Causes | Disc protrusion

Causes

The causes of a disc protrusion are similar to those of a herniated disc. First of all, one should be aware of how such damage can occur. The cartilaginous intervertebral discs consist of two parts, the fibrous cartilage ring and the gelatinous core.

In most cases, disc protrusions (as well as herniated discs) are the result of many years of previous damage, so that their number increases with age. Long-term incorrect loading can reduce the water content and thus the elasticity of the gelatinous core, so that it can no longer perform its function as a pressure pad properly. Consequently, the load on the fibrous ring increases enormously over time.

This can result in a bulge or even cracks in the fibrous ring. Weakness of the paravertebral muscles and genetic predispositions can also play a role in the development of a disc protrusion. The paravertebral muscles are precisely those muscles that lie directly on the spine.

It is discussed whether accidents and traumatic injuries can cause disc protrusions or herniations. This usually remains a point of contention, especially in labour courts. Another risk factor for changes in the intervertebral disc is overweight.

A lack of exercise and poor posture, as often observed in office workers, for example, also appear to contribute significantly to the increasing incidence of intervertebral disc events. Finally, herpes viruses also seem to play a role in the development of degenerative changes in the cartilaginous intervertebral discs, which can then cause a disc protrusion or prolapse. The therapy of a herniated disc is carried out according to the National Guidelines for Low Back Pain Treatment.

In general, the therapy is similar to that of a herniated disc. Initially, the therapy is conservative. Surgical interventions should only be considered if all conservative therapy approaches have failed, or if severe paralysis and muscle weaknesses occur.

The latter, however, is more likely to occur in case of a herniated disc and not in case of a disc protrusion, so that a disc protrusion can almost always be treated conservatively. However, it is important to have sufficient patience for the therapy, as it usually takes months of treatment, which also requires an adjustment of the general lifestyle. First of all, sufficient exercise is necessary.

Resting in bed is not recommended and does not bring any progress in therapy. If mobility is restricted due to severe pain, pain therapy is indicated as soon as possible. In pain therapy, so-called non-steroidal anti-rheumatic drugs are mainly used.

These are painkillers which have a peripheral effect (at the site of the pain) and also relieve inflammation. Aspirin, for example, belongs to this group. But also muscle relaxants, which relieve and relax muscle tension, as well as centrally acting painkillers (analgesics) are used.

Connective tissue massages, heat and electrotherapy can alleviate the symptoms. However, their scientific benefit is controversial. Chronic and sub-acute pain is treated with the help of physiotherapy exercises and physiotherapy.

However, they are not suitable for the treatment of acute pain. Acupuncture represents a further therapeutic approach in pain therapy and is also used in the treatment of disc protrusions. In some cases, anti-inflammatory agents (e.g. cortisone) are injected directly into the spine to achieve pain relief.

However, such treatment is usually not covered by the statutory health insurance companies. In severe cases, patients can wear a corset to support the spine. With all these therapeutic approaches, however, good patient cooperation is essential.

These are lengthy therapy concepts that can last for months and depend on the conscientious cooperation of the patient. In so-called back schools, patients learn to integrate “back-friendly behaviour” into their everyday life. Such courses are offered by health insurance companies, fitness studios, occupational and physiotherapists and physiotherapists.

There, participants learn how to properly strain and relax their back in everyday life and at work and how to avoid damaging movements and postures. In addition, specific exercises to strengthen the back and abdominal muscles are carried out to strengthen them. The course content also includes relaxation exercises and training in dealing with back pain, stress and health resources.

They contain a comprehensive course concept and are especially useful for patients who have a sedentary occupation or who put a lot of strain on themselves and wrongly. The surgical therapy corresponds approximately to the treatment of a herniated disc. However, due to numerous risks and the danger of a relapse, the indication is very strict.

The operation is to be seen as a last resort, if no conservative therapy shows success or if there is already severe damage to the spinal cord. Such damage manifests itself in paralysis and vegetative loss of function. Vegetative dysfunctions include stomach, intestinal and bladder problems, such as urinary retention.

The therapy of intervertebral disc protrusion in the lumbar spine area, a bulging of the disc in the direction of the spinal canal with irritation of the nerves running there, is based on conservative measures, consisting of medicinal as well as physical treatment approaches through certain movement exercises. The main goals are sufficient stabilization and strengthening of the muscles in the lumbar spine and the greatest possible freedom from pain. Furthermore, the complication of a herniated disc should be prevented.

With regular, i.e. daily back exercises, which are often referred to as back exercises, you can achieve an improvement in your complaints. For the treatment of disc protrusion, the following exercises, among others, are suitable as examples: Important in the treatment of your disc protrusion is also a balanced development of your back muscles through regular sports such as swimming, walking, cycling and gymnastic stretching and strengthening exercises. Furthermore, there is the possibility to have your treating doctor prescribe physiotherapy.

In general, it is important to perform the exercises for the treatment of your disc protrusion continuously, preferably daily, to counteract a worsening of your symptoms. Even in everyday life, you should always take care to lift heavy loads in a way that is easy on your back. – When standing four-footed, both hands and knees are on the ground.

One arm and the leg on the opposite side are raised and held in a straight line for about 15 seconds. Alternate the sides and repeat the exercise five times. – One method of mobilizing the lumbar spine is called knee waving.

In the supine position, the legs are angled and tilted alternately to the right and left. This position should be held for a few seconds at a time and repeated five times on each side. The protrusion of the intervertebral disc differs from the clinical picture of a herniated disc (prolapse) mainly in the size of the protrusion.

In addition, the fibrous ring of the intervertebral disc, which keeps it in shape, is not yet torn during protrusion. For these reasons, the disc protrusion is often called an incomplete disc prolapse. Since there is no severe damage to the spinal segment, a treatment of a disc protrusion is in almost all cases conservative.

This is mainly limited to an adequate pain therapy and physiotherapy. A surgical intervention, on the other hand, is only considered if a conservative therapy is not successful, or the symptoms worsen rapidly despite therapy. Surgery is more likely to be the therapy of choice in case of a disc prolapse.

The diagnosis of a herniated disc raises a number of questions for most patients. One of the most frequently asked questions is whether and if so, how much and which sport may still be done. The first question must be answered with a clear “yes”.

Sport actually plays an important role in the therapy of what can be done about a herniated disc and the prevention of a worsening of the symptoms. The primary goal of sports exercises should be to strengthen the back muscles without overloading the back. On the one hand, this can be achieved through targeted strength and movement exercises, for example in a fitness studio, ideally under the guidance of trained trainers.

Also highly recommended are sports that train the trunk muscles and improve posture and coordination. These include endurance sports such as swimming (especially backstroke and crawl), hiking and table tennis. Since the limitations caused by the disc protrusion are very individual, sports such as dancing, cycling or ball sports can also be pleasant and helpful.

If pain occurs during a disc protrusion, the treating physician (e.g. orthopaedist) will put the patient on sick leave as long as the pain or other restricting symptoms occur. How long the sick note lasts depends on the current complaints of the patient, so that no general time frame can be given here. Furthermore, the duration of the sick leave depends on the type of activity of the patient. For example, a physical worker may be on sick leave for a longer period of time than an office worker, for example.