Lumbar Disc Herniation
The lumbar spine consists of 5 vertebrae numbered L1-L5. Intervertebral discs, also known as lumbar discs, occupy the space between each vertebra. Intervertebral discs make up about 25% of the total length of the entire spine. The discs’ main functions are to absorb and distribute some of the load that is applied to the spine, form the main connection between vertebrae to allow movement, and separate the vertebrae to allow space for nerve roots to pass from the spinal cord to the body. Discs are composed of two main parts: a nucleus pulposus (inner portion) and an annulus fibrosis (outer portion).
A lumbar disc herniation occurs when the inner portion of the disc bulges out into or past the outer portion of the disc. This can result from age-related degeneration or can be caused by trauma, lifting injuries, or straining. Disc herniation almost always occurs posterior-laterally due to the anatomy of the spine.
There are three classifications of disc herniation:
- Protrusion – nucleus pulposus bulges into the outer annulus, the annulus remains intact and no material is displaced beyond the normal disc diameter
- Extrusion – the outer annulus gives way to the nucleus pulposus allowing the nucleus pulposus to bulge beyond the normal disc diameter and into the neural canal, which contains the spinal cord and nerve roots
- Sequestration – the nucleus pulposus escapes the annulus completely breaking free from the disc and becomes a free-floating fragment
Common signs and symptoms of disc herniation include localized pain that can range from mild to severe depending on the amount of disc displacement and radiating pain and/or numbness/tingling in the lower extremity (most commonly one sided). Pain is often constant and may be exacerbated or reduced with certain positioning of the body.
Physical therapy intervention can often help to alleviate the symptoms of lumbar disc herniation as well as decrease the severity of the injury.
- Manual therapy: A skilled PT or PTA can perform hands on treatment which includes soft tissue massage/release to irritated and tight muscles and joint mobilization to increase mobility, improve spinal alignment and modulate pain.
- Therapeutic Exercise: The physical therapy team can work together to develop exercises that are specific to your body and injury. Exercises will include core and lower extremity strengthening to activate muscles that will support the spine and can include job or sport specific exercises.
- Stretching: Stretching will be included in your treatment plan to decrease soft tissue tightness and improve posture in order to balance the forces placed on the lumbar spine.
- Body Mechanics Education: Education will be provided on proper posture/positioning and lifting technique as well as exercises will be geared towards strengthening the muscle necessary to allow for proper posture and lifting. This education will also prevent further injury or additional episodes of injury.
- Home Exercise Program: These exercises will be provided early on in care and updated throughout your rehabilitation. These exercises are essential to supplement your therapy visits in order to maximize the effectiveness of your visits with a therapist and to allow continued progress of your rehabilitation.
- Modalities: The physical therapy team will utilize modalities to help decrease pain and alleviate symptoms in the lumbar region: moist heat, cold pack, interferential electrical stimulation, phonophoresis, iontophoresis and traction among others.
Research shows that “physical therapy programs including convention lumbar traction are quite beneficial on lumbar disc herniation…generally clinical improvement occurs prior to radiological improvement, MRI findings and clinical findings are not always correlated. It can be concluded that clinical parameters should be taken into consideration primarily in evaluation of treatment results of patients with lumbar disc herniation.”
Kamanli A, Karaca-Acet G, Koc M, Yildirim H. Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Bratisl Lek Listy. 2010; 111 (10):541-554.