What is Herniated Lumbar Disc, its Signs and Symptoms, Elevating and Aggravating Factors and itsTreatment? What is sciatica?

Herniated Lumbar Disc:

A herniated lumbar disc is a protrusion of the annulus fibrosus to the surrounding vertebrae. The annulus fibrosis is the soft spongy material embedded between the discs. The strong annulus fibrosus can absorb significant stress and maintain stiffness in the presence of the tensile forces induced by bending and twisting of the spine.
When the annulus fibrosus (the tough outer layer of an intervertebral disc) bulges toward the surrounding vertebrae, it presses nearby spinal nerves or the spinal cord. This compression can lead to symptoms like pain, numbness, tingling, or weakness, particularly in the limbs unilaterally or bilaterally. 90% of the herniated lumbar disc occurs in the lower back, lumbar region specifically between the vertebrae L4/L5 and between vertebrae L5/S1. However, it may occur in the cervical and thoracic regions.

sciatica:

It is the pain going down the leg from the lower back. It is most commonly associated with a disc bulge at the Lumbar spine. A disc bulge can sometimes put pressure on the sciatic nerve, leading to sciatica. This condition causes pain, tingling, and numbness that starts in the lower back and travels down through the buttocks, thighs, and to the foot on the same side. It may be unilaterally or bilaterally depending on the nerve impingement.

Signs and symptoms:

• 1.  Lower back pain
• 2. Pain going down the buttocks, thigh, and calf
• 3. Tingling and numbness in the area of the pinched nerve.
• 4. Lower back muscle weakness
• 5. Muscle spasms in the lumbar
• 6. Walking may become slow and cautious, sometimes on tip-toes, and there could be noticeable spine or trunk misalignment

Causes:

• 1. Trauma
•  2. Sudden weight left
• 3. Spine degeneration
• 4. Poor posture and prolonged sitting
• 5. overweight

Aggravating factor:

• Aggravating factors are the positions and activities with which the condition of a person worsens. In the case of a lumbar disc bulge, the following are the aggravating factors.
• 1. Forward bending
• 2. Sneezing and coughing
• 3. SLR (raising the affected leg )
• 4. Prolonged bed rest
• 5. Lifting things from the ground
• 6. Pain with standing from the ground

Relieving factors:

•  1. Extension (bending backward)
• 2. Prone lying (lying on the face)
• 3. Hot pack (Warming the lower back)
• 4. Sitting with placing a pillow below the lumbar region
• 5. Side lying

Positive SLR:

The Straight Leg Raise (SLR) test, though not a definitive diagnostic test, is indeed a clinical maneuver commonly used to help identify the presence of a lumbar disc bulge, especially one that is compressing a nerve root (such as in sciatica).
SLR is positive when lifting the leg causing radiating pain down the leg, especially between 30° to 70° of elevation; it suggests nerve root irritation, often due to a lumbar disc herniation or bulge compressing the sciatic nerve. The test is usually more indicative of a herniated disc at L4, L5, or S1 levels.

Limitations of the SLR Test:

• The SLR test alone cannot confirm the diagnosis of a disc bulge; it indicates nerve compression, which can be caused by other conditions too.

Treatment of herniated disc bulge:

The first line of treatment to ease pain and heal from acute bulging is physiotherapy. Exercise is the best option for treating disc bulges conservatively. Exercises have a positive effect in rehabilitating those having herniated lumbar disc bulges. Therapeutic exercises reduce pain, improve flexibility and mobility, and prevent further worsening of the symptoms.

4 key Exercises for herniated Lumbar Discs.

Exercise 1: Rest on the abdomen:

This simple technique is highly effective in providing relief of pain immediately after an acute lumbar disc bulge. When a person suffers from acute pain in the lower back and is unable to stand or the pain increases with forward bending and decreases with backward bending then lying down on the abdomen is the best way of managing acute lumbar discomfort.

Steps:

• 1. Lie down on the abdomen on a flat surface.
• 2. Place a pillow under your abdomen.
• 3. Turn your head on the side of the pain
• 4. Rest your hands along your body.
• 5. Lie down for half a minute.

Exercise 2: Press up on the Elbow.

• Perform this exercise three times a day each time hold for 10 seconds with 15 repetitions and 3 sets.

Steps:

• 1. Lie face down on the floor with your hands placed near your shoulders.
• 2. Press your hands into the ground, lifting your upper back and shoulders while keeping your forearms resting on the floor.
• 3. Hold this stretch for 10 seconds, then lower your back down. Repeat the movement 15 times.

Exercise 3: full press-up on the wrist.

• Perform this exercise 3 times a day each time holds for 10 seconds and 15 repetitions and 3 sets.

Steps:

• 1. Lie down on your face, keeping your elbows close to your sides and directly under your shoulders.
• 2. Slowly straighten your elbows and push your upper body up as high as possible, letting your lower back arch naturally.
• 3. Keep your hips, pelvis, and legs relaxed throughout.
• 4. Hold this position for about 10 seconds, then lower yourself back down and relax. Repeat this exercise 10 to 15 times.

Exercise 4: bridges.

Do this exercise when acute pain is relieved usually one week after the herniated lumbar disc. This exercise is a core stabilizer improving lumbar stability, preventing recurring of disc herniation.
Steps: How to Perform the Bridging Exercise:

Starting Position:

• Begin by lying on your back with your knees bent and your feet flat on the ground, about hip-width apart.
•    Place your arms at your sides, palms facing down.
•    Maintain a neutral spine position, avoiding excessive arching or flattening of the back.

2. Engage Your Core:

• Tighten your abdominal muscles to engage your core, ensuring your ribs don’t protrude outward.

3. Lift Your Hips:

•    – Press down through your heels and lift your hips off the floor by contracting your glutes.

•    Raise your hips until your knee and your shoulders become in a straight line.

•    Keep your shoulders, head, and arms relaxed on the floor.

4. Hold:

•    Maintain this position for 3-5 seconds, ensuring a straight line from your knees to your shoulders.

5. Lower:

•    Gradually lower your hips back down to the ground, controlling the descent with your muscles.

Perform this exercise 3 times a day each time 10-15 repetitions, 3 sets and 10 seconds hold