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Herniated Nucleus Pulposus

Tais Fernandez Gil

Florida National University

April 1, 2019

Introduction

Too much or rather too little physical activities have become a call in today’s world. People’s daily routine either involves staying glued to the computer all day long or being subjected to hard labor. As a result, one ends up developing muscle strain, and particularly on the lower back area on the vertebral column that provides support and protection. Among the disorders suffered include Herniated Nucleus Pulposus (HNP). A condition caused by the injuring of the intervertebral thus causing the bulging of the content into the spinal canal. The population at risk of developing the disease is aged between 30 and 50 with a male to female ratio of 2:1 (Schroeder et al., 2016). The HNP condition is also known as the raptured, disk protrusion, bulging, or the extruded disk. It is caused by the gradual degeneration of the disk, attenuation of the posterior annulus fibrosis, and the subsequent protrusion of the nucleus pulposus into the spinal cord, resulting in the compression of the nerve root. HNP can also be as a result of trauma or injuries.

Causes

There are three factors leading to the development of the herniated disk. First is the tear and wear on the spine. Usually, backs help to carry and distribute the weight. The disks on the spine are meant for shock absorption while walking, bending, or even twisting. The disk wears out in the process of helping in the movement; as a result, the annulus fibrous weakens allowing the nucleus pulposus to push through and cause a bulge of the cell. Another cause can be injuries and accidents that expose the cell to sudden pressure. Lastly, a combination of birth degeneration and trauma can create Herniated Nucleus Pulposus. It is not evident that only one cause can be responsible, both can lead to the problem altogether.

Stages of HNP

Cell degradation takes place in four distinct stages. The first stage is disc degeneration where the nucleus pulposus tends to weaken as a result of chemical changes in the disk which is associated with age. At this particular stage, the disc starts to dry thus reducing the ability to absorb the shock. The second stage is the prolapse where the form of the disk is expected to change. A slight bulge is developed thus crowding the spinal cord or the spinal nerve depending on the area of the swelling (Trafimow & Trafimow, 2016). Regarding the third phase of the condition, Extrusion, nucleus pulposus breaks through the tire-like walls of the annulus fibrosis, but this remain in the disk. Last is the sequestration in which the gel breaks through the annulus fibrosis and eventually move outside the disk of the spinal cord.

Examination Herniated Nucleus Pulposus and PTA

Usually, a physician is expected to conduct several investigations on the patient to establish the cause of the condition in a person. Among the questions put across during the diagnosing process include when the pain started and the exact place where the pain is located. This helps to determine the severity of the disease as well as establish the precise form of HNP. It provides the right interventions to relieve the pain.

Additionally, they inquire on the activities that one has engaged in leading to the development of pain. Determining the exercises help to identify those that cause the HNP, as well as advice the patient on the most appropriate actions to engage in and avoid such effects. For the question on the kind of remedies taken is to ensure that the doctor is fully aware of the medication and other alternatives that the patient might have considered. Thus, they can decide on the most appropriate intervention without causing a reaction of the medicines that might make the condition worse. Finally, they inquire about the factors that tend to raise or lower the pain. They can help the patients avoid the negative while embracing the positive elements of the condition.

Tests

Several tests may be conducted to obtain an accurate state of the spinal cord. Among the tests performed is the discography where dye is injected into the vertebral disc and is observed to establish the cause of the pain. For the bone scanning, computer-based images of the bones are generated. Radioactive material is injected into the blood vessel and then spread into the blood before collecting in the bones where it is detected by the scanner (Seyam et al., 2018). The method is useful in identifying even other spinal problems like infections, tumor, and arthritis. A lab test is the routine blood test where the blood drawn undergoes scrutiny and determines the availability or even the prevalence of the condition on the patients.\

Treatment

The HNP condition can be treated using both the surgical and non-surgical methods depending on the severity and the seriousness of the disease. Several non-surgical alternatives can be employed to mitigate the ongoing pain as well as the frequency and intensity of the flares; for instance, engaging in modifying activities to prevent the cases of lifting massive leads and rotation of the back such as playing golf and basketball. Another option to ease the pain is by applying heat on the affected area. The heat is required to help the stiff muscles to become flexible and easy to move.

On the other hand, ice packs used in cooling down the sore muscles, as well as numb the areas concentrated with the painful flares and taking medications another strategy that involves the consumption of non-steroidal anti-inflammatories like the ibuprofen and naproxen (Manske, 2015). Also, the pain reliever is necessary for easing the pain brought about by the condition. Taking medication helps individuals manage their pain thus being able to engage in their activities without suffering.

The exercise program is another excellent mitigation for the HNP. The activities include hamstring stretching to release and enhance the flexibility of the muscles. Often, tightness of the muscles tends to promote stress development on the muscles thus increasing the pain suffered as a result of the disc degeneration. Besides, strengthening exercises like the dynamic Lumbar Stabilization exercises are essential. Patients are educated on how to establish their natural spine and encouraged to determine the spot in which they feel the most relaxed posture. Engaging in low-impact aerobics like swimming, biking, and walking promotes the flow of nutrients and the blood to the spine structure; thus relieving the pressure experienced on the disc.

Chiropractic manipulation involves relieving pressure of the sensitive nerves by increasing the range of motion, thus triggering the release of endorphins to act as a natural painkiller under the general anesthesia. However, the assistant requires extra training to be in a position to conduct the manipulation task. Finally, on the non-surgical methods is the epidural; steroid injection to provide; low back pain through direct medication into the affected area to reduce inflammation (Fajar & Azharuddin, 2017). On the other hand, surgical treatment is offered to the patients experiencing difficulties in performing their duties due to the given Herniated Nucleus Pulposus. In this case, Lumbar Spinal Fusion Surgery is considered appropriate. The fusion surgery helps to stop the movement of the painful disc. Discectomy is initiated to ensure the removal of the protruding disc. According to Massa & Mesfin (2017), 85% of the patients suffering from acute Herniated Nucleus Pulposus take 8 to 12 weeks to heal without the application of a specific treatment option.

Physical Therapy for Acute, Semi-Acute, and Chronic HNP

The physical therapy technique applied during the acute stage is Spinal manipulative therapy (SMT) and mobilization (MOB). It enhances short-term pain relives together with suffering from severe low back pain (Leininger et al., 2011). Cervical manipulation helps in declining distress during sub-acute Herniated Nucleus Pulposus. However, the intervention does not allow short term follow-up. For the chronic Herniated Nucleus Pulposus, lumbar tender point and deep massage are useful for relieving both the muscles and the non-specific back pain. Other interventions leading to a decline in chronic pain include inactive control therapy and cervical mobilization. According Bussières et al. (2018), chronic neck pain can be managed and treated using spinal manipulative therapy (SMT) while Traditional Chinese Medicine for low back pain (TMC) can be adequate for both the illness and disability for the chronic low back pain.

Plan

· 10 min on Nu-Step to warm up.

· Trunk rotation, pt supine, 2 set of 15 reps.

· Quadruped alternating UE and LE, 2 set of 10 reps.

· Dead bug alternating UE and LE, 2 set of 12 reps.

· Full press up, pt in prone, 2 set of 10 reps.

· Rows seated on physioball w/ green there-band 2 set of 10reps.

· Seated upper trap stretch 3 set of 30 sec hold (B).

· Hip flexors stretch 3 set of 30 sec hold.

· Lumbar traction for 10 min

Conclusion

HNP is caused by the inflammation of the disk that results in the building of the nucleus pulposus fluid into the spinal cord. People can experience pain that requires intervention in the form of surgical methods or the non-surgical depending on the seriousness of the problem. Accidents and other injuries that expose the delicate disc to pressure also cause HNP. Several tests like a bone scan, lab test, and discography are used by spinal specialists to identify the condition and its seriousness which differs from the stage of the disorder.

References

Bussières, A. E., Stewart, G., Al-Zoubi, F., Decina, P., Descarreaux, M., Haskett, D., & Stupar, M. (2018). Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the Canadian chiropractic guideline initiative. Journal of manipulative and physiological therapeutics, 41(4), 265-293.

Fajar, J. K., & Azharuddin, A. (2017). Surgical treatment of lumbar disc herniation in Aceh, Indonesia: description in 28 patients. Journal of Health Sciences, 7(2), 132-136.

Leininger, B., Bronfort, G., Evans, R., & Reiter, T. (2011). Spinal manipulation or mobilization for radiculopathy: a systematic review. Physical Medicine and Rehabilitation Clinics, 22(1), 105-125.

Manske, R. C. (2015). Fundamental orthopedic management for the physical therapist assistant. Elsevier Health Sciences.

Massa, R. N., & Mesfin, F. B. (2017). Herniation, Disc. In StatPearls [Internet]. StatPearls Publishing.

Schroeder, G. D., Guyre, C. A., & Vaccaro, A. R. (2016, March). The epidemiology and pathophysiology of lumbar disc herniations. In Seminars in Spine Surgery (Vol. 28, No. 1, pp. 2-7). WB Saunders.

Seyam, O., Smith, N. L., Reid, I., Gandhi, J., Jiang, W., & Khan, S. A. (2018). Clinical utility of ozone therapy for musculoskeletal disorders. Medical Gas Research, 8(3), 103.

Trafimow, D., & Trafimow, J. H. (2016). The shocking implications of Bayes’ theorem for diagnosing herniated nucleus pulposus based on MRI scans. Cogent Medicine, 3(1), 1133270.