Dr Ozello's Sports Medicine Report: Lumbar Spine Disc Herniation and Disc Bulge
*Disclaimer: Viewing this video does not take the place of seeing a medical professional. Please visit a medical professional for evaluation, diagnosis and treatment. Never perform an exercise that elicits or intensifies symptoms. If an exercise elicits or intensifies symptoms, stop immediately and use a viable substitute. Always perform all exercises through a symptom free range of motion. Begin your training at your current health, fitness and strength levels. Increase intensity in small gradual calculated increments.
Lumbar Radiculopathy (AKA Lumbosacral Radiculopathy)
Low back pain is one of the most common musculoskeletal complaints.
Low back pain is the leading cause of disability in the developed world.
Lumbar Radiculopathy (AKA Lumbosacral Radiculopathy) is a syndrome caused by compression or irritation of spinal nerve roots in the low back.
Lumbosacral radiculopathy results from irritation and/or compression of a spinal nerve root as it exits the lumbar spine. Spinal nerve roots L4, L5 and SI roots are most commonly involved.
This condition can be a significant cause of low back pain, lower extremity pain and disability. Pain is a common presenting symptom and may be accompanied by numbness, tingling, burning pain and weakness in areas innervated by the affected cervical nerve root.
The most common causes of lumbosacral radiculopathy are a lumbar disc herniation with resultant nerve root compression or spondylosis, which is a general term for spinal degeneration or spinal osteoarthritis.
Symptoms of a lumbosacral radiculopathy include low back pain that radiates into the lower extremities in a dermatomal pattern. These symptoms can include
Sharp-shooting, shock-like pain or stinging pain radiating into the lower extremity.
Numbness, tingling and/or a deep burning sensation.
Weakness.
Muscle spasm, tightness and stiffness.
Muscle guarding or splinting.
Limited active and passive range of motion due to pain and muscle guarding.
Difficultly moving in all planes.
Slow and guarded motions in all planes.
Altered gait or limping. Due to pain, altered sensations and/or weakness.
Location of radicular symptoms depends on the spinal nerve root involved.
L4
Altered Patellar Tendon reflex.
Weak Tibialis Anterior (Ankle Dorsiflexion). Possible foot drop.
Altered sensations: Pain, numbness, tingling or burning along medial lower leg and medial malleolus.
L5
Altered Medial Hamstring Tendon reflex.
Weak Extensor Hallucis Longus (Great toe extension).
Altered sensations: Pain, numbness, tingling or burning along anterior lateral lower leg and mid-dorsum of foot.
S1
Altered Achilles Tendon reflex.
Weak plantar flexion (Gastrocnemius and Soleus).
Altered sensations: Pain, numbness, tingling or burning along lateral lower leg, lateral malleolus and lateral aspect of plantar aspect of the foot.
Contributing Factors
Disc Degeneration
Osteoarthritis
Weak core and weak lumbar muscles especially the deep abdominals, deep lumbar and the gluteal muscles.
MRI: Imaging modality of choice because it is the most sensitive study to visualize a herniated disc.
Lumbar disc herniation and reduced neural foraminal space.
Prevention and Rehabilitation
Don’t stay in one position too long. Constantly shift positions. Move through a symptom free range of motion.
Supine: Hips and knees flexed. Pillow or wedge under knee and/or lower legs.
Side-Lying: Hips and knees flexed. Small pillow or leg separator between knees.
Seated: Sit in good posture. Use lumbar support.
Zero gravity chair.
Motion exercises. Slow and controlled through a symptom free range of motion.
Slow static stretching: Lumbar spine, hip flexors, glutes, hamstrings.
McKenzie Protocol if lumbar disc herniation is present.
References
Lumbosacral Radiculopathy www.ncbi.nlm.nih.gov/books/NB...
Radicular Back Pain www.ncbi.nlm.nih.gov/books/NB...
Chiropractic management of a 47-year-old firefighter with lumbar disk extrusion www.ncbi.nlm.nih.gov/pmc/arti...
Disc Herniation www.ncbi.nlm.nih.gov/books/NB...
Lumbar Disc Herniation www.ncbi.nlm.nih.gov/books/NB...
Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV
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