifting techniques
Physiotherapy & Rehabilitation:
Physiotherapy is the gold standard treatment for slipped disc and sciatica. 95-98% patients respond very well to physiotherapy treatment.
•Non-surgical spinal decompression therapy creates a dramatic decrease of pressure in the disc (decompression) which can foster the drawing in of a disc bulge and help take pressure off a pinched spinal nerve. This can relieve back pain and sciatic symptoms completely.
•Theal therapy to reduce inflammation and foster healing over the affected tissues.
•TENS to improve symptoms via pain gate mechanisms.
•Supplemental Multi-vitamins during the treatment & recovery process
•Core stability exercises to improve stability of the spine during all functional activities.
•Mckenzie exercises are 1 of the most highly recommended rehab exercises for spine
By Dr. Aalap Shah,
B.P.T., M.I.A.P., M.S.P.T., Ph.D. (Scholar)
Founder & Director of MISSION HEALTH in Ahmedabad, India.
