Damage to intervertebral discs is one of the most common causes of excruciating back pain. Problems with the intervertebral discs occur predominantly in the lumbar spine, less frequently in the cervical vertebrae and only very rarely in the thoracic vertebrae. Common reasons are poor posture, lack of exercise or one-sided strain – the pressure on the spine poses a risk to the intervertebral disc. How can discomfort be effectively treated?
How does disc damage occur?
The intervertebral discs consist of a fibrous ring in which there is a gelatinous core. They lie between the vertebrae in the spine, making the spine flexible and acting as a kind of “cushion.” Damage to the intervertebral discs occurs for a variety of reasons: Too little exercise and a predominantly sedentary lifestyle cause abdominal and back muscles to weaken. The spine is no longer sufficiently stabilized and the intervertebral discs can bulge. If the fibrous ring tears and gelatinous mass escapes, the disc herniates. Anyone who weighs too many kilos also risks disc problems. This is because excess weight is one of the most important factors in the incorrect loading and premature wear of the intervertebral discs.
Incorrect loading and accidents as the cause
Anyone who handles heavy objects incorrectly or lifts loads that are too heavy can trigger an acute herniated disc. There is also a risk of overloading during pregnancy, because the body’s center of gravity is shifted forward and the hormonal changes cause more water to be stored in the intervertebral discs. They lose stability, which favors a prolapse of the gelatinous nucleus. Accidents can also result in a herniated disc, for example a fall down stairs. More rarely, inflammatory processes are the cause of disc problems.
Damage to the intervertebral disc: typical symptoms
Not every disc change has to lead to discomfort. Symptoms only arise when a bulging disc presses on the surrounding nerves. This often manifests itself as a pulling pain in an arm or leg, often associated with sensory disturbances such as tingling or numbness. If the disc presses against the spinal cord, increasing weakness of both arms and legs is a possible consequence. If the pressure on the nerves persists for a longer period of time, paralysis may even occur. In some cases, control of bladder and rectal function is lost. Sensory disturbances in the intimate area, on the inner side of the thighs, and paralysis of the legs are also typical signs. Because numbness occurs in the area of a rider’s contact with the saddle, it is also called breeches anesthesia (anesthesia = numbing).
Diagnosis in the case of disc damage
Important for the diagnosis are first the patient’s medical history and an orthopedic-neurological examination. In many cases, this can already tell with a high degree of probability at which point the disc is bulging. A computed tomography (CT) scan or magnetic resonance imaging (MRI) of the affected spinal region can confirm or refute the diagnosis.
Types of disc damage
There are several types, depending on where the disc damage occurs:
- Cervical disc damage occurs in the cervical spine (C-spine).
- Lumbar disc damage refers to disc damage in the lumbar spine (LS).
- A thoracic disc damage occurs in the area of the thoracic spine (BWS), but is extremely rare.
One speaks of a zerivikalen herniated disc with radiculopathy, if there is also damage or irritation of a nerve root. This leads to a radiation of pain along the nerve towards the fingers. In conjunction with disc damage in the lumbar spine, radiculopathy leads to discomfort in the legs.
Exercise as part of treatment
Herniated discs that are not associated with paralysis, bladder or rectal dysfunction should be treated more conservatively, without surgery. In the past, pain sufferers were first prescribed bed rest – this is no longer an issue today. On the contrary, targeted exercise is part of the treatment right from the start. In physiotherapy, patients learn to move as painlessly as possible. At first, this often only works with painkillers and medication to relax the muscles.In case of problems with the intervertebral discs, the discs must be relieved in any case. Continuous training of the trunk muscles has proven to be a very good remedy for persistent pain in the lumbar spine. A physiotherapist can explain to the affected person which exercises he or she should perform daily on his or her own.
If muscle paralysis occurs, go to the hospital immediately
Care must be taken with muscle paralysis, as the longer the paralysis persists, the lower the chances of complete recovery. You need to be evaluated immediately in a hospital and have surgery as soon as possible. Otherwise, surgery can only be considered if all nonoperative forms of treatment have been unsuccessful.
Herniated disc: conservative therapy and surgery.
For conservative therapy, you need some patience. The affected person should allow for several weeks of intensive, preferably inpatient treatment. In surgery, the destroyed disc tissue is removed, which relieves the constricted nerve roots. Gentle procedures such as microsurgery are now available. Here, neurosurgeons work with a surgical microscope, and the access created is only a few centimeters in size. Scarring and discomfort after the operation are less. An intervertebral disc operation always carries risks: damage to nerves and blood vessels, infections and later instability of the spine cannot be ruled out. If scars form in the area of the operation, the complaints can always recur. Therefore, surgery is only performed if it is urgently necessary and the expected benefit is significantly higher than the risks.
Preventing a herniated disc
Everyone can do a few things for their back themselves to prevent disc problems. This includes continuous training of the back and abdominal muscles to stabilize the spine for daily demands. This is because a well-trained muscle corset takes on a good portion of the mechanical loads. Back schools teach you how to strengthen the important muscle groups and how to bend, carry, sit, stand and lie down properly. Back swimming, walking or cycling are also recommended to strengthen the muscles and thus prevent damage to the intervertebral discs. Physical exercise also lifts the spirits.
