The disease, which is called lumbar disc herniation in medicine, but which patients call herniated disc in daily use, develops from structures called discs between the vertebrae. Lumbar hernia constitutes the most common and important group among diseases that cause low back pain and/or leg pain. There are 5 vertebrae in our waist, and between them there is a special connective tissue organ called the disc, and the disc serves to ensure the durability, mobility and resistance of the spine, to absorb the shocks applied to the spine and to distribute the force to the surrounding tissues in a balanced way. Lumbar hernia is the discomfort that occurs as a result of the herniation of these discs, which act as a shock absorber between the vertebral bones in the waist. Herniated disc is usually caused by the last two disc structures.
There is a jelly-like soft part called the nucleus pulposus on the inside of the discs, a harder layer called annulus fibrosus, and cartilage structures called the end-plate on the faces facing the vertebrae. Disruption of the anatomical integrity of the outer layer and the protrusion of the soft part inside is called herniation. The herniated, that is, the protruding disc, compresses the nerves passing through the spinal canal (spinal canal) or on the posterior side of itself, and the disease thus occurs. In addition, some chemicals released from the herniated disc to the environment also affect the nerve roots and cause pain.
If some of the outer fibers of the annulus fibrosus have not been torn while herniated disc develops and all of the disc material is inside the disc, it is called a contained disc. This group is classified as bulging and protrusion in itself. However, if all of the annulus fibrosus fibers have lost their integrity and the material inside the disc has protruded beyond the annulus, it is called an uncontained disc. This group is also classified as extruded (extruded) and broken out (sequestered).
Herniated disc for the dura, which we rarely see, occurs when the disc material pierces the thick membrane called the dura and enters the spinal canal. Herniation according to the relationship of the herniated disc with the ligament, membrane and nerve root; It may also be called subligamentous, extraligamentous, submembranous, transmembranous, or intraradicular. In addition, the protruding disc material may be displaced towards the head or coccyx. In this case, there is a cranial/caudal extension or migrated lumbar hernia.
How Does Herniated Back Occur?
Since the lumbar spine is the most load-bearing region, the lumbar region is exposed to trauma many times without realizing it, due to movements such as lifting, bending and turning in daily life. Therefore, herniated disc is due to many reasons. Lumbar hernia is most commonly caused by the musculoskeletal system and these are called mechanical causes. Other disorders are often related to the disc or facet joints found in the normal structure of the spine.
In addition to many external factors such as lifting a heavy load or making a reverse movement, personal factors also play an important role in the formation of herniated disc. At the beginning of the personal factors is the deterioration of cartilage-like structures called discs, which are located between the vertebrae. As age progresses, the vessels feeding the disc decrease and the nutrition of the disc is by diffusion. The water content of the discs also starts to decrease gradually from childhood. This rate, which is 80% in children, drops to 50-60% in adults. As a result, the height of the disc decreases. Nutritional disorder and chemical changes in the discs are added to this, and as a result, the disc loses its elasticity over time. When excessive load is placed on the cracks at the micro level or when the person makes a wrong move, the soft part inside the disc easily tears the capsule around it and protrudes and a herniated disc occurs. As a result of this herniation pressing on the adjacent nerve, symptoms such as pain, loss of sensation and loss of strength in the leg along the related nerve also occur. In addition, some chemicals released from the herniated disc to the environment also affect the nerve roots and cause pain.
Vascular diseases, diabetes and smoking; They adversely affect the quantity and quality of blood flow to the disc and thus its nutrition, thus accelerating the deterioration. Those at risk of herniated disc are those who do sports with high weights such as weightlifting, those who do high-risk contact sports, those with weak back and abdominal muscles, those who are overweight, those who do heavy lifting and wrong bending movements, those in the last months of pregnancy, driving for a long time. They are people who have to and people who have bad posture. As a result, unconscious movements during daily activities are the leading external factors that play a role in the formation of herniated disc. When we lift a load by bending or reaching, the load on the discs in the waist becomes asymmetrical, not symmetrical.
How Can Hernia Be Prevented?
It should be known that the load on the waist while sitting is more than when standing in an upright position. Worse than this position is to pick up an object from the ground by leaning forward while sitting in a chair. The worst thing is to bend forward while standing and lift a weight off the floor with the knees straight.
In order to protect low back health, a person should never lift a heavy load, and if he is going to lift it, he should definitely take the object from the ground by bending his knees, that is, by crouching, and not lift it by bending from the waist. He should not pick up any object by reaching out, he should always take it by approaching, without leaving any distance in between. If the person puts a support on his back or starts to tilt the back of the chair he is sitting in, the load on the waist will gradually decrease and the waist will be much more relaxed in this case. While he is healthy, he should do exercises that strengthen the waist and abdominal muscles. Adopting an active lifestyle is beneficial.
