Hernia - Is It A Sentence
“I can’t lift and play sports. I suffer from discopathy. I very often hear this statement from my patients and friends. Most often it is supported by the opinion of a doctor who (if we are lucky) will look at an MRI image and perform one or two quick functional tests before issuing it. but should they make decisions so easily and forbid patients to function normally?
Discopathy, or spinal hernia, is a disease in which the nucleus pulposus, located in the center of the disc, moves outwards, which puts pressure on nearby structures (e.g. nerve structures). This causes paralyzing pain, often radiating to the lower limb which is popularly referred to as ischialgia.
The main factors leading to a hernia may be, for instance:
- Age - with age, there is a natural degeneration of the intervertebral discs
- Spine curvature (e.g. scoliosis)
- Spinal instability (e.g. due to limited hip and thoracic mobility)
- Myofascial disorders
- Lack of adequate central stabilization
- Prolonged and incorrect sitting position (sedentary lifestyle)
- Improper exercise
The formation of a hernia is a long-term process and a whole chain of various events. As you can see above there are many reasons for its formation. Interestingly, the above-mentioned problems before (!) lead to a hernia can also be a source of pain, even similar to sciatica - for instance, myofascial tension in the hip area, changing the position of the pelvis and compressing the sciatic nerve in its course, manifested by pain radiating to legs.
Back pain is not always associated with a hernia.
There are situations where there is nothing disturbing in the MRI image, and the patient howls in pain. And the other way round - there are many hernias in the image and the patient is asymptomatic.
How is this possible?
Our bodies are incredibly intelligent and are very good at “running away” from pain. Figuratively speaking, when any problem starts, the body creates compensations in various structures of our body (e.g. muscles, internal organs) to neutralize it. This is possible until the body's capabilities are exhausted - then the pain starts to last longer and disturbs a lot, and we physiotherapists know that the problem is really big and related to many structures.
Imaging studies are not everything.
In order to be able to make an accurate diagnosis, in addition to the evaluation of X-ray or MRI images, a thorough interview should be conducted, focusing on current and past ailments, a functional examination, assessing the range of joint mobility, strength and movement patterns presented by the patient. . So, back to the introduction - relying only on the resonance assessment is often not 100% reliable.
Of course... I realize how many irreversible cases there are, which we need to be careful with and which qualify for surgery. However, should we also stop exercising and physiotherapy then?
Immobility plus the stress of paying attention to every movement will cause a lot of additional tension of the whole body and certainly will not reduce the pain. It is worth considering whether a better way would not be to make the muscles more flexible and strengthen, improve circulation, learn proper exercise and everyday ergonomics, and thus - prepare the patient for a possible surgery. Or maybe thanks to physiotherapy and appropriate and safe activities, the patient will be free from pain before it?
A good solution in this situation may be fascial and manual therapy, as well as functional training. The physiotherapist, after a thorough assessment of the patient, will be able to safely take care of his body depending on the condition and problem, that is preparing him for surgery or protecting him from it.