Herniated disc: defective intervertebral disc? It also works without surgery!
Damage to intervertebral discs is often diagnosed prematurely. BUNTE answers the most important questions and explains why surgery is unnecessary in most cases.
"One night I woke up and could only move in a very limited way, if at all. I still crawled to the set on all fours for two weeks – literally. And then, despite injections, nothing worked. A real nightmare!" This is how Valerie Niehaus, last seen in the ZDF series "Die Spezialisten", describes to see her herniated disc. The actress is not alone in this: depending on which statistics you believe, 100,000 to 180,000 Germans suffer a herniated disc every year. Every 60. Employees are written off work at least once a year due to intervertebral disc disease.
What do the intervertebral discs do?
In order to be equipped for the stresses of everyday life, our spine must be very stable, but at the same time also very flexible. The vertebral joints provide mobility, muscles and ligaments give support to this construction. The intervertebral discs play a particularly important role: "They are one of nature's great miracles", says Dr. Hans- Joachim Wilke, Deputy Director of the Institute for Trauma Surgery Research and Biomechanics in Ulm, Germany. They connect the vertebral bodies, ensure the flexibility of the spine and also serve as elastic shock absorbers. "The design of the discs, each about five millimeters thick, is perfect. On the outside, it is surrounded by a so-called fibrous ring of collagenous connective tie and cartilage fibers. Similar to a car tire, the fibrous ring is made up of several layers of intersecting fibrous structures. Inside sits a deformable gel-like core",the biomechanist explains the anatomy of our 23 intervertebral discs. During the day, they are compressed between the vertebrae and lose fluid. That's why we are about three centimeters taller in the morning than in the evening. When they are relieved, for example at night when sleeping, the intervertebral discs absorb fluid and nutrients like a sponge and regain volume. The intervertebral disc can only "nourish" itself through the alternation of loading and unloading, because it has no vessels to supply itself.
When do the intervertebral discs cause pain?
Not only during the day, but also in the course of our lives, we lose a few centimeters in height. With age, the intervertebral discs can store less fluid and become flatter. This also reduces their elasticity. "In simple terms, the intervertebral disc can be compared to an old car tire whose rubber has become brittle over time and which has lost some of its air.", says Wilke. This natural aging process, in combination with lack of exercise, bad posture, overweight or overload, can cause small cracks to gradually form in the fibrous ring.
Sharp pain is a signal
Then the soft core has too little support, presses outwards and a kind of bump develops, which can press against individual nerves, nerve bundles, nerve roots or the spinal cord. In such a case, one speaks of a disc protrusion or protrusion. A medical herniated disc (prolapse) is present when the impacted fibrous ring ruptures completely and part of the gel mass escapes. The pain varies depending on where the prolapse occurs, how large it is and whether nerves or nerve roots are involved. The main symptoms include acute stabbing pain – limited to the spine or radiating to sensory disturbances, numbness and paralysis. In more than 60 percent of cases, such a herniation occurs in the area of the lumbar spine (lumbar disc herniation) – as in the case of Valerie Niehaus. A herniation of the cervical spine (cervical disc herniation) is much less common.
The intervertebral disc is often hastily declared to be the culprit of back pain
If you go to the doctor with back pain, it's not uncommon to be diagnosed with damaged discs. However, there is one big problem: most degenerations and protrusions do not cause any symptoms and are often only discovered by chance during examinations with imaging techniques. According to studies, one in four 30-year-olds has. One in two 16-year-olds has a herniated disc – without ever realizing it. "Even if you can see something on the discs in the picture, there are many other possible causes for the pain", knows Dr. Martin Dietmaier, physician and physiotherapist from Regensburg, Germany. With specific questions, you can often determine in advance whether the discs are really to blame for the pain. "Those who come to the doctor's office with pain need a thorough enough discussion of the history with careful clinical examination to rule out other causes. Only then is it decided whether an imaging procedure is needed at all, and if so, which one."
What happens after the diagnosis?
If the intervertebral disc really is the cause of the pain, some doctors are relatively quick to pull out the scalpel. Dietmaier emphasizes: "The focus should always be on conservative, maintenance therapy. Nine out of ten patients can be helped in this way – if you want to." The most important thing is first that the affected person can move again without pain. "Warmth has a good influence on the musculature, which would like to secure the pain area and becomes thereby by high tension the pain generator ",says Dietmaier. Hot baths or heat patches (z.B. "doc Therma" or "Therma- Care") relax the muscles. Anti-inflammatory pain medications such as ibuprofen and diclofenac can be applied topically and externally as a gel or ointment (z. B. "Voltaren pain gel") or in tablet form (e.g.B. "ibudolor") help. "In my opinion, therapy in tablet form should only be used for the first few days, and then, if it is not effective enough, I use injection therapy with local desensitizing drugs and also cortisone for a short time to reduce irritation. Not in order to gloss over something, but in order to achieve consistent treatment of the cause of the pain and inflammation-related swellings right at the beginning, and thus to prevent the pain from becoming chronic at an early stage."
What else you can do for your intervertebral disc
Preventing pain and relieving mild discomfort in a gentle way. There are numerous possibilities. Try out what helps you best!
Learning to relax
Today, almost all back experts agree that stress is poison for our intervertebral discs. Here we introduce effective methods to counteract.
Autogenic training: If the back muscles are under constant tension, the autosuggestion technique relaxes body and psyche. In the process, formulaic phrases such as "I am completely calm, nothing can disturb me" are repeated. In the long run, this convinces the subconscious to actually believe in it. Autogenic training must be practiced for a few weeks until it works. The effect is scientifically proven. The costs for group courses (e.g. B. at adult education centers), many health insurance companies participate.
Mindfulness training: The effect of Mindfulness-Based Stress Reduction (MBSR) has also been documented. The training includes meditative movements in rest and movement. Through it you learn to pay attention to thoughts and feelings. Eight-week courses are recommended for beginners; health insurance companies usually subsidize them. More at mbsr-association.en.
Progressive muscle relaxation according to Jacobson: The basic principle is to tighten and then relax one muscle group after the other for a short time. This technique can be learned quickly, z. B. in fitness studios. Adult education centers. in fitness studios and adult education centers.
Training body awareness
Alexander Technique: The teacher directs the attention of the student to fixed movement patterns that lead to poor posture and tension. Then he practices with him to perform them again in a manner appropriate to the body, giving manual support. Read more at alexander-technique.org. In these classes, the instructor gives verbal exercise instructions. While doing this, ask questions about body awareness. The movements are first performed in the way the students are used to, then broken down into individual sequences and varied many times. More under feldenkrais.
Test alternative manual therapies
Rolfing: It can help when disc pain is the result of bad posture. Rolfing consists of ten consecutive sessions in which the therapist loosens tangled fascia with certain hand movements. More under rolfing.org.
Myoreflex therapy: The holistic treatment concept combines knowledge from osteopathy, traditional Chinese medicine and neural therapy. On the one hand, the therapist manually works prere points on the muscle attachments. Releases so excessive tension in the musculature. This relieves prere on the spine. So that the intervertebral disc. On the other hand, the patient is instructed to do exercises at home that stretch and strengthen the muscles at the same time. For herniated discs, six to ten sessions are usually needed. More under myoreflex.
As a patient, everyone must also become active themselves
The second component of treatment, according to Dietmaier, is: "Movement through manual mobilization, including physiotherapeutic mobilization." Studies show that after a longer period of rest, even greater complaints occurred than in patients who were active. As soon as the first severe pain has subsided, regular relaxation exercises, muscle stretching and strengthening should be part of the program. "Intervertebral disc therapy still involves a certain amount of personal work. And not only acutely, but permanently." Targeted movement therapy is the first step. Afterwards Dietmaier advises versatile movement. "Anyone who puts one-sided strain on themselves professionally or athletically should pay attention to balancing exercise programs. The aim should be to strengthen and maintain the musculature while maintaining mobility." Surgery is actually only necessary in two cases: if the complaints do not end despite consistent conservative therapy and in emergencies, if a nerve threatens to die off. A study of the universities of Freiburg and Tubingen with 1244 patients confirms what back specialists preach again and again: When it comes to intervertebral disc surgery, restraint is advisable. 75 percent of all patients who were treated conservatively after a herniated disc felt better afterwards. The incident was no longer detectable after two years. In the remaining patients, something could still be seen on MRI images, but the patients were pain-free.
Exercises for a strong back
Mobilization: Round the back vertebra by vertebra while standing on four feet. After 1-2 breaths roll back. Slowly move the spine toward the floor. The arms remain stretched. Pain the wrists, alternatively put up the fists (3 x 15 repetitions).
Mobility: In quadrupedal position, the left hand wanders along the floor under the body. Push the arm between the right arm and the knee to the right, 3 to 4 times forward and back again – with each time a little further. Left shoulder and upper body turn in – until shoulder and head touch the ground. Then repeat with the right side (3 x 15 repetitions).
Strengthening: Starting position is the quadruped stand, pull belly button slightly inwards. The back should not move! Start with step 1, next step of the exercise only if the back remains stable. STEP 1: one arm forward. Move back again. STEP 2: stretch one leg straight back and pull it back again. STEP 3: Move arm and leg diagonally away from each other at the same time and then move them back again. Initially each side 3 x 10 repetitions, then two more repetitions each week.
Exercise is a must
But the fact is: it does not work without one's own intervention. Neither conservative therapy nor surgery can regenerate an intervertebral disc – as if nothing had happened. Especially those who were once intervertebral disc patients should therefore pay special attention to an active, back-healthy life. Niehaus also feels the importance of exercise in his own body: "After a period of rest, I slowly started outpatient rehab: I started with manual physiotherapy, and the phase gradually led into physiotherapeutic strength exercises.