HERNIATED DISC
(Ruptured Disc)

Description
Sudden or gradual break in the supportive ligaments surrounding a spinal disk. The disc functions like a cushion between the bony vertebrae. The jellylike contents of the disk then protrude and may push on the spinal cord or nerves coming from the spinal cord, causing symptoms.  This may occur in the neck, mid-back, or lower back.

Common Signs and Symptoms

  • Pain in the back that usually affects one side, is worse with
  • movement, and may be worse with sneezing, coughing, or
  • straining
  • Muscle spasms of the muscles in the back
  • Pain, numbness, or weakness affecting one arm or leg
  • (depending on whether injury is in the neck or low back respectively)
  • If chronic, wasting of the affected muscles
  • Loss of bowel (stool) or bladder (urine) function

Causes
Weakening and rupture of the disc material, creating pressure on nearby spinal nerves. Ruptured disc is caused by sudden injury or chronic stress, such as from constant lifting.

Risk Increases With
•Any sport in which movement causes downward or twisting pressure on the neck or spine, most commonly football, weightlifting, horseback riding/equestrian competition, bowling, tennis, jogging, track, racquetball, and gymnastics
•Poor physical conditioning (strength and flexibility)
•Inadequate warm-up before practice or play
•Family history of low back pain or disk disorders is usually 75% of the time
•Previous back surgery (especially fusion)
•Preexisting spondylolisthesis
•Poor mechanics with lifting
•Prolonged sitting, especially with poor mechanics

Preventive Measures
•Use proper mechanics when sitting or lifting.
•Appropriately warm up and stretch before practice or competition.
•Maintain appropriate conditioning.
•Cardiovascular fitness
•Back and hamstring flexibility
•Muscle strength and endurance
•Maintain ideal body weight.
•If previously injured, avoid any vigorous physical activity that requires twisting of the body under uncontrollable conditions.

Expected Outcome
This condition is usually curable within 2-6 weeks with appropriate conservative treatment (80% resolve within 6 weeks). Some patients need epidural injections or surgery.

Possible Complications
•Permanent numbness, weakness, or paralysis and muscle wasting
•Chronic back pain
•Loss of bowel or bladder function
•Decreased sexual function
•Risks of surgery, including infection, bleeding, injury to nerves (persistent or increased numbness, weakness, or paralysis), persistent back pain, and spinal headache

General Treatment Considerations
The injury to the back results in pain and inflammation. The pain and inflammation result in muscle spasms of the back muscles, which in turn result in more pain. Thus the initial treatment usually consists of treatment to relieve pain, inflammation, and muscle spasm. As pain and spasm subside, exercises to improve strength and flexibility and proper back mechanics are started.  Chicago Spine and Sports use McKenzie Method for these exercises and education regarding back mechanics.  Prolonged bed rest is felt to do more harm than good. Bending your knees to pick things up off the ground (as opposed to bending at the waist), laying flat on your back on a firm mattress with a pillow under your knees, and using good posture when sitting are helpful back tips. If conservative treatment does not work a trial of oral steroids or epidural (into the space around the lining of the spinal cord) steroid injections may be attempted to reduce the inflammation around the herniated disk and inflamed nerve. For patients with loss of bowel or bladder function or persistent pain, numbness, or weakness or paralysis, surgery is often recommended to remove portions of the disk pushing on the nerves or spinal cord.

For more information check out: Spine-Health.com

 

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