Shoulder and neck pain, low back pain, lower back pain, back stiffness, pain that even extends to the hands and feet, numbness and pain, and more severe muscle weakness may be suspected as a Herniated Intervertebral Disc (HIVD). Herniated discs tend to occur in people between the ages of 12 and 55, although they are less common under the age of 25. Approximately 80% of these patients are male. These individuals usually have a history of early trauma. What is a herniated disc? Before we do, let’s understand what a disc is! The location and anatomy of the disc: Figure A: shows that our disc is located between two vertebrae; Figure B: the disc is composed of two parts, the nucleus pulposus and the annulus fibrosus, the nucleus pulposus is located in the middle of the disc; the annulus fibrosus is encased in the periphery of the nucleus pulposus. The nucleus pulposus is composed of viscoelastic and flexible polysaccharides and water, so it can absorb shocks and reduce the pressure between the vertebrae. The annulus fibrosus: a dense tissue made of interwoven collagen and elastic fibers arranged in concentric circles, which is tough and protects the nucleus pulposus and limits its protrusion into the periphery. Simply put, a disc can be thought of as a water balloon, filled with water and encased in rubber so that the water does not leak out. If we squeeze the front side of the water balloon very hard, the water will run backwards and the rubber on the back side of the water balloon will be deformed and damaged after a long time. Our intervertebral discs are the same principle. The disc is subjected to pressure from the spine, and if it is subjected to sudden impact or unbalanced pressure for a long time, it may just deform the annulus fibrosus at first, but in more serious cases, the nucleus pulposus may break through the annulus fibrosus and press on our spinal nerve from the ligamentous space, which is called disc herniation. At the beginning, it is said that people aged 12-55 are more prone to herniation because the nucleus pulposus has more water at this time and is more likely to have disc herniation due to pressure disorder; on the contrary, as people get older, the water in the nucleus pulposus decreases and disc herniation is less likely. Because of the tissue structure (the size of the ligaments in the front and back of the spine are different) and human habits (bending lifestyle), usually the anterior side of the disc is under more pressure, making the nucleus pulposus run backwards. There are three main categories of disc herniation: 1. Annular: The annulus fibrosus is deformed by the pressure of the nucleus pulposus and presses back on the spinal nerve. 2, Nuclear: The nucleus pulposus runs backward under anterior pressure and compresses the spinal nerve. 3.Mixed: Combined type, in addition to the nucleus pulposus that runs out and presses on the spinal nerve, there is also a broken fiber ring that presses on the spinal nerve. The herniated intervertebral disc affects the factors 1, bad sitting posture: the anterior side of the intervertebral disc is pressed for a long time, so that the nucleus pulposus protrudes backwards. Bad sitting posture for a long time will make the spinal mobility worse, and will also make the muscles on one side shorten, for example: the lumbaris major muscle, which will make our symptoms more serious. As shown in the figure below, the psoas major muscle connects our lumbar vertebrae to the femur, and when this muscle becomes tight, the disc looks like it is being stressed on the back side to push the nucleus pulposus back. But in fact, instead, because the muscle becomes tight, and make the pressure on the lumbar vertebrae become larger, and if there is an intervertebral herniation of the patient, but because the back of the intervertebral disc is overly pinched, and make the disease more serious. 2, frequent bending action: increase the chance of pressure on the front side, so that the nucleus pulposus protrudes backwards. 3, lack of backward stretching of the spine: backward stretching can squeeze the nucleus pulposus back in the back, reducing the chance of nucleus pulposus protrusion. 4, obesity: especially waist obesity is likely to increase the burden on the lumbar spine, abdominal and lower back muscles are also likely to have more weakness, increasing the risk of disc protrusion. Disc herniation symptoms 1, shoulder and neck pain, lower back pain, pain may extend to the extremities. 2. Abnormal sensation on the affected side. 3.Sciatica or cervical neuralgia, numbness in the limbs, and even muscle weakness and atrophy in severe cases. 4.Coughing and bending are aggravated. Diagnosis of a herniated disc A herniated disc can be diagnosed by physical examination, movement tests (such as repeated bending, sciatic nerve tension test, etc.) and imaging tests (such as X-ray, magnetic resonance imaging (MRI) or computerized tomography (CT) scan, etc.). In general, the symptoms of a herniated disc are often directional, meaning that movement in one direction will aggravate the symptoms, while movement in the opposite direction will reduce the symptoms, for example, lower back pain after sitting for a long time (lumbar flexion), while walking will reduce the symptoms (lumbar straightening). Treatment and prevention of herniated discs In principle, non-surgical conventional treatment is the preferred treatment. However, if you have the following two conditions: 1) weakness of the hands and feet, which is getting worse; 2) cauda equina syndrome, there will be weakness of the hands and feet or incontinence of urine and stool. If you have either of these conditions, you can ask your doctor if surgery is the first priority. The advantage of surgical treatment is that it can immediately stop the nerve from deteriorating and provide a good environment for the nerve to heal. Therefore, if you have symptoms of muscle weakness in the hands and feet or incontinence, you can discuss with your physician first to decide whether you want to undergo surgical treatment. There are three main M’s in physical therapy interventions: Modality, Manul, and Movement. 1.Modality (instrumentation) treatment: The use of traction machines to pull the spine apart to reduce the pressure on the discs, as well as the negative pressure generated when pulling apart, to bring the discs back into place. 2.Manul (freehand) treatment: relax the over-tightened muscles, such as the psoas major, by massaging the muscles with freehand. For the situation where the mobility of the spine has deteriorated, the manual method is used to increase its mobility. 3.Movement (exercise) treatment: 1), extension exercise (Extension Exercise): the use of arm strength to support the upper body, the pelvis does not move, get up, not in the highest position to support the stay, the body then lie back. Repeatedly do this action, the posterior protrusion of the intervertebral discs squeeze back. (2), lumbar major muscle stretch: stretch lumbar major muscle The following figure is stretching the right lumbar major muscle. First lie flat on the edge of the bed, hand holding their left foot, pull to the chest, so that the right foot to be stretched naturally down. (3), spinal rotation exercise (Spinal Rotation exercise) lying flat, head turned to the right, both knees turned to the left at the same time; head turned to the left, both knees turned to the right, two movements alternately. By this action, stretch the waist, relax the over-tightened muscles. 3, the activity process using the correct posture: 1), when carrying heavy objects: If you use the wrong posture is easy to make the lumbar spine injury, should be chest straight waist, using the feet bent down to lift the heavy objects; not directly bent down to carry heavy objects. (2), sitting posture: sitting relative to standing, lying, the pressure on our lumbar spine is relatively large, so avoid long-term sedentary, it is best to get up for 20 minutes, and try not to sit on the sofa. The correct sitting posture should be: 1, choose a chair with the hip joint higher than the knee joint. 2, the chair back angle of about 110 degrees, and in the cervical spine, lumbar spine where there is support to support the spine. 3, hands on the armrests of the chair, elbows greater than 90 degrees, and let the forearms horizontal ground. 4, able to step on the ground with both feet. (3), sleeping posture: front lying: a pillow under the knees to reduce the pressure on the spine. Lying on the side: a pillow between the thighs, so that the body and the bed in a straight line, reducing the pressure on the spine. Pillow: the correct height of the pillow should be able to complete support the cervical spine, in the positive lying, chin level our body, side lying can also make the cervical spine and the body into a straight line. And too high or too low will cause pressure on the cervical spine. Mattress: choose a soft and hard mattress, lying down should not sink more than five centimeters. And make our spine into a straight line.