What is prolapsed disc?
The disc is a firm but compressible cushion between each vertebra, consisting of a firm outer ring and a soft central core. Prolapsed disc is a condition in which part or all of the gelatinous central portion (the nucleus pulposus) of an intervertebral disc is forced out a weakened part, resulting in back pain and/or leg pain.
Who gets it?
- Sedentary workers
- Commonest age is between 30 and 50 years
- Twice as many men as women are affected
- Faulty postures, prolonged tension or stress
- Repeated overuse during bending, lifting, and sporting activities
Mechanism of prolapsed disc
Most low back injuries are not the result of a single exposure to a high- magnitude load, but instead a cumulative trauma from sub-failure magnitude loads: for instance, repeated small loads (e.g., bending) or a sustained load (e.g. sitting). The back is more vulnerable at certain times of the day. In the first hour after awakening, or after prolonged static forward bending such as sitting or stooping, the body is at greatest risk. While bending forward, the gelatinous nucleus would be pushed back, with the fact that the ligament & fibrous ring at the back are congenitally weaker, they may eventually fatigue and damage will be resulted.
Diagram showing the change in disc pressures in various positions
The higher the pressure in the disc, the more potential risk it causes to the disc. Patients should AVOID those positions.
Signs and symptoms
- The pain in the low back from a prolapsed disc is often severe. Pressure on the nerve can cause pain extending into the leg. The pain may be accompanied by tingling, numbness and weakness of the leg.
- Sitting often be most painful. Lying is a more comfortable position while pain during standing/ walking is intermediate.
- Coughing and sneezing increase the pressure within the disc and exacerbates the pain.
- Bending forward, lifting, squatting or even lifting the legs will make the condition worse and intensify the pain.
- Severe disc pain may be accompanied by sideway sway of the spine.
- Usually pain is more intense in the first hour after wakening because of the behavior of water absorption of disc at nighttime.
- Pain-relieving medication is usually necessary for a prolapsed disc. The acute pain normally lasts for a few days and the patient should rest during this period. However, pain can last up to 6 weeks in severe case.
- In most cases of a prolapsed disc, the symptoms can be relieved if the patient gets into a position of spinal extension. This can be achieved by lying on their front and gently propping the shoulders up on the elbows. This puts the spine in the opposite position to that in which the injury occurred and encourages the prolapsed nucleus gel to recede into the disc.
- Patient’s daily self-care is crucial in the process of recovery. The patient should avoid all movements leaning forth (e.g. bending forth during brushing teeth, wearing socks or shoes in a stoop posture), squatting or prolonged sitting, especially sitting on bed with legs straight/ sitting on soft surface. In other words, the patient should avoid all painful movements.
- The outer layer of the disc will heal with scar tissue over a period of weeks/months, but the disc is vulnerable to re-injury and there will always be weakness. For this reason, and to reduce the chances of a recurrence, the patient should follow the rehabilitation program set by a chartered physiotherapist. This will involve regaining the range of the movement in the lumbar spine and training the muscles which support the back.
- Most people do well with non-surgical treatment. However, a few may benefit from injection of drugs or surgery.
Notes to remember
Maintain good posture helps to prevent undesirable stress to the spine and the disc, avoiding deterioration of the condition.
Look forward with shoulders level and back straight.
Sit up straight on chair with back fully supported, hips and knees kept in 90 degrees with both feet flat on floor. If possible, use a lumbar cushion or roll. Avoid sitting on sofa, soft surface, low stool, ground or long sitting. Whenever is possible, try to limit the duration of a seated posture to the minimal.
Side lying: slightly bend the knees and use a pillow between the legs for support.
Supine: May use a towel to support the lumbar curve or use a pillow to support under the knees in order to relieve the muscle tension of the back.
Lying < => sitting:
Turn to non-painful side first. Then gradually lower the legs down over the edge of bed and support oneself to get up with upper limbs. After sitting up, the patient may use both hands to support the low back, thus reminding oneself to keep the back straight and prevent stooping.
Adjust the seat so that the hips and knees are kept at the same level. It is highly advisable to use a lumbar cushion to keep the back straight if driving is unavoidable. Caution would need to be exercised upon getting in and out of car to avoid any form of trunk bending.
The “Mckenzie exercise” can be done in a progressive way according to the instructions of your physiotherapist.
The above information was produced by Physiotherapy Department, Canossa Hospital (Caritas).
Please call 28255392 for physiotherapy appointment
Reference : McKenzie RA, May S; The Lumbar Spine. Mechanical Diagnosis and Therapy. (Vol. 1 and 2) Spinal Publications, Waikanae, New Zealand; 2nd Edition, 2003.