The intervertebral discs act as shock absorbers for the spine, therefore when a disc slips out of place it can result in a great deal of pain and many postural deficits.
There are several different factors which must be considered in these cases – the direction in which the disc has moved, whether a hernia is present or not and whether there is a compressed nerve root.
In almost all of these cases, conservative treatment is appropriate and effective.
Through a combination of manual therapy and physiotherapy designed to improve core strength and endurance in the lower limbs, we can reduce pain and restore normal posture.
Surgical treatment here is reserved for selected cases where conservative treatments have proved inefficient. Surgical interventions may also be used in cases where irreversible neurological damage through the worsening of symptoms is a risk.
Hernias removed through surgery are typically ‘hard’ i.e. dehydrated, these can cause substantial sensory and motor impairments and rarely improve over time, explaining the need for removal.
The treatment is usually done with non-invasive technique (2-3 cm scar). In cases of major complications, it might be necessary to take a more traditional approach using a laminectomy. Some surgeons may also perform percutaneous disc decompression, using lasers. However this treatment does not guarantee the symptoms will not recur.
After surgery, a fitting rehabilitation programme is essential to ensure optimum recovery.
The patient with herniated discs has usually suffered some episodes of low back pain and after an effort (sometimes a sneeze or bend of the trunk) begins to have pain in the leg, tingling, muscle stiffness; all symptoms indicating involvement of the nerve root.
Only after a thorough medical examination and an accurate diagnosis is possible to start the customized therapeutic program to the type of herniation.
The first objective of rehabilitation is to reduce pain and regain mobility; at this stage of therapy are important: massage therapy, relaxant for paravertebral and hip flexors, the physical non-invasive therapy (TENS, laser, hyperthermia), the elongation of the anterior muscle chain with selective exercises for the hamstrings and especially the recovery global postural in the pool, with exercises in exhaust to stimulate the control of the position of the pelvis and legs, and safely recover the daily movement.
After the symptoms of radicular pain have disappeared and straight leg raise (medical test) is negative, you can proceed to muscle recovery in the gym with selective toning exercises of the abdominal (transverse), quadriceps, the core muscles of the buttocks with the objective to create a natural corset that stabilizes the spine during movement.
Once you have achieved excellent control and muscle strength is useful to conclude the rehabilitation cycle with some sessions on the sports field, with exercises on unstable platforms, Bobath balls for the recovery of vestibular function and spatial perception, for a smooth and safe resumption of sports and everyday practice.