There are many different causes of low back pain. Most people immediately assume that the problem is lumbago or irritation of the sciatic nerve. However, in many cases, it is a slipped disk (intervertebral disk prolapse) that is causing the pain. If this is the problem and additional symptoms appear, such as signs of paralysis, swift action is essential in order to prevent further damage. However, if it is not an acute emergency of this kind and the slipped disk is diagnosed at an early enough stage, the symptoms of the intervertebral disk prolapse can be treated without surgery in most cases. Pain can be relieved through measures such as physiotherapy and medical supports and orthoses. Sometimes these measures can even prevent the manifestation of the condition. Many people with one or more slipped disks can live relatively pain-free for years with no surgical intervention at all.
Symptoms and treatment options
Intervertebral disks – the shock absorbers in the spine
The human spine contains a total of 23 intervertebral disks, with one disk located between every two vertebrae. These disks act as buffers, cushioning vibrations, friction, and shocks, and ensuring that the pressure load is distributed evenly along the entire length of the spine. Each disk is made up of a gel-like core surrounded by tough tissue. Over the course of a lifetime, the intervertebral disks wear away. They lose height and their ability to act as buffers is slowly diminished too. The result is that, sooner or later, the intervertebral disk tissue gradually herniates out to the side and reaches the spinal cord in the most severe cases.
If the intervertebral disks are causing noticeable problems, the disk tissue is either bulging out or herniating out completely. When the disk is simply bulging, the term used by physicians is protrusion – in other words, a bulging disk. When the intervertebral disk tissue herniates out completely, this is known as an intervertebral disk prolapse – a slipped disk.
However, the actual bulging or prolapse of the intervertebral disk is not in itself particularly painful, so people are often completely unaware of problems with their disks for quite some considerable time. It is only when the herniated intervertebral disk tissue presses on the surrounding nerve roots that extremely unpleasant pain occurs, often making movement of any kind unbearable.
Certain parts of the spine are more susceptible to bulging or herniated disks than others, with the lumbar spine being affected by slipped disks far more frequently than the cervical or thoracic spine, for example.
Risk factors such as being overweight, poor posture, severe physical strain, or lack of exercise are generally responsible for the development of intervertebral disk problems.
Slipped disk – lumbar spine symptoms
The area of the spine that is producing the pain usually points to the location of the slipped disk. If, for example, the herniated intervertebral disk tissue is pressing on the nerves of the lumbar spine, patients complain of lower back pain, while pain that is felt more in the neck region may be a sign of a slipped disk in the cervical spine.
The pain may not necessarily be confined to the area of the slipped disk, however, as it can also radiate to other parts of the body. A slipped disk in the lumbar spine can frequently cause pain that extends into the legs or even right down to the toes. The pain usually increases when coughing, sneezing, or clenching the body in some way. If the pressure on the nerve roots in the lumbar spine is particularly strong or persists over a lengthy period of time, the patient may even experience symptoms of impaired sensitivity, such as tingling or pins and needles, or signs of paralysis in the legs. If the patient loses control of the bladder or bowels, this is a medical emergency and rapid surgery is absolutely essential.
Treating a slipped disk
Many people believe that the only treatment for a slipped disk is surgery. In actual fact, surgery is not required in the vast majority of cases, since the condition can often be adequately treated by means of a suitable conservative therapy. Physiotherapy, painkillers, and medical aids such as supports and orthoses play an important role here. In fact, only 5% of all slipped disks in Germany are treated surgically. Although strict bed rest and an elevated leg position were recommended in the past for a slipped disk, physicians nowadays are increasingly advising patients to continue with normal, light everyday activity. Painkillers and anti-inflammatories are used so that patients can get moving again. The application of heat, e.g. fangotherapy, mud, or red light, supports the effect of the painkillers.
As soon as the patient is able to move again with practically no pain, the drug-based treatment is supplemented by physiotherapy exercises as well as massages or hydrotherapy if necessary.
A course of physiotherapy to treat a slipped disk with no complications lasts for around six to eight weeks. Rehabilitation over the course of several weeks may also be required thereafter. During this period, medical supports or orthoses can provide effective support for the spine during both physiotherapy and everyday movements, thereby helping to reduce pain.
If the conservative treatment fails to improve the symptoms even after a number of weeks, the physician will probably advise surgery after all.
Of course, there are always risks associated with surgery. For example, intervertebral disk surgery on the lumbar spine can result in an incisional hernia, an abdominal hernia, or intestinal paralysis. In the case of intervertebral disk surgery on the cervical spine, possible risks include nerve irritation and, in rare cases, permanent hoarseness. There is also the risk of the more general complications associated with all surgery, such as impaired wound healing or blood clots.
Intervertebral disk surgery
The aim of surgery is to prevent lasting secondary damage. If, for instance, the intervertebral disk tissue presses on the sensory and motor nerve fibers responsible for bowel and bladder function over a protracted period of time, this can lead to bowel and bladder control problems (fecal and urinary incontinence). Individual muscle groups may be weakened or paralyzed, possibly even resulting in permanent sensory function impairment as associated with paraplegia.
During the surgical procedure, part or all of the intervertebral disk is removed (discectomy) in order to reduce the pressure being exerted on the surrounding nerve roots. This helps to relieve pain and prevent long-term nerve damage.
Patients are generally started on physiotherapy soon after the operation in order to strengthen the weakened muscles and rectify any mobility impairments that may have occurred. The physiotherapy exercises need to be performed regularly over a period of several weeks. The postoperative follow-up care can also be effectively supported by wearing a support or orthosis.
Supports for stabilizing and relieving the lumbar spine
Medical supports are an important part of effective therapy for slipped disks. For example, the LumboTrain® supports the lumbar spine and helps to provide long-lasting pain relief. It also features an integral friction pad with massage nubs in the lumbar region to massage the lower back with a gentle circular pressure during every movement. The medical support is made from a breathable knitted fabric that is gentle on the skin, and it adapts perfectly to the shape of the body. It offers excellent support and is comfortable to wear, even over extended periods of time. The support also has very good elasticity, so it can be worn during sporting activities or physiotherapy sessions.