Herniated Lumbar Disk Etiology Signs & Symptoms Management
{"Image DocumentName": "Herniated Lumbar Disk Etiology Signs & Symptoms Management", "Image ImageDescription": "Etiology \u2013 The lumbar disks are subject to constant abnormal stresses that stem from faulty body mechanics, trauma, or both, which, over a period of time, can cause degeneration, tears, and cracks in the annulus fibrosis. The disk most often injured lies between the L4 \u2013 L5 vertebrae. The L5 \u2013 S1 disk is the second most commonly affected. In sports, the mechanism of a disk injury is the same for the lumbosacral sprain \u2013 forward bending and twisting that places abnormal strain on the lumbar region. The movement that provides herniation or bulging of the nucleus pulposus may be minimal, and associated pain may be significant. Besides soft tissue injuries, such a stress may herniate and already degenerated disk by causing the nucleus pulposus to protrude into or through the annulus fibrosis. A disk that progressively degenerates may develop into a prolapsed disk, in which the nucleus pulposus moves completely through the annulus fibrosis. If the nucleus pulposus moves into the spinal canal and comes in contact with a nerve root, the result could become an extruded disk. This protrusion of the nucleus pulposus may place pressure on the cord of spinal nerves and thus cause radiating pains similar to those of sciatica. A sequestrated disk occurs when the material of the nucleus pulposus separates from the disk and begins to migrate. Pressure within the intervertebral disks changes with various positions or postures. Studies that used intervertebral disk pressure in the standing position as a constant found that pressure was decreased by 75% when the spine was in the supine position and by 25% when in a side-lying position. Pressure was increased by 33% when the athlete was sitting, by 33% when the athlete was standing slightly bent forward, by 45% while the athlete was sitting slightly bent forward, by 52% while the athlete was standing bent far forward, and by 63% when the athlete was sitting bent well forward. Signs & Symptoms \u2013 There is usually a sharp, centrally located pain that radiates unilaterally in a dermatomal (dermatome - an area of the skin supplied by nerves from a single spinal root) pattern to the buttocks and down the back of the leg, or pain that spreads across the back. The athlete may describe weakness in the lower limb. Symptoms are usually worse in the morning with axial loading such as when the athlete gets out of bed. Onset may be sudden or gradual, and pain may increase after the athlete sits and tries to resume activity. Forward bending and sitting increases pain. Backward bending reduces pain. The athlete\u2019s posture will exhibit a slight forward bend with side bending away from the side of pain. Side bending toward the side of pain is limited and increases pain. There is tenderness around the painful area. Straight leg raising to 30 degrees increases pain. Tendon reflexes may be diminished. Muscle testing may reveal weakness with bilateral differences. A Valsalva maneuver (the action of attempting to exhale with the nostrils and mouth, or the glottis, closed. This increases pressure in the middle ear and the chest, as when bracing to lift heavy objects, and is used as a means of equalizing pressure in the ears) increases the pain as does coughing, sneezing, or laughing. The athlete has difficulty putting on shoes and socks. Management \u2013 Initial treatment should involve pain-reducing modalities such as ice and/or electrical stimulation. Manual traction combined with passive backward bending or extension makes the athlete more comfortable. The goal is to reduce the protrusion and restore normal posture. Thus, the athlete should be taught appropriate posture self-correction exercises. As pain and posture return to normal, back extensor and abdominal strengthening should be used. If the disk is extruded or sequestrated, all the athletic trainer can do is modulate the pain with electrical stimulation. Flexion exercises and lying supine in a flexed position may help with comfort. Sometimes the symptoms will resolve with time. But if there are any signs of nerve damage, surgery may be required to eliminate pain and dysfunction.", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}