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Monday, 10 October 2011

Herniated disc

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Your spine is made up of vertebrae, each separated by intervertebral discs made of fibrocartilage.  The discs are made up of inner and outer parts - a soft gel like elastic inner core called the nucleus pulposus and the tough annulus fibrosus being the outer rim of cartilage. The nucleus pulposus is there to distribute the pressure of each disc when they are put under load, i.e. they are shock absorbers. They also enable each vertebrae to glide over the other, keeping movements smooth.

What is a herniated disc?
Also called a slipped, ruptured or prolapsed disc. What happens is the soft inner nucleus pulposus herniates - it bulges through a tear or distortion in the annulus fibrosus into the vertebral canal or intervertebral foramen. The damage to the annulus fibrosus can happen because the disc is compressed beyond its normal range.

Depending on which way the bulge protrudes will determine what symptoms are felt. The disc can compress the spinal cord or nerves which can lead to reduced, or loss of function to the areas of the body served by the nerves. To you, this will feel like mild to severe back ache with or without burning, tingling, numbness or other sensations. If really severe muscle function can be affected or even paralysis. It really depends how severe the injury is, and what structures are affected.

Why does it happen?
For a fit and healthy person it is usually caused by sudden trauma, generally because of strenuous exertion (e.g. lifting a heavy object) or exercise (e.g. improper technique when weight lifting). Trauma can occur because of the lightest of movements, e.g. picking up a small object, and this would point to an underlying cause, or with forceful trauma to the vertebral discs such as in a fall or car accident. Poor posture can also contribute to this condition. In the healthy/young population the herniation is generally sudden and acute.
For older people the herniation can occur because of wear and tear - bone disease or degeneration, and the onset can be more progressive and chronic. That said, the onset, i.e. when you feel the pain, is usually sudden and sharp.

Can it be prevented?
Obviously accidents and traumatic occurrences are difficult to prevent. You can however ensure you perform lifting with proper technique, and keep yourself generally fit and healthy. Avoiding repetitive twisting movements is generally a good idea as this can put extra pressure on the discs. In a gym ensure your trainer shows you correct posture and technique and continues to monitor you so that you continue to do the exercises correctly. This should minimise the risks.

How to treat it?
Immediate care is rest and application of ice initially, heat can be applied after the acute stage has passed. Seeing your GP or emergency doctor may be appropriate. With medical intervention anti-inflammatory and pain medication may be prescribed.  As the injury progresses bed rest may be applicable for a period but generally normal activity should be undertaken ('active rest') to prevent muscle guarding and keep the spine mobile. If there is pain then stop what you're doing. Longer term, you should be looking to undertake strengthening and flexibility exercises with a sufficient warm up. It should go without saying that sudden or excessive heavy lifting is to be avoided to prevent re-injury. In severe cases surgery may be necessary but the majority of cases resolve with this being necessary.

Can Sports Massage help?
Yes, it can. Providing the therapist avoids treating on a day when symptoms are bad then there are no reason not to massage. Sports Massage will help to relieve muscle spasms, muscle guarding and tension which is your body's natural reaction to 'protect' the area. The intention of massage is to create space around the affected vertebrae, thereby allowing for the retreat of the herniated tissues.

Massage will also help to manage pain. A good therapist will look at the wider issues occurring in your body which might be contributing to, or a result of the disc injury. For example, postural imbalances, muscle functioning (what might be inhibited or short), firing pattern dysfunction and gait reflexes should be considered as part of the treatment. The aim is to look for the cause of the issue, as well as managing the acute area and muscles surrounding the injured disc. 

It is often appropriate with this condition for massage therapy and osteopathy treatments to be included in the overall treatment plan. This is to allow the soft tissues and bony structures to be worked in tandem, since both are involved.

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