Frequency

Herniated discs can occur especially at the age of 20 to 65 years. The most frequent herniated discs occur in the lumbar spine with about 62%, followed by 36% in the cervical spine. Only about 2% of all herniated discs are located in the thoracic spine.

Diagnosis

The first step is the careful taking of the medical history. The attending physician will ask the patient to describe the complaints regarding pain and limited movement. In addition to the examination (inspection) and palpation of the spine, functional tests are carried out to clarify the range of movement and the localization of the pain.

Depending on the severity of the abnormalities, an orienting neurological examination should also be performed. These concentrate on any numbness or tingling (sensory disturbances, paresthesias), reflexes and motor functions. These examinations also provide information about the location of the herniated disc.

In addition, imaging examinations are performed. These include x-rays in 2 planes (from the front and the side) usually in standing position. Here, the actual advancement of the gelatinous core cannot be seen in the x-ray, but an overview of the position of the vertebral bodies in relation to each other is obtained, so that a visible reduction in height of the intervertebral disc increases the suspicion of a herniated disc.

In addition, other diseases such as tumors, fractures or advanced spinal curvature (scoliosis) can be excluded. Another method is myelography followed by computer tomography. Here, contrast medium is injected into the dural space where the nerves run and is shown in white in the finished image.

Now an existing constriction of nerves can be easily detected and the actual herniated disc becomes clearly visible. Magnetic resonance imaging (MRI of the thoracic spine) also shows the soft tissue structures very well. This procedure is of the greatest importance nowadays, as it is a non-invasive and radiation-free examination.

Conservative therapy

The most common form of therapy for a herniated disc is conservative treatment. This means that initially no surgery is performed. Since pain relief is the main focus, the patient receives painkillers (analgesics) as well as medication to reduce the swelling of a fluid accumulation (edema) in the spinal cord (anti-inflammatory drugs).

Another option is to inject local anaesthetics (narcotics) or anti-inflammatory drugs such as cortisone into the area where the pain is expressed. Physical measures such as local heat treatment, massages and current therapy (electrotherapy) are intended to relieve the pain-related increased muscle tone and prevent a relieving posture. Targeted physiotherapy and back training are also part of conservative therapy and help to strengthen the back muscles and prevent a further slipped disc.

Physical measures such as local heat treatment, massages and current therapy (electrotherapy) are intended to relieve the pain-induced increased muscle tone and prevent a relieving posture. Targeted physiotherapy as well as back school are also part of conservative therapy and help to strengthen the back muscles and prevent a further herniated disc. Physiotherapy is an important pillar of the conservative therapy of a herniated disc.

However, the timing of the exercises is crucial. Shortly after the herniated disc, the first priority is to take it easy and to treat it with medication. Only when this therapy has caused a symptom relief, the physiotherapy should begin to maintain and restore the mobility in the back.

A first exercise for targeted muscle building of the upper back is the so-called “planking”. This involves adopting a position similar to push-ups, but with the forearms on the floor. The position is held with the back and legs stretched out.

Initially, 10 seconds are sufficient, which can be repeated 3-5 times after a short break. Later the time intervals and repetitions can be increased. Afterwards another exercise can be performed kneeling with the hands supported in front.

Here, on all fours, the back is slowly stretched to a hollow back and the head is placed in the neck. Afterwards a strong hump is created and the head is left hanging. If the exercises are carried out very slowly, considerable muscle activity will occur.

A very strenuous exercise for the upper back begins in the lying position on the stomach. Then the arms are placed on the back and the chest is lifted from the floor. The shoulder blades are pulled back. This position should be held for several seconds, followed by a break.