The Limb Numbing Lumbar Disc Herniation

Can you do this without feeling any numbness below your knee or pain in your hip? If no...well you just MIGHT have a disc herniation.

What exactly is a Disc Herniation?

Source: http://www.backpainhelptoday.com/herniated-disc/

Source: http://www.columbianeurosurgery.org/wp-content/2009/11/sc.gif

The "disc" in disc herniation is referring to the intervertebral disc (seen on the right, but also in blue below) that can be likened to a jelly doughnut. The "jelly" on the inside is called the nucleus pulposus (in white) and the "doughnut" is a ligamentous structure called the anulus fibrosus (in pink).





Simply put, a disc herniation is a tear in the anulus fibrosus which leads to the protrusion/bulging of the nucleus pulposus. This bulge can compress a nerve root which may cause symptoms seen in a disc herniation.

These bulges can be either posterior or lateral (depending on where the ligament tears), but they occur most commonly at the L4-L5 or  L5-S1 spinal level.




What is the cause of disc herniation and what are the symptoms?

Disc herniations can be caused by repetitive lifting and twisting events (as demonstrated by Deanna Savant in the above video). Improper lifting techniques can lead to a disc herniation, but remember it is due to REPETITIVE TRAUMA and NOT a single event; so following in Sally O'Malley's steps one or two times might not a disc herniation.

Symptoms include:

• Low back pain (at first) because you have sprained your back (torn those ligaments)
• Numbness and tingling into extremity in a dermatonal pattern, usually L5-S1 (refer to page 360 - 361 in the Muscle Manual for a map of the dermatones)

What confirmatory tests can be performed?

Straight Leg Raise Test

When you are at the apex (or at the maximum point where there is no reproduction of symptoms) and have dorsiflexed the foot, bend the knee and continue to flex the hip to rule out any hip problems. A positive test will show possible sciatic nerve impingement due to disc herniation.

Deep Tendon Reflex (DTR)

For disc herniations, the "ankle jerk" reflexes (testing L5-S1) is most applicable. An abnormal reflex (must perform test bilaterally to determine what's considered normal for the patient) may confirm lumbar disc herniation, but other tests must be performed.

Resisted dorisflexion test

The patient will dorsiflex as shown in the video, but instead of the elastic band, the practitioner will push the patient's foot into plantar flexion and the patient will be asked to resist their force. If the patient cannot (or weakly can) resist the practitioner's force, it may confirm a disc herniation impinging the sciatic nerve.

Treatment of a disc herniation

Acute Disc Herniation:

• Decrease inflammation (via PRICE) and decrease load bearing
• Avoid any twisting or aggravating activity (especially the activity that caused the injury in the first place)
• Lock the pelvis in a neutral position for any movements (to protect the back and decrease potential for further injury)

Chronic Disc Herniation:

• Spinal decompression
• There are several ways to decompress the spine:
• Inversion table
• Decompression machine
• Hanging from a stable door/bar
• Simply laying down (takes the pressure off the spine and allows for re-hydration of discs)

A disc herniation should resolve itself IF you deal with it EARLY/ACUTELY, don't wait until it becomes chronic and a major problem! If you want to be able to kick and stretch at 50 like Sally O'Malley, PROTECT THAT BACK and get it looked at early!