Lumbar herniated discs:
– 95% are at the L4-L5 and (between the fourth and fifth bone) and L5-S1 levels. (between the fifth bone and the coccyx)
– The reason why lumbar disc herniation is more common in these regions may be due to the fact that these levels are more loaded, the canal diameter is narrower and they are the most mobile segments.
Findings:
– Most patients are between 30-50 years of age.
– The main complaint is low back and leg pain.
– Patients often report that their previously mild low back pain increases with exertion and radiates to their legs.
– The pain increases with coughing, sneezing, straining and back movements.
– Along with the pain, the patient may complain of numbness, tingling, weakness and thinning of the legs.
– The patient has difficulty standing upright.
Treatment:
Differences are observed in acute, subacute and chronic periods. The first 2-3 weeks can be taken as the acute period, up to 3 months as subacute, and after 3 months as chronic.
Acute period (first 2-3 weeks)
– Bed rest (1-3 weeks)
– Medication (painkillers, muscle relaxants)
– Superficial heat (hot bag, etc.)
– Isometric exercise
Subacute period (3 weeks-3 months)
– The patient is allowed to stand up and walk with a lumbosacral corset.
– The patient is admitted to an outpatient or inpatient physical therapy program. In this program, treatment is organized by applying methods such as superficial and deep heat, traction, low frequency currents, manipulation. Exercises should be increased during this period.
Chronic period (after 3 months)
The patient is given an exercise program that stabilizes and strengthens the lumbar-abdominal-leg muscles and a training program (lumbar school) to use the lower back appropriately in daily life.
Surgical treatment
Despite conservative treatment, surgical method is applied in hernias that are progressive, have neurological deficits, are large and have progressed into the canal or fall into the canal.
Osteoarthritis (joint calcification):
Osteoarthritis is a multifactorial etiology disease characterized by degenerative and inflammatory pathological changes in and around the joints.
Affecting people from all walks of life, causing pain, loss of workforce and disability, osteoarthritis has been accepted as a disease of natural aging and wear and tear for many years. In our opinion, it has attracted much less attention than it should have, possibly because it does not directly lead to fatal diseases, and because it mostly affects retired people. This fatalistic view has started to be abandoned in the last few years. The prolongation of human life span, the increase in the number, effectiveness and cost of surgical interventions for osteoarthritis, the increase in the number, effectiveness and cost of patients and their owners, and the considerations regarding the economic outlook of insurance organizations and governments have attracted the attention of pharmaceutical factories and research laboratories and have led them to focus on the disease again. With advancing technology and knowledge and economic and social support, studies on osteoarthritis have gained momentum.
Common pathologic changes in osteoarthritis are found in the joint connective tissues, especially the joint, subchondral bone, joint fluid and capsule. The main pathology is the progressive loss of articular cartilage, accompanied by depolymerization of hyoluniric acid in the joint fluid, subchondral sclerosis, osteoarthritis of the articular margins and varying degrees of synovitis.
Risk factors
– Genetic factors
– Hormonal factors: Endocrine diseases (diabetes, acromegaly, etc.) and metabolic diseases (gout, etc.) are serious risk factors.
– Traumatic factors: Frequent heavy lifting and carrying of loads due to occupation, obesity, osteoarthritis of joints that are used a lot due to occupation.
When planning the treatment of lumbar disc herniation, it should be checked whether there are other conditions and the program should be organized accordingly. For example, facet joint pathologies and arthritis can often accompany a herniated disc. Therefore, in such a case, the treatment must be planned correctly in order to yield results.
Treatment is divided into two categories: conservative and surgical treatment. Considering that 3-5% of herniated disc patients go to surgery, the importance of conservative treatment becomes clear.
We plan conservative treatment by dividing it into 3 periods.
1-Acute period (first 2-3 weeks)
2-Subacute period (3 weeks to 3 months)
3-Chronic period (period after 3 months)
– Acute period:
For the first 1 week, the patient should be bed rested and medication should be administered. Muscle relaxants, anti-inflammatory drugs, vitamins and tranquilizers should be given; hot bags should be placed on the lumbar region 1-2 times a day. Since lying patients may lose muscle strength, isometric back and abdominal exercises should be started to prevent this. When the patient is lying on his/her back, a pillow should be placed under the knees or he/she should be advised to lie on his/her side by pulling his/her knees to his/her abdomen.
– Subacute period:
Patients whose complaints do not improve after 2-3 weeks are included in the physical therapy program. Corsets may be recommended for patients who stand for a long time. Superficial heaters and deep heaters such as ultrasound and short wave are applied to the patient. With the effect of these, tissues are nourished, metabolic wastes are accelerated and the repair process of tissues increases. After heat and low frequency currents, traction and exercises are applied. Traction relaxes tense muscles, increases the nutrition of the disc, reduces compression and relieves pain. Exercises given to patients with low back pain reduce pain, strengthen muscles, improve posture and mobility, open the muscle program with massage and manipulation and relax tense muscles. Apart from all these classical methods, muscle strengthening devices have been used in recent years. The most important side effect of a herniated disc is the loss of strength and atrophy of the surrounding muscles due to nerve compression. In the past, only exercises were used to strengthen the muscles. Today, with the muscle devices used, every muscle can be brought to the desired strength. Thus, the growth of the hernia is prevented and the joints and bone structure are protected. It is very important that this treatment method is applied to every patient after the surgery in order to maintain the success of the surgery in the following years.
– Chronic period:
“Waist School” has been established to protect the waist and surrounding muscles 3 months and more after the herniated disc. In the back school program, it is aimed to inform the patient about the causes of low back pain and the disease, to organize daily life activities and to teach exercises. Regulation of daily living activities, reducing the load on the spine is achieved by organizing the spaces in which the patient lives and teaching how to behave during activities. The patient is told how to sit, what to pay attention to when lying down, what to consider in the toilet and sink, in household activities and in carrying loads.
Is it possible to treat a herniated disc without surgery?
98% of herniated discs can be treated without surgery. Only 2-3% of herniated discs require surgery. Physical therapy is applied to the remaining 98%.
What are the treatment methods? How long does the treatment last?
Physical Therapy is the general name of a very wide treatment chain. The frequency equipment that will be used, ultrasound, traction, manipulation, massage, exercise etc. are all included in physical therapy.
The aim of the treatment of herniated disc is to open the muscle spasm in the deep tissues, regulate blood circulation, relieve pain and strengthen the weakened surrounding muscles, in short, to try to restore the broken mechanism.
The success rate of treatment of herniated discs with physical therapy is close to 100%.
Is there a possibility of recurrence?
There is a possibility of recurrence of a herniated disc even after surgery. Recurrence can be prevented by following certain rules in daily life, exercising regularly and being careful not to gain weight.
In which cases is surgery inevitable?
Surgery is inevitable in hernias that protrude into the canal we call extruded hernia or become ruptured. This rate is 2-3%.
Who is at risk of herniated disc?
– Obese (overweight)
– Sedentary people (those who live sedentary)
– Excessive weight lifters (weightlifters, porters, etc.)
– Trauma (after an accident)
– Genetics (those with a family history of herniated discs) are at higher risk.
What kind of problems does a herniated disc cause if left untreated?
When the surrounding muscles weaken, it can lead to hip and knee joint problems.
The patient may have difficulty walking, may fall down while walking in advanced cases, may not be able to move the ankle, may have foot and ankle problems, and in more advanced cases, there is a risk of paralysis.