There are four stages of herniated discs: Bulging; Protrusion; Extrusion; Sequestration (see image below)

Bulging: extension of the disc margin beyond the margins of the adjacent vertebral endplates	Protrusion: the posterior longitudinal ligament remains intact but the inner nuclear material impinges on the outer annular fibres
Extrusion: the nuclear material emerges through the annular fibres but the posterior longitudinal ligament remains intact	Sequestration: the nuclear material emerges through the annular fibres and the posterior longitudinal ligament is disrupted. A portion of the nucleus pulposus has protruded into the epidural space

The encouraging news is that 75% of intervertebral disc herniations naturally resolve within 6 months. Surgical intervention only becomes necessary when conservative treatments fail to yield positive results. However, in recent years, significant strides have been made to reduce the necessity for spinal surgery. According to the clinical guidelines outlined by the “National Institute for Health and Care Excellence 2016,” the initial approach leans heavily toward conservative treatments, including medication, support, advice, and exercise therapy.

Physiotherapy interventions offer a non-complicated and cost-effective alternative to surgical treatment. It serves as a frontline management approach before considering invasive surgical procedures.  Therefore, prioritising evidence-based physiotherapy management for disc herniation holds immense clinical significance.

Some physiotherapy modalities that prove beneficial in managing disc herniation include:

• Stretching exercises
• Muscle strengthening 
• Traditional Chinese Medicine methods such as acupressure, acupuncture, and cupping
• Spinal mobilisation techniques
• Postural re-education exercises
• Transcutaneous Electrical Nerve Stimulation (TENS)

By incorporating these physiotherapy modalities, individuals struggling with disc herniation can explore non-invasive and effective avenues for relief and recovery.

References

de Carvalho ME, de Carvalho RM, Jr, Marques AP, de Carvalho Lucio LM, de Oliveira AC, Neto OP, et al. Low intensity laser and LED therapies associated with lateral decubitus position and flexion exercises of the lower limbs in patients with lumbar disk herniation:Clinical randomized trial. Lasers Med Sci. 2016;31:1455–63. 

Eichen PM, Achilles N, Konig V, Mosges R, Hellmich M, Himpe B, et al. Nucleoplasty, a minimally invasive procedure for disc decompression:A systematic review and meta-analysis of published clinical studies. Pain Phys. 2014;17:E149–73. 

Giles L. G. F., Singer K. P. The Clinical Anatomy and Management of Back Pain. Butterworth-Heinemann, 2006. 

McConnell J. Recalcitrant chronic low back and leg pain a new theory and different approach to management. Man Ther. 2002;7:183–92. 

McGill S, Low Back Disorders: Evidence Based Prevention and Rehabilitation, Second Edition. USA: 2007 Human Kinetics.

Satpute K, Hall T, Bisen R, Lokhande P. The effect of spinal mobilization with leg movement in patients with lumbar radiculopathy a double-blind randomized controlled trial. Arch Phys Med Rehabil. 2019;100:828–36. 

Singh V, Malik M, Kaur J, Kulandaivelan S,and Punia S. “A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc.” Int J Health Sci (Qassim), 2021: 15(2): 49–57.

The post What is a ‘Slipped Disc’? appeared first on The Physio Factory.

The main system in the body that is affected is the nervous system. The nervous system transmits signals and is connected to the hormonal system via the hypothalamic-pituitary-axis. Therefore, it can make connections to every cell and system of the body. Certain areas in the brain regulate the perception, transmission, and inhibition of pain. Using strong acupuncture points (found in the hands, face and feet) aimed at stimulating these areas can have a long lasting analgesic effect throughout the entire body. 

The skin acts as a battery where outside is negative and inside is positive. Acupuncture points are more positive than the surrounding skin, therefore the insertion of a needle would short circuit this battery and generate a current of injury lasting for several days. Further electrical activity occurs due to ionic reactivity between the metal needle and body fluids and due to low-frequency pulses of electricity from twirling the needle. 

Acupoints act as amplifiers of a current travelling along the perineural cells, which wrap around each and every nerve in the body.  This generated electrical energy would flow along the nervous system to the brain and would be analogous to the QI described by classical acupuncture. 

References:

Becker, R.O., Spadaro, J.A., Marino, A.A. (1977). Clinical experience with low intensity direct current stimulation of bone growth.  Clinical Orthopaedics and Related Research, 124: 75 – 83

Bailey, S., (2018) Dry needling and traditional Chinese acupuncture.

The post How does acupuncture work? appeared first on The Physio Factory.