To start off with, an intervertebral disc is a structure which is situated between two vertebrae and which gives the spine stability, guaranteeing its mobility at the same time. The disc is formed by a anulus fibrosus which surrounds and holds the nucleus pulposus.
With the passing of time, and simultaneously, with the deterioration of the disc, the anulus fibrosus can present cracks which allow parts of the nucleus pulposus to dilate.
There is a high percentage of adults, especially in their third decade, in which this kind of deterioration is found by chance, through clinical studies and with the total absence of symptoms. In fact, only in 5-10% of cases is it possible to establish a clear correlation between the clinical feedback and the pain felt in one’s back.
Therefore, in which situations can a hernia be symptomatic?
If only the fibres of the anulus fibrosus are stimulated, the pain is triggered mainly in the lumbar area. If, instead, the inflammation involves the nerve’s root at the corresponding level, well then the lumbar symptomology can be associated with a kind of radicular type of pain (sciatic or cruralgia). Finally, if the hernia compresses the nerve’s root, it can compromise the function of the fibre itself, causing a radiculopathy with the consequent alteration of strength, sensitivity and reflexes.
It is logical to think that these three different pathological conditions have significantly different implications in how they can be dealt with, and above all their recovery times will be different. What is certain is that only a tiny percentage of these situations require surgery because disc pathologies tend to have a benign evolution, and often, they present a spontaneous regression of the symptoms.
What to do or how to deal with a painful symptomology?
If there is a vague lumbar pain, and there is no further specific nervous symptomology, on the contrary of what is often believed, it is fundamental to continue being active, limiting bed rest as much as possible. This active attitude allows to maintain, as much as possible, a mobile back and tonic muscle tone, gradually speeding up recovery.
Initially it is necessary to modify or adapt the positions which trigger the pain. Most often this happens with a sitting down position and with leaning forward movements. It is useful, to place a lumbar support when sitting down and to try to stand up and walk roughly every 30’; it is also useful to use hips and knees when bending forward.
Instead, in the case of sciatica, as well as being active and trying to modify the positions which cause the pain, it is recommended to place the painful limb in a position without bearing any weight on it. In fact when the nerve’s root is inflamed, as happens during a sciatica, it does not tolerate excessive stretching. In this case, it may be useful to take symptomatic medication which your doctor can prescribe.
In the case of radiculopathy with sensorial and strength deficit, the expectations of improving must be appropriate with the gravity of the problem. In fact, if in the first two conditions there is an improvement of the symptoms in 4-8 weeks, in the case of radiculopathy, it is usually, necessary to wait many months before the nerve goes back to functioning normally. Treatment, even in this situation, must be a guided symptom; it is best then to prefer directions of movement which reduce the peripheral symptom, restricting the ones that reproduce the symptom when bearing weight on the lower limb.
In case of lower back pain, and above all in the presence of sciatica and/or a deficit of strength and sensitivity in the lower limb, it is indicated, always, to refer to specialized health care to follow the correct and adequate therapy».
Article by Silvio Reffo