Introduction
What many patients do not know, already in the acute phase of a herniated disc of the lumbar spine, physiotherapeutic applications can bring about a significant reduction in symptoms. The physiotherapeutic treatment for a slipped disc in the lumbar spine is primarily based on the current complaints of the patient, as well as the phase of the disease. During the acute phase of the lumbar spine syndrome, the main focus of the physiotherapist should be on rapid pain relief. The characteristic pain of a herniated disc is caused by the fact that the damaged disc structure exerts pressure on the nerve root exiting the intervertebral hole of the spine. In the context of physiotherapy, therefore, first attempts are made to reduce this pressure through targeted positioning, mobilization techniques and manual therapeutic techniques.
Therapy of a lumbar spine syndrome
Here the patient lies in a supine position, the legs are placed on a foam cube, whereby the hip and knee joints should have an angle of approximately 90°. The positioning angle of the legs can also be varied individually, depending on the most comfortable position. Some patients with a lumbar spine syndrome prefer a somewhat flatter position by placing a blanket or similar under the lower legs.
The lying surface should be rather hard. The aim is to relieve the lumbar spine and to widen the intervertebral holes (neuroforamas) for the nerve roots that are under pressure. This positioning can be well supplemented by local application of heat by placing a flat warm pack, a hot water bottle or a warm towel under the lumbar spine, without naturally moving into a hollow back position again.
This positioning is very well suited for self-treatment at home during the acute pain phase of lumbar spine syndrome. An even more effective position for a lumbar spine syndrome, which in principle uses the same effect as the stepped bed position, is the pelvic-leg suspension in the so-called sling table. Sling table treatment is mainly offered by physiotherapeutic practices or physiotherapeutic departments in hospitals.
In this special device, the pelvis and legs are fixed in special belt systems and aligned in the positioning described above. The loop construction simulates a certain “weightlessness” and the relief for the intervertebral disc structures often brings a considerable improvement of the complaints. Another effective physiotherapeutic treatment method of the herniated disc (prolapse) is the traction treatment (stretching treatment).
This is done manually (by the physiotherapist physiotherapist), or in the sling table via an additional weight, a pull in the longitudinal direction of the spine. By this dosed traction, one tries to pull the vertebral bodies apart minimally and to relieve the affected intervertebral discs and nerve roots. However, this therapy of the lumbar spine syndrome should only be carried out by a qualified therapist who can dose the intensity of the traction according to the situation.
Of the physical therapy measures of the lumbar spine syndrome, heat applications (thermotherapy) in the acute phase promise a relief of symptoms, since the effect of a mud pack or other heat media can relax the often painfully cramped muscles. A massage therapy is often not recommended in the acute phase of a herniated disc, since intensive grip techniques can cause additional irritation of the affected nerve structures. Furthermore, the possibilities of Traditional Chinese Medicine (TCM) can of course be exploited.
The best known part of TCM is certainly acupuncture, but also moxa therapy (burning of medicinal herbs on acupuncture points) or foot reflexology can be successfully applied. The physiotherapeutic treatment of a slipped disc of the cervical spine in the acute phase is very similar to the physiotherapy of the cervical spine syndrome. In the subacute phase (the strongest, immobilizing pain is over) of the lumbar spine syndrome / herniated disc, one of the most important aspects of physiotherapeutic treatment is targeted training of the trunk muscles (abdominal and back muscles).
The above mentioned therapy methods and also the medical treatment are primarily symptom-oriented. A long-lasting and preventive therapeutic effect can only be achieved by a well-executed muscle building training and by learning how to behave in everyday life in a way that is suitable for the back.While in recent years great importance was attached to training the back and abdominal muscles, a trend reversal has recently become apparent. Newer concepts neglect the aspect of abdominal training more and more and clearly focus on training the back muscles.
It also makes sense to exercise the rotational movements of the spine after a slipped disc (in a certain time interval). However, more complex exercises, such as the rotational component of the spine, should only be done under professional supervision in a physiotherapeutic practice or gym with physiotherapeutic supervision, since more harm than good can be done by incorrect training. Also a training with free weights (dumbbells) moves again more into the foreground.
Simpler, but still effective exercises can be done well at home, however, even without a great deal of expertise and equipment. For example, exercises in a four-footed position are very well suited to efficiently strengthen the entire back muscles. The most important thing is to make sure that you have a good starting position.
For example, the entire spine should be muscularly stabilized to avoid evasive movements. Another important clinical picture, which very often leads to an acute lumbar spine syndrome, is the “blocking” of one or more vertebral joints. A blockage, known in medical terminology as segmental articular dysfunction, describes a temporary movement disorder of a joint.
In the classic case of an acute blockage of a vertebral joint, patients typically report a sudden, lumbagolike back pain that leads to the immediate cessation of all activities. Movements are hardly or no longer possible. The cause of such blockages is often a jerky lifting of heavy objects, but sometimes it is simply an unfavorable movement in a stooped position.
In a very short time, the surrounding lumbar spine muscles tense up enormously, as an expression of the body trying to immobilize the pain-triggering movement segment (the blocked vertebral joint). Blockages can also be less dramatic. Patients are more likely to complain of unspecific back pain or have the feeling of “being somehow crooked”.
Therapeutic treatment methods aim at restoring the physiological (natural) joint play and freeing the blocked vertebral body from its constrained position. The most frequently used treatment techniques to achieve this goal are manipulation techniques and mobilization techniques. Both techniques are part of manual therapy.
In the manipulation techniques, targeted, rapid impulses are placed in the area of the blockage. In the population this technique is understood as the classical “setting”. The mobilization techniques are muscle energy techniques that work without fast impulses and use the patient’s own muscle power to free the blocked vertebral joint.
In Germany, the “settling of a blocked spinal column” is reserved for doctors with special additional training (chiropractic manual therapy). Mobilization techniques are performed by doctors and physiotherapists who are trained in manual therapy, due to the lower possibility of complications. Both techniques are equally well suited to release a blockage when used properly.
Back problems, as they frequently occur in the lumbar spine syndrome, are often caused by tension in the muscles, incorrect loading of the spine or due to pathological changes in the small vertebral joints. In addition to conservative therapy (e.g. the administration of analgesic and muscle-relaxing drugs), acupuncture is another, non-surgical way to alleviate the complaints. Special needles are inserted into certain acupuncture points (meridians) by a physician or alternative practitioner trained in natural history.
They remain there for about 20 to a maximum of 30 minutes. The patient feels a slight tingling or warm sensation during the treatment. The aim of acupuncture is to activate and stimulate the flow of energy, the blood circulation in the affected areas of the body and the body’s self-healing powers.
Often an improvement of the symptoms is achieved after only a few sessions. A new treatment method is the NSM neurostimulation. Here, fine probes, similar to acupuncture needles, are inserted into the diseased tissue.
An electrical field is then applied between these probes, which is generated by a special stimulation device.The aim is to neutralize pain- and inflammation-inducing substances and at the same time to direct important cells for wound healing to the site of damage. The treatment is completely painless for the patient and, according to current knowledge, can have an anti-inflammatory and regeneration-promoting effect.
