Lumbar Disc Herniation
Spinal disc herniation is a medical condition affecting the spine in which a tear in the outer ring of a disc that allows the soft central portion to bulge out beyond the damaged ring. Lumbar disc herniation can occur at any age, but the age average is approximately 40 years old(Spengler.) Because of this it is very uncommon for an athlete to present with this disorder. The cases we do see are usually in result from a trauma rather than degeneration. Disc herniation’s in the lower back often occur between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Tears are almost always postero-lateral in nature. This often applies pressure to the posterior side where the spinal cord and clauida equina is located. These nerves run to the leg and any type of pinched nerve in the lower spine can causing radicular pain through the buttock and down the leg. A tear in the disc ring may result in the release of inflammatory chemical mediators, which may directly cause severe pain, even in the absence of nerve root compression. There are four stages of discal displacement. Intradiscal mass displacement is non-physiological displacement of tissue within the disc. Protrusion is when displaced material causes a bulge in the intact wall of the annulus. Extrusion is when the disc material is displaced through the ruptured annular wall. And Sequestration is a small fragment of disc material is forced through the ruptured wall into the spinal canal(McKenzie.) Disc herniation’s are normally a further development of a previously existing disc protrusion.
Symptoms of a herniated disc can vary depending on the location of the herniation and the types of soft tissue that become involved. They can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting lower back pain that will radiate into the regions served by affected nerve roots that are irritated or impinged by the herniated material. Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet. Other symptoms may include sensory changes such as numbness, tingling, muscular weakness, paralysis, paresthesia, and affection of reflexes. Unlike a pulsating pain or pain that comes and goes, which can be caused by muscle spasm, pain from a herniated disc is usually continuous or at least is continuous in a specific position of the body. Typically, symptoms are experienced only on one side of the body. If the prolapse is very large and presses on the spinal cord or the cauda equina in the lumbar region, both sides of the body may be affected, often with serious consequences. Compression of the cauda equina can cause permanent nerve damage or paralysis. The nerve damage can result in loss of bowel and bladder control as well as sexual dysfunction. This disorder is called cauda equina syndrome.
Disc herniation’s can result from general wear and tear, such as when performing jobs that require constant sitting and squatting, lifting, or driving. Professional athletes, especially those playing contact sports, are prone to disc herniations as well. Weightlifting athletes are also at a high risk for lumbar injuries.
There are a few different evaluation techniques that can be used for lumbar disc herniations. The two most common are the well-leg raise and the straight-leg raise. The straight leg raise identifies sciatic nerve root irritation that may be a result from disc herniation. The well-leg raise test identifies a large disc lesion that protrudes medially to the nerve root (Shultz.)
Usually MRI is the most commonly used diagnostic test used to confirm a disc herniation. The doctor will occasionally order x-rays to make sure there is no fracture in the facets or spinous processes. This test can be used to confirm the location of the herniated disk and to see which nerves are affected. Most...
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