| Lower back pain caused by a herniated lumbar disc is a very common problem and a
major reason for lost productivity and time off the job in the United States.
First a bit about what a "disk" is. Our vertebrae (spinal bones) are cushioned
by pads of tissue called disks. The disks are made up of a outer capsule or
ring called the annulus which is made up of a tough fiber amterail. It
surrounds a nucleus, which is a spongy center of "jelly" material.
When disks
are healthy and working like they should, they serve as shock absorbers to the
spine and keep us flexible. When the disks are damaged somehow by an injury or
age or disease, they begin to bulge abnormally and can even rupture (the
jelly-like material breaks through the tough outer layer. This is called a
herniated disk. Herniated disks can occur anywhere in the spine, but most of
them take place in the lumbar (low back) region.
The disk material can place
pressure on the adjacent spinal cord or the nerve roots exiting the spine. This
can cause pressure on the spinal cord or nerve roots can result in pain or
numbness or tingling in the lower back, in the buttocks, hip region and down the
legs to the feet.
There are many risk factors contributing to a herniated lumbar disc. As we age,
there is an ongoing loss of both water and proteins from the disc which causes
it to become thinner and less able to function as an adequate cushion between
the vertebrae. There are genetic (inherited) predispositions to having
herniated discs. Obesity puts undue pressure on the spine and lack of exercise
results in a loss of muscle strength and diminished spinal support. Smoking
deprives blood flow and nutrients needed to the spine and disks. Work activities
consisting of heavy lifting, poor body mechanics, and repetitive motions, can
also play a part in increasing one's chances of having problems with herniated
disks.
You should consult your physician if you have symptoms such as prolonged severe
back pain, problems with urination or a sudden change in bowel habits or
control, and prolonged numbness, tingling, and perhaps weakness in your legs and
feet.
The diagnosis of a herniated disk is based on a history and physical examination
by your doctor and perhaps imaging studies such as xrays or an MRI scan. Most
back injuries resolve in a matter of weeks and one shouldn't expect to have an
MRI scan ordered by your doctor initially unless he feels it is necessary.
Most back problems, even due to a herniated disk, can be managed conservatively
with some rest, anti-inflammatory medications, physical therapy and exercises.
For patients who have ongoing severe back pain or weakness or functional
problems with walking and performing their everyday functions, then surgery or
epidural corticosteroid injections maybe considered. There is a significant
misconception among the public that surgery is the only solution. One should
reserve the surgical option when all conservative measures have been tried and
failed.
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