Hyperextension with hernia of the lumbar spine

Protrusion of intervertebral discs is a physiological pathology consisting in bulging of the disc without compromising the integrity of the fibrous ring. Often occurs against the background of osteochondrosis. A healthy ring does not extend beyond the boundaries of the disc, but as this disease develops, it begins to bulge. Treatment of protrusion must begin immediately after detection. According to statistics, I diagnose it more often than a hernia.

Localization of the disease is the lumbar, cervical and thoracic regions. That is, the most mobile parts of the spine. Without treatment, the protrusion develops into a hernia, which can interfere with quality of life and seriously reduce a person's ability to work.

Prevalence of the disease

Statistics show that protrusion is a fairly common disease, especially in people over thirty years of age. Half of the documented evidence of the disease is that the most common type of protrusion is localized in the lower back. It occurs less often in the thoracic region. It is extremely rarely diagnosed in the cervical region.

Often, hernias develop from protrusions of intervertebral discs, for this reason it is necessary to undergo timely examinations and monitor your health.

Causes

Protrusion does not develop out of nowhere; first of all, stable morphological and pathological changes in the column occur, which can last up to several years. Other deformities of the spine and intervertebral discs lead to protrusion.

The disc consists of a fibrous ring and its immediate center, the nucleus pulposus. The core surrounded by a ring is protected. However, under the influence of various circumstances, the tissue of the ring can be damaged and suffer from micro-tears. This gives rise to the development of the disease.

Then the following happens: the vertebrae put pressure on the core, so it, avoiding this pressure, begins to slowly shift into the newly formed micro-tears. The center begins to produce additional resistance to the periphery, which subsequently leads to protrusion of the intervertebral disc. Treatment for bulging discs involves pushing the annulus fibrosus back into place before it ruptures.

Causes of protrusion

Protrusions develop due to wear and tear of the intervertebral discs. This process is accelerated by injuries, obesity, and lack of physical activity. Other factors that lead to the occurrence of this pathology are:

• difficult working conditions associated with regular heavy lifting;
• incorrect posture;
• smoking;
• passive lifestyle;
• staying in an uncomfortable position for a long time;
• poor nutrition.

This disease occurs when there is a sudden load on the spine, which is possible due to an accident and poor lifting technique.

People who have genetic defects and are prone to degenerative damage are predisposed to the formation of protrusion. Pathology is also possible in patients with congenital spinal anomalies.

With age, the tendency to lumbar protrusions increases. To prevent the development of pathology, it is recommended to lead an active lifestyle and eat right.

Symptoms

The pathology develops and lasts for a long time due to the influence of provoking factors and risk factors, sometimes it can last for decades. For this reason, at first the patient may not notice the disease.

The protrusion forms and progresses without any obvious symptoms. Since people do not know about the pathology, they do not seek treatment. And the ring begins to protrude more and more until it ruptures and forms a hernia. But what is happening still has a clinical manifestation. Among the characteristic symptoms are the following:

• numbness of the limbs;
• tension in the spine;
• headache;
• discomfort in the spine;
• sleep problems;
• fast fatiguability;
• chronic pain in the spine;
• chilliness of the limbs;
• movements are limited.

These signs must be carefully monitored in order to begin treatment on time. If you notice that new symptoms have appeared or old ones have begun to develop in strength, do not delay in contacting a doctor.

Degree of progression of protrusion

Conventionally, the degree of neglect of the disease can be conditionally attributed to one of three stages. Depending on how long the disease has progressed, treatment and rehabilitation are prescribed. Let's look at each of the stages.

First stage

At this stage, the fibrous ring, which is the shock absorption of the spine, begins to suffer from disturbances in its structure: cracks may form, the shape of the core may change, and so on. Patients with mild protrusion can be treated quickly and without further consequences.

Second phase

After this, the ring continues to deform. The core begins to protrude to a distance of approximately 3-4 millimeters. This leads to pressure on blood vessels and nerve endings that lie nearby. Patients at the second stage complain of lumbago in the spine and developing pain in the area where the ring was deformed.

Third stage

If the protrusion is not treated, the disease will move to the next stage. The ring begins to protrude to a distance of at least 5 millimeters, which leads to rupture of the core. The patient develops a hernia as a result.

What is lumbar disc protrusion?

The lumbar spine is formed by 5, sometimes 6 vertebrae. Between them are intervertebral discs, which are designated depending on which vertebral bodies they are located between: L1–L2, L2–L3, L3–L4, L4–L5. Their nutrition is carried out through the circulatory system of the vertebrae and diffusely through the upper and lower surfaces of the disc (endplates).

They are natural gaskets between the bone elements of the spine and ensure the preservation of their integrity, stability of position, as well as mobility and flexibility of the ridge.

Protrusions of the lumbar spine account for about 90% of all cases of their formation. They most often occur in the L5–S1 and L4–L5 discs.

Age-related changes, the negative effects of external factors, a sedentary lifestyle and a number of other reasons lead to disruption of blood circulation and disk nutrition. The consequence is degenerative-dystrophic processes in the disc, i.e. osteochondrosis develops.

If left untreated, degenerative changes progress, spreading to the marginal plates and causing them to become sclerotic. This prevents the flow of nutrients into the nucleus pulposus, which provokes a decrease in the moisture content in it and the occurrence of nutritional deficiency. This subsequently leads to the formation of protrusion. In such situations, the disc is already so damaged that its shape is deformed, the fibrous ring becomes thinner and a slight protrusion forms.

After all, a lack of water and nutrients leads to the separation of collagen fibers, from which the fibrous ring is formed, as well as their microtears. This creates the preconditions for the nucleus pulposus to move towards the area of ​​thinning, which puts increased pressure on the already deformed annulus fibrosus. Gradually, it ceases to cope with the increased load, an even greater number of collagen fibers are torn, which leads to the bulging of the disc into the spinal canal.

As long as the integrity of the fibrous ring is preserved, they speak of the presence of protrusion. But in the absence of therapy, the pressure of the nucleus pulposus on the fibrous membrane does not disappear, so more and more collagen fibers are destroyed. As a result, the fibrous ring ruptures, and the internal contents of the disc are able to come out into the spinal canal. This is how a hernia is formed.

Thus, protrusion is a manifestation of osteochondrosis, manifested by the formation of a slight protrusion of the intervertebral disc beyond the physiological boundaries, but while maintaining the integrity of the fibrous ring.

Today, osteochondrosis occurs in people of all ages and is extremely rarely diagnosed in the early stages. Usually the disease is detected when it has already led to protrusion, since even minor changes in the condition of the lumbar intervertebral discs lead to pain and other disorders.

Possible consequences

And although at first glance the disease seems imperceptible and harmless due to its mild onset and virtually asymptomatic nature, it can still cause truly terrible consequences after itself. Among them are lower back pain, disability, paralysis of the lower extremities, serious disorders of the pelvic organs (for example, the development of incontinence), and the appearance of disability. Therefore, it is so important to start treatment of disc protrusions on time.

The main danger of this pathology lies in the possibility of progression to large sizes and the formation of a hernia in the future. A small deformity will not cause discomfort, but already developed protrusion and hernia lead to the following problems:

• chronic and severe pain;
• chronic and severe pain;
• blood vessels and nerve endings are compressed in the sleeve or hole.

Kinds

Depending on the location of the protrusion, three types of protrusion are distinguished. They are most often formed in one of three sections - cervical, thoracic, lumbar. This happens because these segments of the spine are characterized by the greatest mobility.

Cervical protrusion

Despite the rarity of the formation of protrusions in the cervical spine, we must not forget about the possibility of its occurrence in you. First of all, you need to pay attention to localized pain in the neck and shoulder area. The pain in this place is usually aching and sharp. As the disease progresses, the pain begins to increase. In addition, your hands may also begin to suffer.

Often, cervical protrusion leads to numbness, tingling of the skin, a noticeable loss of sensitivity of the skin, muscle weakness, “jumping” blood pressure, problems with coordination and dizziness.

The cervical region is where the brain begins and where the main blood vessels are located that provide blood flow to the brain. Therefore, deformation of the rings in this segment can lead to really serious health problems. The first signs of this are high fatigue. The neck often begins to become numb when sitting for a long time, it is uncomfortable to lie in bed (the pillow seems uncomfortable), the head is held only with great tension in the neck. These signs should alert you, after which you should immediately consult a doctor.

There are seven vertebrae in the cervical region, separated by IVDs. The main difference between this segment of the spine and others is mobility, high mobility thanks to the discs. Therefore, neck movements are easy for us, and the head is kept quite stable without additional problems in a healthy state.

Excessive mobility can lead to wear of the intervertebral discs and the appearance of a bulge. And this leads to pinching of nerve endings, roots, and also the spinal cord.

Another factor that makes cervical protrusion the most dangerous is the severity of detection without examination. Unfortunately, it is often discovered only after the ring has ruptured. During the progression of the disease, myelopathy, one of the types of chronic damage to the spinal cord, may develop. The syndrome is characterized by an irritating effect.

The main consequences of the pathology: hearing loss, loss of vision. Reflexes may disappear, and patients suffer from invincible muscle weakness. In the worst cases, paralysis of the entire body is possible.

Thoracic protrusion

It is rare to see protrusion of the intervertebral disc in this region. This is due to the relatively low mobility of the chest and spine in this segment. But they can still form. Why is this happening?

This can occur with general pain in the spine or incorrect diagnosis of a heart attack (the symptoms are quite similar). The disease most often manifests itself in the form of neuralgia in the intercostal space with varying strength. Pain is accompanied by muscle weakness and noticeable stiffness in the chest and back.

Not only pain can become an important signal about the development of thoracic protrusion: thus, another flag should be discomfort that appears when sitting or standing. Also, an eternal, persistent feeling of fatigue in the back muscles, a negative effect on the spine in the form of irritation of local places. Unpleasant sensations in the thoracic region. The body uses these signals to tell you that the IVD is in poor condition.

Let's highlight the main symptoms of the development of pathology, which indicate the need for treatment of spinal protrusion in the thoracic region. You should never give them little importance, everything is important. So the list is like this:

• the middle of the back suffers from constant pain;
• numbness and lumbago appear in the chest and abdomen;
• intercostal pain;
• the tone of the abdominal muscles noticeably decreases;
• stiffness in the back.

This variant of the pathology becomes dangerous for the internal organs of the body. First of all, the kidneys and liver come under fire, which can lead to permanent diseases, pathologies and problems with the gastrointestinal tract. The pain can become chronic and intense.

Lumbar protrusion

The most defenseless section of the spine, which is most often susceptible to protrusion formations, is the lumbar and lumbosacral sections. This occurs due to the large number of loads on this area, the greatest amplitude in movements and mobility. With age, protrusions can only get worse. Intervertebral discs noticeably wear out over time, especially under the influence of provoking factors. In this case, the characteristic features are pain in this region, which spreads to the lower limbs and significantly complicates coordination, up to the loss of the ability to move the legs.

There are other markers that need to be considered for the possible formation of a bulge. This is tension and aching pain in the lumbar region before going to bed (the syndrome is relieved by lying down), lack of comfort in a sitting position. It is difficult for patients to spend at least a few minutes without changing their position; sitting without leaning on the back of a chair becomes difficult. These and other signs indicate deeply developed protrusions that need to be treated urgently. Don't delay this, especially if you have the following symptoms:

• pain in the central part of the lower back, which spreads horizontally and covers the entire lower part of the torso;
• there is noticeable stiffness in the affected area;
• radiculitis develops;
• the muscle frame in the legs noticeably weakens, especially in the thighs and calves;
• constant feeling of numbness in the toes;
• tingling feet;
• from time to time the process of urination is disrupted, the body’s false urge to urinate appears;
• leg reflexes noticeably decrease and disappear;
• the body is difficult to rotate along the vertical axis;
• when sitting, the lower back suffers from severe pain;
• the body reacts sharply to changing weather conditions.

In the future, lack of treatment leads to paralysis of the lower limbs. Don't delay going to the doctor.

Manual therapy for protrusions

If the protrusions are small, the patient's condition is alleviated by manual therapy. It helps to quickly cure pathology without the use of interventional methods and surgery.

At the first sign of pain, osteopathic manual therapy is quite effective. To improve blood supply and relieve muscle spasms, the patient is referred for a massage. Massage the lumbar and sacral regions. It is taken into account that tapping and patting movements lead to the disc falling out. The procedure should be performed in a medical facility, since a special massage technique is used for protrusion.

Physical therapy improves motor activity of the spine. Training should be aimed at developing flexibility and include elements of stretching. The spine is strengthened through weight-bearing exercises. It is recommended to change your position as often as possible and spend less time in a sitting position, since this places the greatest load on the spine.

Painful sensations are relieved by acupuncture and physiotherapy. Transcutaneous electrical stimulation, ultrasound, magnetic therapy, and cryotherapy are especially effective. MBST therapy allows you to speed up the recovery of damaged discs. These methods are not permissible during periods of acute pain.

Manual therapy, massage and physiotherapy are also recommended as a preventive measure for protrusions of the lumbar spine.

Diagnostics

The main obstacle and problem in diagnosing and treating spinal protrusion is the weak manifestation of the disease at the clinical level in the early stages of development. Often the patient notices the problem and seeks help already at the third stage, when the ring breaks and the formation of a hernia begins.

People who are suspected of having bulging intervertebral discs are prescribed a variety of diagnostic tests by various specialized doctors. In addition, the patient undergoes a number of additional measures to more accurately determine the disease:

1. A life history is collected, which is needed to determine why the protrusion formed and the pain began to intensify;
2. Inspection and further palpation of the spine (column), making it clear about the tension of the nerve roots and the position that brings more pain. At this stage, it is possible to notice low reflexes, weakness in the muscles, decreased skin sensitivity, which indicates progressive protrusion;
3. An X-ray image that provides a huge amount of information about the condition of the spinal column: structural features of the vertebrae and discs, the distance between them, pathologies, signs of osteochondrosis, sustained injuries, the level of neglect of the disease;
4. MRI of the spine, which makes it possible at the first stage of the disease to determine whether a person is more protrusive, as well as provide information about the size and strength of compression of the roots and tissues.

The patient is also required to undergo examination for impaired functionality and efficiency of the spinal roots and other neurological problems.

During diagnosis, it is important to distinguish the disease from osteochondrosis, radiculitis, myositis (they all have similar external symptoms with protrusion of the vertebral discs). In the thoracic region, gastritis, pancreatitis and angina must also be excluded.

Treatment

To begin with, the patient is subjected to a comprehensive examination and diagnosis of the root cause of the complaints. If a protrusion has been identified, the specialist develops a course of treatment adjusted for the characteristics of the patient’s body, the location of the pathology and its size. The most optimal option for removing a victim from protrusion is a set of measures that will prevent the nucleus pulposus from being further injured and reduce the overall pressure in the painful segment. The following specialists provide treatment:

• Physiotherapy doctor (in private situations);
• Traumatologist;
• Surgeon (in worst situations);
• Orthopedist;
• Neurologist.

Fortunately, intervertebral discs are able to return to a healthy state on their own, but to do this they need help. In this regard, the main task of treatment is to launch this mechanism, allowing the body to restore everything on its own. The methods and courses that have now been developed make it possible to stop the development of protrusion and relieve chronic pain.

The main direction in treatment is the use of non-steroidal medications. The prescribed medications help not only reduce pain, but also stop the inflammation process and help return the cartilage to its previous state. The main disadvantage of this direction is the steady development of side effects with long-term use of medications.

Other main areas of treatment are conservative treatment and surgery.

Conservative

To solve the problem of protrusion it is not necessary to go under the knife. This direction represents special measures that eliminate excess load from the disk. First of all, it is necessary to stretch the spinal region and securely fix it. This also includes a medicinal method of treatment, as it helps relieve pain, reduce swelling and inflammation of tissues.

The main advantage and advantage of conservative treatment of disc protrusion is noticeable results in a fairly short time. Patients stop complaining of pain.

The approach itself can be noted as a disadvantage. It treats the symptoms, not the root cause, which can ultimately lead to a relapse. To prolong the effect, it is necessary to be treated for a long time according to the prescribed course.

Operational

The essence of the method is surgical intervention. In fact, he is approached quite rarely; a decision to operate on protrusions requires really compelling reasons. These include:

• The protrusion is too large, it is no longer possible to pull;
• Other methods do not provide improvement for a long time;
• The location and/or size of the protrusion threatens the life of the patient and can cause irreparable harm to health.

Other situations are not considered convincing enough for the surgeon to intervene. Moreover, this method cannot deal with the cause of protrusion, only with the consequences of the course of the disease. There is a certain risk of a new protrusion forming in the future after surgery. But the percentage is lower than with surgery for intervertebral hernia.

How does therapeutic swimming help your back?

First of all, swimming relaxes the supporting muscles of the spine. At the same time, other muscles develop that should come to their aid - the abs, the trapezius muscle of the back. In water, all this happens smoothly, without unnecessary overloads and unwanted jerks. In addition, swimming improves endurance, coordination, and flexibility; normalization of the respiratory, cardiovascular systems and general strengthening of the body.

Rehabilitation

After a course of treatment for protrusion, it is important to undergo rehabilitation. This will not only help you get yourself in order, but also prevent the protrusion from forming again in the future.

It is important to give more rest to the affected area of ​​the spine and not to disturb it again. Try to pay more attention to your posture, engage in therapeutic physical training, and eat right. It is important to gradually end the course of medication, otherwise the disc will quickly return to its original position before treatment.

In addition to the classic methods of withdrawing from treatment, there are others that are beginning to gain increasing popularity. Thus, among many others, one can note the effective treatment complex of Professor Kozyavkin. He uses a precise and effective technique for treating SINR, which, among other things, allows for rehabilitation after treatment of protrusion. The abbreviation stands for “Intensive Neurophysiological Rehabilitation System.”

The foundation of this popular treatment system is the idea of ​​​​using various methods of influencing the patient. The main component is correction of a biomechanical nature, which is skillfully combined with therapeutic and rhythmic gymnastics, massage, apitherapy, mechanotherapy and reflexology.

Operation

If drug treatment is not effective, the patient is recommended to undergo surgery. Thus, it is possible to reduce pressure on the nerves. A suitable technique is selected taking into account the severity of the protrusion. With minimally invasive procedures, rehabilitation is quick.

Surgical techniques include:

1. Microdiscectomy. This method is less invasive and rarely leads to negative consequences. The operation allows not only to reduce compression, but also to replace the damaged disk. Complications include rupture of the spinal membrane, damage to the nerve root, bleeding and infection.

2. Percutaneous nucleoplasty. The technique is also minimally invasive and involves the insertion of a puncture needle. The affected area is exposed to cold plasma. During the operation, an x-ray is required. The patient can walk 2 hours after the intervention.

3. Discectomy. This operation involves removing the damaged disk. It is prescribed in situations where the patient has nerve damage, which leads to loss of sensation in the limbs and impaired bladder function. The intervention can be open or minimally invasive using a microscope.

4. Laminectomy involves removing a fragment of bone tissue above the root and a small part of the disc below it. The technique is not often practiced because there are less invasive ways to relieve compression. During the operation, if necessary, the spine is stabilized.

5. If surgery to eliminate decompression does not produce the expected effect, fusion surgery is recommended.

To treat lumbar protrusion, in most cases, medications and physical therapy are sufficient. Surgery is used quite rarely, mainly if improvements do not occur within 3 weeks after the start of therapy. During the rehabilitation period it is necessary to reduce the load. It takes several months to restore spinal function. To reduce the likelihood of relapse of the disease, you need to monitor your posture and exercise. Exercises are selected individually and require regular repetitions.

Exercises

Gymnastics are prescribed by the specialist involved in your treatment, based on the results of MRI and other studies of the patient’s body. Physical activity will help to “set” the disc and give the body the necessary physical activity. But you should understand that this method of treatment is not suitable for every person. There are a number of people for whom exercise therapy can only harm. For example, you should not exercise if the pain gets worse in the affected area. It is also prohibited to exercise in the following cases:

• heart diseases;
• inflammatory processes;
• infections;
• opened internal bleeding.

Other cases do not prohibit physical therapy. But it is important to take into account the age of the patient, the location of the protrusion and the severity of the pathology before drawing up the program.

Localization determines the list of exercises, since each affected department has its own exercises. However, their goal is the same - to remove displacement, stretch the vertebrae, improve blood flow and increase physical activity. All this can have a positive effect on the patient.

Before starting class, choose comfortable clothes. You should also not forget about sports shoes: without them, gymnastics can only harm an already sore spine. To choose the right shoes, make sure that the sole is textured, thick, elastic and cushioned.

You don’t need any special equipment for practicing, just a chair and a mat (in case you are sliding on the floor). The main thing to remember is that exercise should not cause discomfort. Otherwise, you are doing something wrong and may make your situation worse.

Warm up before you start. Without warming up, you can injure unprepared muscles; this is as important a part of the lesson as the exercises themselves.

1. For people with protrusion not in the cervical region, you can tilt your head to the sides and back and forth five times;
2. Next, carefully rotate your wrists, elbows, and shoulders five times;
3. Stand on your toes and lower yourself several times in a row;
4. Stand on your toes and lower yourself several times in a row;

To improve the quality of your workout, you can take a hot shower before starting the class, which will better warm up your muscles.

Is it possible to play sports with protrusion?

Sports during protrusion are not only not contraindicated, but are also recommended. Protrusion itself is most often a consequence of a sedentary lifestyle. When the disease manifests itself, a person has two options - leave everything as it is, and then the protrusion will progress, or go in for sports and strengthen the back muscles to improve overall well-being and avoid complications.

If the patient was involved in sports before problems with the spine, there is no need to stop exercising, just reduce the load and work out with a trainer or rehabilitation doctor.

What sports can you do with protrusion?

Physical therapy is included in the list of therapeutic measures for disc protrusion. Exercise therapy classes are usually carried out in the appropriate clinic room, under the supervision of a doctor. Exercise in the gym is also allowed.

Acceptable sports: • yoga; • Pilates; • swimming; • fitness and strength training.

Bodybuilding is generally allowed, but a number of guidelines must be followed. When there is protrusion in the lumbar region, exercises that place a strong compression load on this area are prohibited - deadlifts, squats with weights, etc. It is better to give preference to isolating exercises for one muscle group, during which the lumbar region is not subjected to heavy load. Various rows with light weights on special machines are useful. Preference is given to exercises to strengthen the muscles of the lumbar region - hyperextension, gymnastic exercises. They must be performed slowly and smoothly, stretching the back muscles and strengthening them.

Recommended exercises in the gym for protrusion: • any exercises for the legs that do not put a compressive load on the spine; • hyperextension; • wide grip rows; • horizontal thrust; • bar; • pull-ups and push-ups; • exercises with light dumbbells.

Before training, you definitely need to warm up. The “boat” exercise is recommended, but without lifting the legs. Abdominal crunches should be avoided. To strengthen the abdominal muscles, it is better to give preference to the plank and the “vacuum” exercise.

The most useful exercises for a sore lower back are kinesiotherapy. This is a method of treating the spine using special exercises. All training is carried out under the supervision of a rehabilitation physician.

Swimming and water aerobics are the safest and healthiest sports for the back. Such exercises generally strengthen the muscle corset without injuring the spine. When there is protrusion in the lumbar region, it is useful to swim on your back.

Cardio exercise is allowed, but with restrictions. You can exercise on an exercise bike or orbitrek. Running and race walking are not recommended, as they create an impact load on the spine.

Doctors also recommend yoga, Pilates, and callanetics. Such workouts are aimed more at stretching than working out muscles, and do not injure the lower back.

Prevention

The main task of prevention in this case is to develop and maintain healthy muscle tone and their strength value. In the future, this will reduce the risk of complications and further development of osteochondrosis, protrusions, intervertebral hernia, as well as permanently consolidate the results of treatment. The list of preventive measures includes the following measures:

• From early childhood it is necessary to develop correct, healthy posture, and also maintain it in later life;
• Eliminate non-physiological loads on the spinal region from your life;
• Getting rid of bad habits and abstaining from them;
• Proper nutrition, taking into account the characteristics of the body;
• Regularity of sports exercises with a selected load and alternation with unloading.

And although this list is aimed at preventing protrusions, compliance with it will also help improve the quality of life in general. An organism that receives the required amount of nutrients, training and stress copes better with diseases and is less subject to degeneration and deformation. In a situation with bulging intervertebral discs, it is true that it is easier to prevent them than to cure them.

The effect of swimming on the spine

Physical swimming exercises are much safer compared to training in the gym. With osteochondrosis, they will help for the cervical, thoracic and lumbosacral areas of the back. Under the influence of water density, the vertebrae are aligned, reducing the load on the joints and spine. Before the first lessons, you need to consult with the instructor, it is possible to create an individual program.

Swimming is effective for scoliosis and accelerates the regeneration of bone tissue after injuries. Strengthening the back muscle corset prevents the development of protrusion and helps to get rid of excess weight.