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The herniated disc.

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You have pain in the lower back, sometimes it goes down the leg. Your doctor has told you that you had a herniated disc. The scanner or MRI confirmed it. What is it exactly? What is the treatement ? When will you return to sport?
Between each vertebra, we find the famous intervertebral disc. It consists of a gelatinous core and surrounded by many fibrous rings in the manner of an onion. It behaves as a damper and a pressure distributor.
A herniated disc, what is it?
When you lean forward or when you tilt your bust, you squeeze one side of the disc. The viscous substance is driven away and pulls the fibrous rings. A shoulder rotation relative to the pelvis further increases the stresses. This movement pivots the fibers of the vertical disc horizontally. The thickness of the disk decreases, the pressure increases. As the vertebrae are screwed to each other. When the action is slow and well controlled by muscles, the fibers begin pre-tension, pressures are balanced harmoniously within the disk. If the movement is abrupt and uncoordinated, rings tear, gelatin fuse back and out of the disk: the herniated disc! In the manner of a sprain, the injury puts a big swell and edema surrounding the viscous substance. Around the disk is very sensitive and you have very bad in the lower back: the lumbago! If the hernia touches one of the large nerves exiting the spine and down to the toes, pain radiating into the leg: it is sciatica!
Herniated disc consists of the expelled gelatinous substance of the disc. It is surrounded by edema and touches the nerves exiting the column.
Your pain in the lower back is not necessarily a herniated disc. The disc is painful long before the gelatin so completely. When the outermost rings are stretched, they start to hurt. The record "drool" back: the disc protrusion. Over time, the gelatin seeps into multiple cracks. The disc cup. It absorbs less constraints. The bone located on either side must assume, he suffers in turn. This lesion is named disk failure! At the back of the vertebrae, there are also small joints that guide the movement of the back. The cartilage that covers may be damaged. We speak of "facet joint osteoarthritis." The bone bridge joining these small joints in the body of the vertebra may be the victim of a stress fracture. This is spondylolysis! The list could go on! You understand why it is imperative to conduct a thorough examination often complete a targeted imaging assessment to refine the diagnosis, treatment and adapt modulate your sport!
What happened ?
In most cases, you remember this sports movement involving bending, tilting and rotation "rapid and uncoordinated" and an unknown sharp pain tore you back. Sometimes the discomfort has settled more slyly. Indeed, the center of the disc is not innervated. You probably started damaging it with impunity. By manhandling your back, you can crack the fibrous rings in the middle of the disc without pain. And one day, when a harmless gesture, raising you a morning or picking up a pen, gelatin goes into sensitive areas or out of the disk ... and the pain sets!
Fight against inflammation.
You know, around the hernia and torn rings will constitute a large swelling. Either it compresses the large sciatic nerve. Is, it stimulates the sensory nerves located at the rear of the column. Nerve pain is twofold. It is "mechanical" in contact with the hernia. It is also "chemical" due to irritation by the secreted inflammatory substances. Thus, anti-inflammatory drugs decrease the edema around the hernia and you relieve.
Anti-inflammatory drugs reduce swelling around the disc and relieve you.
The pain also comes from the exhaustion of the muscles trying to support the vertebrae. In the vast majority of cases, this contracture is not protective. Rather, it disrupts the operation of the column, it causes overwork other vertebral levels; they become painful in their turn. Muscle relaxants are welcome! Similarly, take painkillers to relieve you ... First, it is essential! ... Second to improve the functioning of your column, so she heals best. If this treatment proves insufficient. It is possible to inject anti-inflammatories, steroids, directly into the spine. This is what is known as an epidural infiltration. The technical gesture is often comparable to that enjoyed by mothers during childbirth, but the products are different.
Rest a little!
To reduce inflammation, in the immediate aftermath of trauma or after infiltration, the supine position is irrelevant but it is recommended to limit the movements. According to doctors, you can avail of safety recommendations, armatur├ęe a belt or a rigid corset (see box). Nevertheless, it is advisable to reconnect quickly with movement. Thus, the muscles are able to retain strength, flexibility and above all the necessary coordination to prevent recurrence and resume training quickly. Furthermore, the gentle range vertebrae allows to "guide" the healing of the disc. A minimum of mechanical stress fibers oriented in the axis constraints, the repair is more solid. In case of total and prolonged immobility, the crack of the ring height of anarchic and fragile crust. Throughout this growth, your physical therapist can help you weigh in your movements.
How to cure your hernia?
Relative rest and anti-inflammatory drugs can reduce the edema surrounding the expelled gelatin. Already, the volume of the hernia decreases considerably. But the gelatinous substance can not return the disc! ... Likewise, the toothpaste out of the tube can not go back!
The hernia can not return the disc, such as toothpaste can not go back in the tube.
These are the white blood cells come clean the lesion gradually digest gelatin. The fibrous rings heal but the disc remains "under-inflated". It has altered its damping capacity. So, it sometimes persists some chronic pain, especially in the morning at sunrise or during prolonged sitting positions. Frequent pain fade while the hernia is still present. Its volume has decreased since the inflammatory edema has disappeared, and the gelatin is partially absorbed. So, she does not touch the large sciatic nerve. You can gradually regain your fitness but caution and preventive exercises are needed (see article: Pain in lower back: self-rehabilitation). From time to time, pain and hernias do not go away despite more than 3 to 6 months of treatment behaved well. A surgical opinion is needed. The operation is mandatory as early as sciatica causes excruciating pain. It is the same when nerve entrapment is causing paralysis or loss of sensitivity. This is especially true when these disorders affect the sphincter and cause urinary problems. The procedure involves scraping the hernia, the surgeon goes to the bottom of the drive to reduce the risk of recurrence. The disc is dry and has lost many of its mechanical qualities.
Sports, gradually!
Nature that sets the pace of your recovery! Your doctor and your valid progression. SANTESPORTMAG indicates the usual steps of the sports recovery.
When the immobilization of the column is put the bike apartment is often well tolerated. Raise a little the handlebars, your spine is placed in an intermediate position, neither looked nor dug. You are resting on hands, well balanced, like your cousins ??the great apes do not suffer back! At this stage, swimming, particularly backstrokeDeserves to be tested. horizontal position, weightlessness and neutral attitude of the column theoretically combine to minimize stress on your injured disk.
When the immobilization of the column is put the bike apartment is often well tolerated.
Road cycling and imbalances can be taken a few weeks later. Sometimes you feel the need to correct you on your seat to relax your column. Do not hesitate ! By releasing your handlebars, you replenish your closer to the standing attitude. You work coordinating your column due to the instability of your bike. In the absence of pain, you can also put you in a dancer, your gesture is similar to that of the race. Try alsobreaststroke. This swimming mobilizes flexion / extension your disk and the absence of weight limit constraints. Here's some guidance in healing your disk. At the pool, taking the aquajogging: into the deep, running in the water clinging to 2 aqua fries. In the pelvis, Jump around the water. The relieved impact of buoyancy also helps in the rehabilitation of your disk
Later, during your walks, alternate walking and trotting. Alternating receptions and pulses every stride, pumping and soften the scar. In a few sessions, you are a true jogging. At the same time, return to the pool to bind in the small bathroom a few tricks specific to your discipline: set the aquatennis, the aquafoot or aquakarat├ę! On land, you can now introducelateral movement. When you feel comfortable, go back to your sport. Start with education. Caution when bending, rotations and tilts bust. When all your tricks are validated, you replenish your collective training. When they are attainable at full power and well controlled despite the fatigue, resume the competition!
Some back belts can participate in the processing of your herniated disc. They are supported on the upper part of the basin. They are made ??of semi-rigid whales along your lower spine and wide elastic belt that tightens your abdomen.
A vertebra strapping
You understood the herniated disc is a "sprain" of the disc. Torn fibrous rings are comparable to specialized ligaments. For a quality scar, limit aggressive acts but preserve the moderate amplitude movements to orient the fibers in the axes of the constraints. It is the mission of the waist belt ... like the ankle strapping.
No muscle loss
The belt does not completely immobilizes your column and does not inhibit your muscles. Instead, it provides a call to order that stimulates the muscles responsible for controlling your position. Inconvenience, it can become a key point of coordination. To remedy this, it is good to remove from time to time, especially during physical therapy sessions where you work your posture and control your movements.
Customized use
A serious injury fibrous tissues heal in 3 to 6 weeks. During this time, your doctor may advise you to keep the belt all day. You take it off to sleep, toilet, for rehabilitation and for the bike. At the end, a progressive withdrawal is customary. Conventionally, for 10 to 15 days, you first remove the home and office. In the following weeks, give it when you impose constraints on your spine when you shop for lifting a heavy object or to return to sport.

Dr. St├ęphane Cascua
Sports medicine

Doctor St├ęphane CASCUA. - 12 f├ęvrier 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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