Therapy of a slipped disc of L3/L4
The aim of the therapy is to eliminate the symptoms and – if necessary – to reintegrate the patient socially and professionally. Various therapies are available for this purpose: Early therapy with painkillers, injection of local anaesthetics in the area of the affected nerve root, physiotherapy (physiotherapy, massage, heat therapy), movement therapy (no bed rest but continuing everyday activities, longer walks), patient training (behavioural changes, sports, back training) and operative therapies (microsurgical or open). Further helpful information can be found here: Therapy of a slipped disc of the lumbar spine
- Early therapy with painkillers,
- The injection of local anaesthetics in the area of the affected nerve root,
- Physiotherapy (physiotherapy, massage, heat therapy),
- Exercise therapy (no bed rest, but continuing everyday activities, longer walks),
- Patient training (behavioural changes, sports, back training) and
- Operative therapies (microsurgical or open).
Medications are used in the case of a herniated disc, primarily to reduce pain. Painkillers are applied according to a certain step-by-step scheme. At the beginning, so-called NSARs (non-steroidal anti-inflammatory drugs) are given.
These include for example ibuprofen or diclofenac. If these drugs do not achieve the desired effect, a drug from the next higher level is given. These include low-potency opioids.
If these also remain ineffective, then strong opioids are administered. In addition, drugs can be injected at the affected nerve root so that the pain is treated directly at the triggering site. This is done with local anaesthetics such as ropivacaine.
To counteract inflammation and thus pain, a glucocorticoid can also be applied locally to the nerve root. Physiotherapeutically, physiotherapy can help to improve pain and also mobility in the case of a herniated disc. Furthermore, heat therapy is often recommended.
This ensures that the muscles in the back relax and thus pain is reduced. Massages are also recommended to relax the muscles, improve pain and increase mobility in the back. In addition, the physiotherapist can recommend exercises that can also be carried out at home and thus further support the healing process.
The exercises serve to stabilize the spinal segments. It is therefore important that the muscles are stretched and strengthened. In the beginning the stretching is the main focus.
To stretch the spine and muscles, the patient lies on his stomach and then rests on the elbows, i.e. the upper body is lifted. Thereby, normal breathing and relaxed back muscles should be observed. The back can be gradually stretched further by lifting the upper body further and further.
There are other stretching exercises that can be done after an L3/L4 syndrome. Once the acute phase is over, exercises to strengthen the back muscles should be performed. However, care should be taken to ensure that the load is not too great at the beginning.
For example, the exercise “Arm support with arm and leg lifting” can be performed. To do this, the patient rests on the hands and knees, making sure that the hands are in line with the shoulders and the knees are in line with the hips. Now the right arm and the left leg are stretched out.
This position is held for about 5 seconds. Then the arm and leg are changed. Which exercises are individually suitable should be discussed with the physiotherapist or doctor.
If you are more interested in this topic, an operation becomes necessary if the pain and complaints cannot be improved by conservative therapy (medication, physiotherapy, back school). In this case a planned operation can be performed. On the other hand, an urgent surgical indication represents an operation that should definitely be carried out within the next 24-48 hours if the muscles in the legs show acute paralysis, sudden sensory disturbances in the area of the affected nerve occur or bladder and rectum voiding disorders occur.
These voiding disorders manifest themselves in uncontrolled outflow of urine and stool. As these are signs that the nerves are permanently damaged, emergency surgery is unavoidable. You can read more detailed information about this here: Surgery for a slipped disc in the lumbar spine