What is a hernia? (hernia nucleus pulposus)

Written by Randy Atmo, Orthomedix

A hernia is a lesion (damage) to one of the intervertebral discs in the spinal column.

The spinal column consists of 33 vertebrae: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, the sacrum (a fusion of 5 vertebrae) and the coccyx (a fusion of 4 vertebrae). In between each of these vertebrae, intervertebral discs can be found. These discs consist of strong ring-shaped cartilage surrounding a liquid core, much like a pudding. The intervertebral discs are responsible for shock absorption from loads placed on the spine.

Herniation of a disc means that the cartilage rings are damaged, causing the ‘pudding’ to leak from the core.

How does a hernia occur?

The onset of a hernia generally occurs one of two ways; acute or over time. With an acute hernia there is a sudden increase in load on the intervertebral disc causing acute damage to the cartilage rings. This results in leaking of the liquid core (we call this a bulging, protrusion or extrusion).

A hernia which occurs over time is generally caused by chronic (over)load. If the overload is persistent, over time, the cartilage rings will get damaged and eventually a bulging disc will occur.

The leaking liquid from the core of the disc can cause pressure on the nerve root. This explains the paresthesia (pins and needles) and radiating pain which can be felt down the leg of the affected side. Therefore it is not the hernia which causes radiating symptoms, but rather the pressure on the nerve root as depicted above. Furthermore, paresthesia can be caused by an inflammation of one or more joints within the spinal column. Hernia’s are most prevalent in the lower back (lumbar spine), but can also occur in the neck (cervical spine) and in fewer cases in the mid back (thoracic spine).

What are the symptoms of a hernia?

The symptoms of a hernia are not always exclusively present at the location of the hernia. In a lot of cases, complaints can be had in different places.

The presence of an antalgic posture is very common. This presents as a shift of the body to one side. Additionally, there may be a presence of radiating pain or paresthesia in the leg and/or the toes. You may also experience numbness in your foot or leg. A common symptoms of a hernia is a decrease in muscle strength in the leg on the affected side. This is often provoked when walking stairs.

How is a hernia treated?

At Orthomedix we evaluate whether a hernia is present by means of a thorough history taking and orthopaedic assessment. During this process we find out if you suffer from one of the aforementioned symptoms. Additionally, we provide an in-depth analyses in order to find the primary cause of the hernia to ensure that the complaint will not reoccur in the future. Ergonomics plays an integral role in this process. These are a few ways of treating and preventing a future hernia:

  • Correct posture and ergonomics.
  • Recover proper joint mobility.
  • Recover muscular strength and coordination.
  • Decrease muscle tension.
  • Identify other causes and discuss these (stressors).
  • Additional diagnostics, if needed (MRI scan).

Are some of these symptoms familiar to you or someone that you know? Then please get in touch with us at Orthomedix and we will be happy to help you.

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