Slip disc in lower back and manipulative intervention
Mr Zaman, the 43 years old gentleman, has been suffering from acute sever lower back pain for 7 days. Pain moves down to right thigh and leg causing difficulty in walking, standing and even moving on bed. Gradually pain increases when he moves for necessary daily functions. Finally he was diagnosed as a case of slip disc or PLID (prolapsed lumbar intervertebral disc) between L4 and L5. However, he and his family become very nervous and frustrated what to do as nothing could relief his pain or could improve movements.
There are many cases like him within our family or office as they have been suffering for months to years. So, it is important to know what is slip disc and why it happen, and how we could feel better in our daily life. Slip disc is a phenomenon where disc materials between vertebra coming outwards and compress associate ligaments, nerve and other structures.
This type of problem often called mechanical displacement or derangements of spine as there are mechanical compression of nerve root; that is why pain and other symptom radiate or move down to leg.
Common causes of slip disc: In slip disc, the exact causes are unknown but it is thought that working in sitting position for long time in awkward position, bending and lifting heavy object from the floor, trauma or traveling in uneven surface for long time may be the contributing factors.
Common symptoms: you may feel severe pain which is unbearable, especially on back or leg, pain often radiate below thigh and leg even up to foot, sometimes patients may complain tingling sensation or heaviness or parasthesia — difficult in movement in bed or unable to sit, stand or walk initially.
How you can conform you have slip disc: Well, there are several ways we conform patients' disc prolapse. Patient usually complain that the pain become worse in the early morning, coughing or sneezing aggravate pain on back, and testing straight leg raising while lying on back. In fact, you may assess by a physical therapist or a physician to conform about diagnosis. Usually a physiotherapist or manipulative physiotherapy practitioner can assess accordingly. Besides, a lot of other manual therapy protocols are followed to relief pain and associated symptoms. There are several research recommended to avoid long time rest or pain killer for the management of slip disc rather early introduction of pain free position, exercise therapy, manipulation therapy, mobilisation techniques are very useful to regain early mobility and return to work.
What should be avoided if you have slip disc: Take relative rest but not for long time, use pain free position while lying, avoid travelling and long walking, try not to lift object in bending position, use hot compression for 10 to 15 minutes in back, be careful during coughing or sneezing.
Finally, to prevent your back pain or slip disc, do some exercises regularly or you may take suggestion from a physiotherapist about the type of exercise you can perform.
Clinical bottom line: Discogenic pain is very common where life time prevalence about 35 to 80 percent. From the beginning, a multidisciplinary team can assess and provide treatment. Therefore, proper assessment, diagnosis and accurate intervention are essential for patients with slip disc; not only that but a clinical jurisdiction on referral to the right professionals are also accountable.
The writer is the Head of outpatients services at Proyash, Dhaka Cantonment.
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