Backache Hernia of the Loins
Lumbar hernia, which is one of the most common and the most important causes of low back pain, is the strain on the vertebrae and the result of activities such as heavy lifting, that the fibers around the disc structure rupture (Nucleus Pulposus) protrudes towards the nerve channel.
Who is at risk for lumbar hernia?
Lumbar hernia is most frequently seen between the ages of 30-50. Having an inactive lifestyle, working in the work environment for a long time, working in jobs that require heavy loads, excessive weight, unconscious sports, wrong sitting, posture disorders and long-term car use, facilitates the emergence of the hernia problem.
What are the signs and symptoms of lumbar hernia?
The most common symptom of herniated disc is back pain. The patients usually state that pre-existing back pain is increased as a result of a strain and spread to the legs. When the herniated disc touches neighboring nerve structures, it can cause leg pain, also known as sciatica.
Along with pain, the patient may feel numbness, tingling, decreased force and thinning in the legs. Waist movements are painful in patients. Lumbar hernia sometimes goes insidiously, does not give any symptoms. Although there are no complaints during routine control, the lumbar hernia can be detected in patients.
How is the diagnosis made?
If the physician thinks that there may be disc herniation during the examination of the patients with low back pain, they ask for magnetic resonance (MR) examinations. If MRI cannot be performed, different imaging studies such as CT may be required. According to the findings, EMG can be requested from the patient.
How is it treated?
Lumbar hernia can be treated mostly by non-surgical methods (medication, physical therapy and exercise, local injections) called conservative treatment. Patients with no nerve damage and no root compression respond more quickly to treatment.
The duration of treatment is prolonged and recovery is difficult in cases with neurological damage. Surgical consultation should be requested in patients who have persisted more than 6 months and who do not benefit from conservative treatment methods, in case of sudden falls in the ankle, progressive loss of force and incontinence.
Although it can be healed with simple therapies at an early stage, it can be the patients who have undergone unconscious operations and even palsy. For this reason, correct diagnosis and specialist treatment are critical in order to be able to heal the lumbar disc without making it more complicated.
The reason for each low back pain may not be herniated disc.
Causes of low back pain;
A bad posture, bad waist positioning, staying in the same position for a long time, wrong and sudden movements can cause muscle pain. Problems such as herniated disc may occur due to the wear and tear.
Waist stiffness and muscle spasm are caused by excessive stretching or rupture of the muscles and ligaments supporting the waist after heavy lifting, falling, sports activities.
Lumbar disc herniation and disc slippage is a shift or overflow of cartilage tissue that acts as a pillow between the vertebrae. It can cause leg pain by pressing the nerve. Coughing can cause back and leg pain in such situations.
The narrowing of the spinal canal is due to the formation of nerve entrapment as a result of narrowing of the canal and the channel through which the nerves pass. Particularly after walking a certain distance, there will be pain that is split into the leg. Pain can be alleviated by resting and leaning forward.
Sliding and distortion of the vertebrae is situations where the vertebrae slides over each other. Examples include: back curvature (scoliosis), back opening (spina bifida), excess lumbar spine (lumbalisation), lack of lumbar spine (sacralizaston). These situations often cause situations in which we call mechanical back pain.
Calcification (Osteoarthritis); It is caused by the progression of age, bone structure, disc and ligament is the formation of wear.
Bone resorption (Osteoporosis); is a disease that increases bone fragility. Crumbs and fractures occur in the vertebrae where the maximum weight is placed and causes pain.
Rheumatic Diseases; Inflammation of the waist joints causes pain and stiffness in diseases that develop as a result of the body’s immune system waging war against its own cells.
Stress is one of the most important causes of chronic pain of low back.
Others; tumors, infections, fibromyalgia, pain associated with abdominal organs are other rare hernia hernias.
Blood and laboratory investigations; used in the diagnosis of diseases such as infection, rheumatism and cancer.
X-ray; it gives information about bone structure, congenital bone anomalies, congenital or later formed curvatures, spine slippage, calcification and advanced bone resorption.
Computed Tomography (CT); It provides information about joint and bone structure in spinal narrow canal diagnosis.
Magnetic Resonance Imaging (MR); It is the most sensitive and reliable imaging technique that provides information about soft tissue.
Electromyelography (EMG); examines the effects of nerve and muscle conduction in the differential diagnosis and the effect of hernia.
Bone scan (scintigraphy); It helps in the diagnosis of spine tumors and infections.
Bone Density Measurement; It is used to determine the level of bone resorption.
Who is at risk?
Those who have to lift heavy
Those who consume excessive weight, smoking and alcohol
Weak waist and abdominal muscles
Those in the last months of pregnancy
High risk sports (such as weightlifting)
Mental and emotional tensions
Treatment principles of low back pain:
1- Conservative Treatment Methods;
Bed Treatment; between 2-7 days of rest is sufficient for acute back pain. Resting for longer than 1 week may result in reduce movement in the joints, shortening of soft tissues and a decrease in muscle strength.
Medication ; Pain relievers, anti-inflammatory drugs, muscle relaxants, anxiety relief drugs and cortisone can be used where necessary. The goal is to reduce pain, increase physical function, reduce sleep-related sleep disorders and other problems.
Physical Therapy: Deep and superficial hot and cold applications, electrotherapy, traction, exercise. The use of the corset should be temporary and should not be used for more than 1.5 months. Long-term use of corset causes weakening of the abdomen and waist muscles. The main goal of exercise therapy is to strengthen the abdominal and lumbar muscles. The exercise program should be arranged by the specialist physician specifically for the patient.
Patient education: the main purpose is to prevent the recurrence of low back pain and the things that should be done for this;
Move and exercise
Keep your waist straight
Crouch to remove something
Do not lift heavy loads
Divide the load and keep it close to the body
Keep your waist flat while sitting and put a support on your waist
Do not stand straight with your legs
Twist your legs while reaching
Do sports such as swimming and jogging
Perform strengthening exercises for waist muscles every day
2- Surgical Treatment
Surgical treatment may be applied in cases that do not heal with conservative treatment. These cases are usually hernias. Only 5% or less of the hernias require surgical intervention. Surgical intervention may also be required in patients with tumor or abscess in the spine.