The herniated disc is one of the most common orthopedic diseases and is constantly increasing due to heavy physical strain, less balancing training and reduced ability to cope with stress. The herniated disc of the lumbar spine outweighs the herniated disc of the cervical spine and BWS. The intervertebral discs are filled with water and have a buffer function.
In case of heavy loads, especially compression loads, they absorb the load so that no bony injuries can occur. In the case of strong acute stress or after long chronic stress, structural changes occur at the edge of the intervertebral disc (annulus fibrosus). As a result, it can lead to the disc material bulging (protrusion), in the further course of the structure completely tears and the disc material in the direction of the foramen intervertebrale (intervertebral opening) pushes (prolapse). In the worst case, the intervertebral disc material completely loses contact with the disc (sequester). Depending on the direction in which the intervertebral disc material is displaced, the nerve root or spinal cord may be affected.
Osteopathic Intervention
A herniated disc does not always have to be operated on immediately. To avoid surgery it is important to find the cause of the problem. An osteopathic session helps to find the cause of a herniated disc.
In comparison to a physiotherapeutic session, which usually only lasts 20-30 minutes and in which the treatment is rather symptom-related, osteopathy is a holistic procedure. At the beginning, the osteopath gets a comprehensive picture of the patient. He learns about the patient’s habits (smoking, sports, nutrition, state of health, stress), possible previous accidents or diseases of the spine or in general, profession and the stress involved, which can promote a herniated disc.
In the osteopathy of a herniated disc, the osteopath looks at the patient’s statics from head to toe. He pays attention to the position of the spinal column, is there an increased hollow back in the lumbar spine or increased kyphosis in the thoracic spine? Does the pelvis move out more on one side, or does the patient stand slightly rotated?
In addition, he looks at the position of the head, pelvis and feet, are they on top of each other and are there any deviations? How are the legs aligned, do the feet point forward and how is the weight distribution on the feet? Are the shoulders at the same height, are there differences and how do the arms hang next to the body?
These aspects are only a rough summary of the actually extensive findings. In addition to this, an appropriate muscle tone and above all a gait analysis must be taken into account. This already shows a compensation or an incorrect posture, which can cause a herniated disc over a long period of time.
In addition to this inspection, the palpation of the patient in case of a herniated disc plays an important role. In osteopathy in case of a herniated disc the osteopath tests the tissue, not only in the area of the herniated disc, for temperature, tension and shiftability. An elevated temperature is a sign of an inflammation of the tissue, an increased tension and less displaceability indicate a protective tension of the muscles or fasciae that are stuck together.
A contrary assumption with too little tension and a lot of displaceability indicates instability. In addition to the superficial palpation, the osteopath examines the deeper lying organs in the abdominal cavity and the small pelvis. This requires a certain amount of trust between the therapist and the patient, since no defensive tension of the abdominal muscles should be created.
During this procedure the osteopath examines the shifting of the organs in relation to each other or the general firmness. If the position of the organ can hardly be changed, this indicates that the organ is stuck together or otherwise changed. The reduced mobility can further lead to congestion in the abdominal cavity, so that the function of the individual organs is no longer 100% guaranteed.
In addition, the suspension structures of the organs are also important to assess. If these are too tight due to the alteration of the organ itself, this could lead to increased tension in the area of the spinal column, which then causes a malposition. The intervertebral discs can then no longer be optimally supplied.
Possibly, it is not the organ that is the cause of the problem, but the spinal column itself.Blockages or misalignments can irritate the nerves that innervate the organs. Through specific examinations and tests the osteopath detects the malpositions. In addition, in the case of a herniated disc, the osteopath tests all joints for their range of motion in order to find and later treat possible deficits that result in altered muscle tone.
For a subsequent treatment it is also important to know whether it is an armpit prolapse (mediolateral prolapse) or a shoulder prolapse (lateral prolapse). The check is done by traction or compression on the spine, depending on what is causing the pain, the opposite direction must be included in the treatment. The osteopath also tests the course of the dermatome (sensitivity of the skin corresponding to the innervated segments), myotome (muscle strength corresponding to the innervated segments) and reflexes.
This shows the existing extent of the herniated disc, how badly the structures are affected. In addition, nerve tests are performed to exclude other structures (such as dura mater, piriformis, congestion in the abdominal cavity) in addition to the nerves. If the tests are positive for one of the structures, they can be treated accordingly.
After the extensive findings, the treatment is due. If the herniated disc is acute, extreme caution is required. The patient has severe pain and movement restrictions, which makes accurate diagnosis difficult.
In order to avoid a worsening of the herniated disc, the findings should only be made as the patient allows and the pain should be addressed in the treatment. If the patient is fit enough to produce the complete above mentioned findings, the treatment should be started accordingly. If the findings show blockages, the first step should be to try to resolve them so that the blood circulation and the innervation of the nerves is completely restored.
Likewise, the tension in the organs will automatically decrease if the segment has caused the problem. These blockages can be released by mobilization in a certain position. Manipulation is not advisable in the case of a herniated disc and should be avoided in order to avoid further irritation of the tissue.
Another possibility to reposition the vertebra is the muscle energy technique. In this technique, the patient is placed in an appropriate position and the affected muscles involved in the malposition of the vertebra are tensed. This automatically brings the vertebra back into the correct position.
The mobilization alone stimulates blood circulation and metabolism, so that the tone of the muscles and fasciae is reduced. Soft tissue techniques in the area of the back can, for example, be performed in a lateral position, where the back extensor can be stretched with the rotation of the pelvis and can be directly triggered or stretched. Of course, simple massage grips in the prone position are also suitable for lowering the tone.
The fasciae can be applied globally by pushing the pelvis in the direction of the feet and pulling it over the ribs in the head direction, or locally by pushing the finger along the fascia. If the tonus in another muscle remains elevated after mobilization of the vertebra, it should also be loosened using soft tissue techniques or fascial solution. However, it is important to note that the tone does not decrease immediately after the blockage is released, this usually happens within the next few days, which is why an osteopathic session should be performed every 6 weeks.
The strength of the organs can be improved by direct techniques. The osteopath mobilizes the organ in its place and thus stimulates the blood circulation of the suspension structures which cannot be palpated directly. Similarly, in conjunction with long levers (e.g. leg in the case of mobilization of the bladder and uterus), he can also perform indirect mobilization if the patient cannot relax properly.
For further information, please refer to fascial training, mobilization exercises and connective tissue massage. If there is still a nervous problem after the mobilization, the nerve can be lengthened by specific nerve stretching, since it will probably have to be regenerated by a longer period of pressing through the intervertebral disc. In order to achieve a general improvement of the statics, the osteopath mobilizes each individual joint in order to detect possible blockages or movement restrictions.
In further sessions these can then be improved by mobilization and manipulation.Especially in the sacroiliac joint (ISG) area, a free degree of movement is important, since a lot of static work must be done in the small joint where little movement takes place. A blockage leads to a rotational position of the pelvis and thus to a changed static and the intervertebral discs are more heavily loaded. This entire false statics must be improved.
Osteopathy for a herniated disc is a very gentle treatment and above all requires a lot of sensitivity. The osteopath often works with very gentle techniques which the patient does not feel immediately afterwards. However, much more is achieved than initially assumed, as the body is activated to heal itself.
The malpositions cause an imbalance in the body. Blood and lymph fluid can no longer flow unhindered, the immune system deteriorates over a long period of time. Through osteopathic techniques the balance is restored and the body is stimulated to heal itself.
