Lower Back Pain & Sciatica (Leg Pain)

Introduction

Lower Back Pain is a condition that is common among middle-aged people & athletes.
The lumbar region of the spine (the lower back) is particularly susceptible to herniated discs because this portion of the spine is responsible for bending the body as well as supporting most of the body’s weight.

Other terms used to refer to a herniated disc are slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve.

The herniated disc symptoms usually start for no apparent reason. Or they may occur when a person lifts something heavy and/or twists the lower back, a fall or accident, poor posture when sitting/sleeping, and movements that put stress on the back.

Lack of exercise, smoking, poor diet, weight gain, age & genetics are also factors.

The herniation itself is not necessarily painful. But if the protruding disc and its jelly come into contact with spinal nerves, pain signals can be sent to whichever part of the body those nerves affect.

The Lumbar Region Overview

There are 5 vertebrae in the lumbar spine region. The vertebrae are made of bones, and each vertebra is separated by a disc. The disc contains the nucleus pulposus which is a jelly-like substance that helps distribute pressure evenly across the disc.

The 5 vertebrae are labeled L1 through L5 as seen in the image below.

The most common levels for a herniated disc are the L4-L5 and L5-S1 (Lumbosacral Joint) levels. This is because these levels receive the most pressure.

Leg Pain (Sciatica)

The lowest of the lumbar spine's five vertebrae (L5) can slip forward over the first vertebra of the sacrum (S1) and affects the nerve root that passes from the spinal canal through an opening in the back of the L5-S1 segment. This nerve root called the L5 nerve root runs down the back of each leg (as part of the large sciatic nerve).

Leg pain (sciatica) occurs when this nerve root is compressed and/or when the nucleus pulposus (jelly-like material of the disc) leaks out and irritates it.

Herniated Disc Treatment

Usually with a herniated disc, sitting, bending and lifting will increase pain and symptoms. Walking and lying down will reduce symptoms.
Luckily, most of herniated discs can be treated without surgery. You just have to do the right things.

Research even suggest that after a year and in about 90% of the cases there was no difference between surgical and non-surgical treatments in terms of effect. Both recovered equally.

If you are diagnosed with a herniated disk, talk to your doctor & begin a course of conservative treatments that may include:

• Pain medication
• Weight loss
• Physical therapy
• Low-impact exercise
• Stretching and yoga
• Corticosteroid injections

Other Conditions affecting The Lower Back

There are also a number of spinal conditions that can run through multiple levels of the lumbar spine and affect the L5-S1 lumbar segment, such as Spondylolisthesis, Lumbar Degenerative Disc Disease (DDD), Osteoarthritis of the lower back and Lumbar Spinal Stenosis.

If you experience the following symptoms you should consult a doctor as soon as possible:
• Loss of sensation in your thigh’s on both sides
• Loss of bowel and bladder control
• Difficulty walking

These symptoms may indicate a severe condition in your lower back that could lead to lifelong problems if not treated quickly.

Exercises for Herniated Disc

Here are 3 exercises that can help you to treat your herniated disc without surgery.

Herniated Disc Exercise 1: Push the disc back into place
The first thing you have to do is to try to push the nucleus pulposus (jelly-like material of the disc) back into place. You can do this by stretching your back backwards as far as possible. This is called extension of the back.
You can do this in two ways: While standing or while lying in prone position. I’ll discuss the one in standing here because that’s the easiest one for most people.

Perform the exercise like this:
• Place your index fingers on the painful spot in your back
• Apply pressure in forward direction
• Now bend all the way backwards
• Make sure also to extend your neck backwards for maximum result
• Hold this position for 3 seconds
• Repeat this 10 times

You can also find the exercise in the video below.

Make sure that you perform this exercise several times a day. It’s especially important to perform the exercise every time you’ve bend forward or lifted something heavy.
When you’ve performed the exercise you will notice that the radiation in your leg is reduced and sometimes totally disappears.

When you feel the pain radiation is coming back into your leg, it’s time to do the exercise again. You want to keep the pain radiation away so that the disc has time to recover.

Herniated Disc Exercise 2: Increase Lower Back stability
This exercise reduces the pressure on the disc. We will do that by training the little muscles around your back.
When you train these muscles, they will keep the disc better in place because there will be less movement between the different vertebrae’s.
The muscles will take over some of the pressure, which helps the disc heal more quickly.

You can perform this exercise in the following way:
• Lay down on your back
• Bend your knee’s
• Cross your arms over your chest
• Now lift up your pelvis
• Hold this position for 10 seconds
• You can increase the difficulty by extending one leg and keep it slightly above the ground

You can also find the exercise in the video below.

Try to perform this exercise 2 times a day. Also try to increase the time you hold your pelvis up to 15 seconds or more.

Herniated Disc Exercise 3: Lower Back Muscle Training
The third exercise you should perform is designed to increase the strength of your big back muscles.
Because of the pain in your back, muscles tend to get weaker. Also, stronger back muscles will reduce the pressure on the disc.
You'll notice that this exercise is pretty heavy. Therefore you’ll have to see if you can already perform this exercise or just stick with the previous two. If it causes more pain radiation in your leg, you should abstain from performing.

Perform the exercise like this:
• Lay down on the ground with your face facing the floor
• Place your arms in front of you with your elbows bend
• Now lift up both your arms and your upper body
• Keep your feet on the ground
• Repeat this 10 times

Try to increase the number of repetitions to 15 or even 20 and repeat 3 times. Perform this exercise 2 times a day.

As you might know, the recovery of your herniated disc may take several months to complete. This means that you have to be patient and continue the exercises as long as it takes.

Herniated Disc Exercises and Activities to Avoid

You must avoid all activities that include lifting heavy stuff, bending forward, and twisting your back until the disc is repaired and you’re free of symptoms.

Examples of exercises to avoid are:
• Crunches
• Deadlifts
• Good morning
• Squats
• Shoulder press
• Straight leg raise
• Leg press
• Twisting exercises

 

Reference:
https://www.spine-health.com/
https://www.laserspineinstitute.com/back_problems/bulging_disc/
https://www.alwaysfysio.nl/en/herniated-disc-treatment/

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