Causes

Although disc protrusions can in principle occur at any height of the spine, the lumbar spine is by far the most frequently affected. In most cases, the bulge is located at the level of the intervertebral disc between lumbar vertebrae 4 and 5, i.e. just below the iliac crests. The simple reason for this is that the greatest body weight rests on this section of the spinal column and the strongest lever forces are at work, for example when carrying heavy loads.

Another factor that promotes the development of a prolapse is normal age-related wear and tear. However, other factors are considered to be the main cause for the appearance of disc prolapse. These include genetic weaknesses of the disc structures, one-sided strain on the spine or weakly developed back muscles.

This view is confirmed by the rapidly increasing number of disc protrusions and prolapses in our time, which is characterized by lack of exercise and office work. At the same time, studies have shown that being overweight with a BMI of 27.5 or higher doubles the risk of suffering from disc disease. In addition, an accident or injury-related cause of disc disease is often discussed. To date, however, this could not be confirmed.

Diagnosis

An initial tentative diagnosis is usually made on the basis of clinical symptoms in combination with positive clinical tests, such as weakened reflexes of the lower extremities. The final diagnosis of a lumbar disc protrusion is then made by means of magnetic resonance imaging of the spine (MRI). A herniated disc is also usually clearly visible in a CT.

Do what?

Once a diagnosis of disc protrusion has been made, appropriate therapy should be started as soon as possible to prevent progression of the disease. For this purpose, a therapy plan should be worked out with the attending physician and the next steps of treatment should be discussed. Contrary to the need for bed rest and physical rest, it is nevertheless important to maintain a certain level of physical activity, provided that no neurological symptoms (paresthesia, muscle weakness) occur.

Otherwise, there is a risk of getting caught in a vicious circle of inactivity, muscle loss and worsening of symptoms. In order to enable pain-free movement, painkillers should not be avoided. Painkillers from the group of so-called NSAIDs, which include ibuprofen, diclofenac and naproxen (Dolormin®), are particularly suitable for long-term use.

Even though exercise is beneficial for the therapy of a disc protrusion of the lumbar spine, heavy physical strain should still be avoided. It is equally important to ensure a healthy posture in everyday life. In almost all cases, the treatment of a herniated disc is conservative, i.e. non-surgical.

If it is consistently applied, a symptom-free life without serious restrictions in everyday life is possible for almost all patients. In addition to the basic behavioral strategy described above as a result of the diagnosis of a herniated disc, physiotherapy and back school play an important role, since the spine can be relieved considerably by strong back muscles. In addition, in some cases, massages, heat treatments or acupuncture can be helpful for further pain and relaxation therapy.

If the protrusion is severe, it may be necessary to wear a supporting corset. Likewise, if other pain therapies are not sufficient, the injection of local anaesthetics or cortisol can improve the symptoms. Even though painkillers can alleviate the symptoms of a disc protrusion, they do not combat its cause.

An important component in the therapy of disc protrusions is therefore the training of the trunk muscles, but especially the so-called autochthonous back muscles, which are particularly important for the stability of the spine. A whole range of exercises and sports are suitable for this. A very classic example of training the back muscles of the lumbar spine is the so-called “bridge”.

Here the buttocks are raised repeatedly in the supine position, while the back remains straight. When training the trunk muscles, it is important not to neglect any muscle group. Thus the abdominal muscles should always be trained as well when doing exercises for the back muscles. It is best to discuss the exact execution and selection of certain exercises with your doctor or physiotherapist.