Clinical Evidence Handbook: Herniated Lumbar Disk - April 1, 2006 - American Family Physician
One of my more common complaints to come through the clinic doors is chronic low back pain with an acute exacerbation. Recently, I had a young healthy individual present with new onset low back pain after weight lifting when she heard an audible pop in her low back resulting in her left lateral leg tingling. Aside from decrease sensation along her lateral thigh, her physical examination was unremarkable. She had full range of motion of her back and hips in all directions, mild pain with bending forward and increased tension along the left side of her back. Oddly, her symptoms were on the opposite side of her MRI findings which revealed a right disc protrusion affecting the right L5 nerve root. The patient desires to return to exercising and is anxious about the thought of not being able to lift people for her work.Herniated lumbar disc is a very common finding in patients with low back pain. The use of aggressive treatment however is not always beneficial. The only management course that has been shown to likely to be beneficial is spinal manipulation. Improving mobility and stability above and below the affected area are likely to provide more lasting results than neurosurgery without the adverse complications. Osteopathic manipulative treatment (OMT) utilizes spinal manipulation to improve the functioning of the spine by encouraging proper alignment. Spinal mobility and stability doesn't rely on correct spinal alignment alone. Balancing muscle tension and elimination of fascial strain patterns are also important in allowing the body to function well. Core strengthening and retraining the body to move effectively are vital components to the healing process.
For many patients with chronic low back pain, the problem isn't a herniated disc but rather poor movement patterns. Correction of these movement patterns and restoring the spinal strength and mobility should be the object of chronic low pain.
