Herniated Disc and Rehab

A herniated disc and the consequences

Intervertebral discs serve as cushions between the individual vertebrae. If the inner core of an intervertebral disc moves, one speaks of a herniated disc. The result can be severe pain, which sometimes radiates into the arms or legs. Surgery is not necessary in most cases. Find out everything about the herniated disc, therapy and rehabilitation here.

Disc herniation: General

Intervertebral discs consist of an elastic gelatin core, which is surrounded by solid connective tissue fibers. They serve as “shock absorbers” between the individual vertebral bodies of the spine. One speaks of an incident of the intervertebral disc when the fibrous sheath breaks and the gel-like core penetrates through the tear of the sheath. The emerging nucleus can press on the nerves running in the spinal cord and trigger pain.

The herniated disc is characterized according to whether it occurs in the area of ​​the lumbar spine (lumbar, approx. 90% of cases), the thoracic spine (thoracic, rarely, <1% of cases) or the cervical spine (cervical, approx. 10% of cases), Since the greatest pressure is exerted on the spine in the lower third of the back, problems are most common here.

Disc herniation: causes

The elasticity of the intervertebral discs decreases with increasing age. The connective tissue becomes more unstable. As a result, the capsule tears around the intervertebral disc core more easily and the core can escape. Affected people are usually between 30 and 50 years old. The risk of herniated discs in the area of ​​the lumbar spine decreases again from the age of 50, since the disc core then loses more and more water, thereby becoming smaller and less likely to occur in the encapsulating capsule. Overweight and weak core muscles can also contribute to the development of a herniated disc. Sometimes the effects of force in the event of a fall or accident are the cause. Herniated discs of the cervical spine often occur in older people. With age, the cervical vertebrae show signs of wear. The vertebrae become looser and the intervertebral discs less elastic. In some cases, abrupt rotation of the head can cause a herniated disc.

Herniated disc: appearance/symptoms

Sometimes a herniated disc causes little discomfort. In most cases, however, sudden, severe back pain occurs in herniated discs in the lumbar regionon. Exercise, sneezing or coughing aggravate the symptoms. In response to the pain, the muscles in the back can become noticeably cramped and feel hard and stiff. If the lower lumbar region, where the sciatic nerve runs, is affected, the pain can radiate into one leg or the buttocks. A numb feeling or paralysis in one leg is also possible. If the herniated disc occurs in the area of ​​the cervical spine, the neck hurts. The pain can radiate in the arm, hand or back of the head. There it can also become numb, tingling or feeling cold. Sometimes the head can no longer be straightened up without great pain.

Disc herniation: examinations & diagnosis

Sudden back pain can have a number of different causes. The aim of the examination is therefore to find out the cause of the pain and to determine with certainty whether there is actually a herniated disc.

Physical examination

The doctor will first clarify the context in which the pain first occurred. For example, he asks you how severe the pain is, where it is located exactly, and whether it is radiating to other parts of the body. Then muscle strength, reflexes, blood circulation and the sensation in the legs (if there is suspicion of a herniated disc of the cervical spine also in the arms) are checked. The location of the painful areas and possible paralysis or numbness already allows an initial limitation as to which vertebrae are affected.

İmaging

A herniated disc can be reliably detected by magnetic resonance imaging (MRI) or computer tomography (CT). These complex investigations are only carried out if there is a specific suspicion of a herniated disc. X-ray is unsuitable as evidence because it only represents bones. The nerve tissue and the tissue of the intervertebral discs are not clearly visible in the X-ray image.

Special investigations

In the case of paralysis or numbness, muscle and nerve activity can be measured using special methods. Blood and sometimes spinal fluid tests are used to rule out certain infectious diseases (such as Lyme disease), the symptoms of which may resemble those of a herniated disc.

Disc herniation: therapy & rehab

The symptoms of a herniated disc depend on the location of the affected disc. If no nerves are squeezed, a herniated disc can remain entirely without symptoms. In this case, therapy is not necessary. If pain or neurological complaints occur, the treatment and rehab ensure that surgery is not required in nine out of ten cases.

Therapy for herniated discs

Surgery on the spine is only carried out if absolutely necessary. In most cases, so-called “conservative treatment”, that is, therapy without surgery is sufficient. The aim is to significantly improve or even eliminate the symptoms within a few weeks. Conservative therapy can be most intensively implemented in the context of rehab.

If symptoms do not improve within one to two months or if the symptoms are very pronounced, surgical intervention may be necessary. During an intervertebral disc surgery, either the entire intervertebral disc or only the tissue that presses on the nerves is removed. Around 140,000 intervertebral disc operations are performed in USA each year. New and gentle procedures are often used, for example microsurgical surgical techniques.

Rehabilitation after a herniated disc

After a herniated disc, outpatient or inpatient rehab helps to alleviate the symptoms and prevent surgery. If surgery is required, rehab contributes to a quick return to everyday life.

Rehabilitation after surgery

After a surgical intervention on the spine, experts recommend a so-called follow-up treatment (AHB). Rehabilitation starts right after the operation. Trained specialist staff and specialists will help you build your muscles during the AHB. In addition, nutritional advice, psychological advice and help with disease processing ensure that you will soon be fit for everyday life. All measures are precisely tailored to the type of surgery performed and your individual complaints after the procedure.

Conservative therapy in rehab

A herniated disc can often be treated without surgery. The most important thing is the quick relief of the pain in order to make you flexible again. Otherwise, spare yourself too long or adopt poor posture to avoid pain. As a result, muscles are broken down, the spine is loaded incorrectly and complaints are made worse. In a rehab, well-coordinated measures ensure rapid freedom from pain.

Therapeutic and advisory measures in rehab

In the rehab, an individual therapy plan is drawn up for each patient. Many different measures can be used:

  • Pain therapy: In addition to medication, therapeutic local anesthesia can also be used for severe pain. Alternative therapies such as acupuncture can also help in some cases.
  • Behavioral therapy and relaxation techniques: severe pain can lead to anxiety. Fear of pain causes excessive protection and less movement. In a rehabilitation clinic, psychological therapies and relaxation procedures (for example, progressive muscle relaxation) ensure that stress and anxiety are reduced.
  • Advice and back training: In rehab, you learn everything about your illness, the correct posture, back-friendly movements and get tips on everyday behavior.
  • Exercise therapy: Stretching, endurance and strength exercises are an essential and central factor in rehab. Experts recommend movement therapy planned and medically controlled with a specialist to build muscle.
  • Physiotherapy: In addition to physiotherapy measures, physiotherapy also includes heat, electrical and ultrasound applications as well as water aerobics, massages and baths. Physiotherapy relieves pain, reduces water retention (edema) and improves mobility.
  • Other measures: Rehabilitation clinics offer additional measures, from occupational therapy to advice on aids (such as gripping aids and adapted clothing), nutritional advice and courses in various sports.

Opportunities and benefits of rehab

In around 90 percent of all herniated discs, conservative treatment is sufficient and no surgery is required. The time window is relatively narrow: If the symptoms do not improve within six to eight weeks, the chances of success of the non-operative therapy decrease rapidly. Then surgery may be necessary. Rehabilitation helps to make the most of this time. Muscles are built, pain is relieved, incorrect posture is avoided and mobility is improved. This means that your quality of life and self-confidence in your own abilities grow again. If surgery is required, a subsequent rehab ensures that a quick return to work, family and leisure is possible.

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