_{Design On Canva}

Disc Herniation

Disc herniation, also commonly called a slipped disc, is a medical condition that affects the spine. It occurs when one of the soft cushions between the bones becomes damaged, meaning it slips out of place. The disc absorbs shock from the spine and helps us move, such as up and down or bending over.

Structure:

The disc in our spine consists of two main parts, which are as follows:

Annulus Fibrosus: It is a hard lining of our discs, made up of fibrous material, that protects our inner core.

Nucleus Pulposus: This is a jelly-like substance in our discs that provides us with flexibility and absorbs the pressure on the spine.

Causes:

There are various reasons why a disc herniation can occur, including:

Age-Related Wear & Tear: Our discs naturally lose water content over time, which makes them less flexible and increases the risk of rupture.
Sedentary Lifestyle: If we don't structure our physical activities, all the muscles around our spine become weak, which makes them more susceptible to disc injuries if they suddenly have to do any activity, such as heavy lifting.
Poor Posture: This can also be a problem for us due to poor posture. Sometimes when we sit or lift anything heavy, there is unnecessary pressure on our spine, which can lead to disc herniation.
Overweight & Obesity: If we are very obese and overweight, this also puts pressure on our spine, which greatly increases the risk of a slipped disc in the lower back.

Types:

There are three main places where we can have a disc herniation:

Cervical Disc Herniation: Cervical disc herniation occurs in the neck area where the cervical spine is located, causing pain in our shoulders, arms, and neck.

Thoracic Disc Herniation: It is less well known, and occurs in the upper back where we feel pain in the middle of the chest or back.

Lumbar Disc Herniation: This is a common type that is commonly found, due to which we have pain in the lower back, which is called our lumbar spine. There is usually pain in the lower back and it also causes sciatica, due to which the pain spreads down our legs.

Symptoms:

Back Pain: Its most important symptom is back pain, especially in our lower back.
Sciatica: When our herniated disc presses on the sciatic nerve, it causes sharp pain in our buttocks, legs, and even feet that quickly spread.
Neck Pain: This causes neck pain and spreads from our shoulders to our arms.
Numbness / Tingling: This disease causes our nerves to contract, causing us to feel numbness and tingling there.
Weakness: Our muscles become weak, both in the arms and legs if the spine is involved.

_{Design On Canva}

I will explain in full detail here how we will diagnose a disc herniation.

Patient History:

Symptoms: The first thing a patient with such a condition is asked about is their history. In the history, we will first ask them about their symptoms, where they feel pain for how long, if they feel any tingling there, or if they have any weakness.

Activity History: We will ask the patient what activities they do that cause them to have problems with their herniation, whether they lift heavy objects, or if they have problems with repeated walking or movement.

Medical History: We will find out his/her entire medical history to see if he/she has had any previous spinal problems or disc problems or if he/she has a family history of such problems.

Physical Examination:

Then we will do a physical exam to assess their spine and their nerves, which includes a few things to look for:

Pain & Tenderness: We will check the pain of a patient with such a condition by pressing on their spine from different places.

Range of Motion: We will ask the patient to move in specific directions so that we can detect the symptoms from their movements, whether they are obvious or not. We will ask them to twist or extend.

Muscle Strength: We will test their muscle weakness, which will be controlled by the nerves that can also contract from each herniated disc.

Sensation: We will test them for numbness or tingling that may be affected by these nerve compressions.

Common Imaging Test:

X-Ray: We will do an X-ray of the patient, in this X-ray, we cannot see the soft tissues, but it can clarify for us other causes such as bone fractures.

MRI: We will do an MRI test, which stands for Magnetic Resonance Imaging, which allows us to see all the soft tissues clearly and see which discs are bulging and which ones we are seeing shrinking.

CT Scan: CT scan is rarely used. We often use it when MRI is not available because it shows us all the structures of the spine in detail.

Myelogram: This is also a special type of X-ray that uses a contrast dye injected into the spinal canal to show us which nerves are being pressured by the herniated disc.

Special Test in Physiotherapy:

There are some specific types of tests that we use to confirm a disc herniation. They are listed below:

For Cervical Disc Herniation:

Spurling's Test: If the patient's head is tilted towards the affected side, then this test is performed by applying slight additional pressure to it to determine whether it recreates the symptoms of nerve compression.
Cervical Compression: With this test, we press down on the top of the patient's head while they are in a neutral position. This way, after we press on their neck, we check how much pain there is in the arms or neck.

For Thoracic Disc Herniation:

Schober's Test: We usually use this test to assess the mobility of the thoracic and lumbar spine. When we bend the patient forward, we can then tell how much further the spine can bend.
Thoracic Spine Rotation Test: In this test, we ask the patient to rotate their upper body and, then we assess their pain and their range of motion.

For Lumbar Disc Herniation:

Straight Leg Raise Test: In this test, we make the patient lie on his back and then lift one of his legs. If the patient feels pain under that leg, then this indicates a lumbar disc herniation.
Femoral Nerve Stretch Test: Through this test, we identify disc problems in the upper part of the spine. This test also tells us about the irritation of the femoral nerve.

Treatment of Disc Herniation:

Conservation Methods:
To cure a herniated disc, we need to rest it as much as possible and we should avoid all movements that cause our disease, such as excessive twisting or lifting heavy objects. To strengthen our spinal muscles, we need to adopt the exercises that are part of physical therapy. For example, we can use the Hip Bridging exercise to strengthen our lower back muscles, which will help us support our spine.

Medication:
To get rid of pain and inflammation, we need to use medications that will relieve our pain, and inflammation, and relax our muscles.

Surgery:
If you are not getting better with medication and physical therapy, then in severe cases you may have to go for surgery. We will have to perform surgery to remove part of each herniated disc and relieve the pressure on all of them.

Hip Bridging Exercise

Knee to Chest Stretch

Sciatic Nerve Glides

When I started doing these exercises, I had a little difficulty because it was my first time. But after I did 10 repetitions of them, I felt a lot of relaxation in my legs and lower back where I was having pain before. It has given my spine a lot of relief. When I stretched it, I could feel the effect of this exercise on top of it. And it has given me a lot of flexibility and has also relieved the pain.

That's all about my task. I hope you guys like my home task. Thanks a lot for staying here. I would like to invite my friends @josepha, @kouba01, @rumaisha, and @djanita to join this amazing challenge.

Cc:
@ashkhan

_{Dated: 05-12-2024 About Me}