PROLAPSE IN THE BACK

Lumbar Prolapse

Prolapse of the lumbar spine is a disc injury where the soft contents of one of the intervertebral discs in the lower back have pushed through the outer layer.

This soft mass is called the nucleus pulposus - and can cause nerve pain depending on how far it protrudes from the disc and whether it irritates a nerve root. This means that the pain associated with a prolapse in the lower back may vary.

 

Article: Lumbar Prolapse

Last updated: 16.03.2022

By: Vondtklinikkene Interdisciplinary Health - dept. Lambert seats (Oslo), dept. Raw wood (Viken) and dept. Eidsvoll Sound (Bay).

 

- At our interdisciplinary departments at Vondtklinikkene in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood) our clinicians have a uniquely high professional competence in assessment, treatment and rehabilitation training for spinal prolapse. Click on the links or here to read more about our departments.

 

In this article you will get to know your prolapse better - and who knows, maybe you will become friends again? At least we will do our best to help you.

 

You will be able to learn more about:

  • Symptoms of Lumbar Prolapse

+ Prolapse and Balance Problems

+ Prolapse and Back Pain

+ Back Prolapse and Numbness

+ Prolapse and Radiant Pain

+ Does Prolapse Always Hurt?

  • Cause: Why you get Prolapse in the Low Back

+ Genetics and Epigenetics

+ Jobs and Everyday Stress

+ Who gets Prolapse in the Back?

+ Will A Back Prolapse Go Away By Itself?

  • 3. Diagnosis of Prolapse in the Lower Back

+ Functional Examination

+ Neurological Tests

+ Imaging Diagnostic Investigation

  • 4. Treatment of Prolapse of the Lumbar Spine
  • 5. Surgical Operation of Prolapse
  • 6. Self-measures, Exercises and Training against Back Prolapse

+ Tips for Ergonomic Self-Measures

+ Exercises for Back Prolapse (with Video)

  • 7. Contact Us: Our Clinics
  • 8. Frequently Asked Questions about Lumbar Prolapse (FAQ)

 

- The acute phase of a spinal prolapse can be quite painful

Popularly called, the condition is often popularly called disc slippage - this then refers to the soft mass sliding out of the intervertebral disc itself. In the acute phase, this condition can be painful  - and then it may be relevant with an interdisciplinary approach consisting of self-measures, physical treatment and painkillers. Feel free to contact us at Our Facebook page if you have any questions or comments. We remind you that you will find exercises and a video further down in the article. Scroll below to see more videos with great exercise exercises for you with back prolapse.

 



 

Symptoms of Lumbar Prolapse

prolapse-in-lumbar
Prolapse of the lower back can cause a number of different types of pain and symptoms - depending on the size and pinch of the prolapse. In this section, we will take a closer look at the various symptoms and pains that you may experience. The classic presentation is often back pain combined with radiation down the legs towards the leg or foot. In addition to this, some may experience numbness and power failure.

  • Poor Balance and Motorism
  • Local Back Pain
  • Numbness and Lack of Feeling in Certain Parts of the Skin (Dermatomas)
  • Referred Pain from Back to Leg or Leg
  • Radiant or Feeling Pain

Prolapse and Balance problems

A disc herniation in the lower back can go beyond your balance and worsen it. This happens due to nerve pinching. The motor nerves can thus not send or receive electrical signals as efficiently as before and the result is slower responsiveness and poorer fine motor skills. This also means that the risk of falls increases due to lack of control on the legs and feet. With major nerve pinches over time, this can also become chronic.

 

Prolapse and Back Pain

A prolapse can occur gradually or in an acute event. What many do not think about is that there is also a reason why they occur - and it is often that you have overloaded your lower back beyond capacity. The result is then tense back muscles, stiff joints and poor back function - which in turn can lead to a disc prolapse in the lower back. The prolapse itself can of course also cause local back pain, but it is often the muscles and joints around that also account for a good portion of the pain.

 

Prolapse and Numbness

By pinching nerves, we can lose sensory sensation and signals. This means that one can lose sensation or become numb in the skin on the affected areas belonging to the affected nerve - such specific areas are better known as dermatomes. If a nerve is pinched in L5 on the right side - then this could lead to you losing the feeling in the right outer leg.

 

Prolapse and Radiation into the Leg, Leg or Foot

When a nerve gets pinched in the back, this can give pain signals down the leg based on which nerve is pinched. This can be experienced as milder excruciating pain or as stronger, more electrical, pain signals. In the example below, we show you how a prolapse in L5 can be experienced.

 

Example: Root infection against S1 (may occur in prolapse in L5 / S1)
  • Sensorics: Decreased or increased sensation may occur in the associated dermatome that goes all the way down to the big toe.
  • Motor skills: The muscles that have their nerve supply from S1 can also be experienced weaker during muscle testing. The list of muscles that can be affected is long, but often the impact is most visible when testing the strength of the muscle that is to bend the big toe backwards (extensor hallucis longus) e.g. by testing against resistance or testing of toe lifts and toe gaits. That muscle also has supply from the nerve L5, but receives most signals from S1.

Why does Prolapse often affect L5 and the lower vertebrae?

The reason why L5 is most frequently affected by prolapse is purely anatomical. L5 is the fifth and lower vertebra - and is thus particularly exposed to load when we stand and walk. It simply has to do most of the work when it comes to shock absorption. The lower back is also most exposed when lifting or doing heavy work. Especially work in forward bent and twisted positions can be unfavorable.

 

Does Prolapse Always Pain?

The fact is that how painful a prolapse is depends on a number of different factors. In some cases, where the volume of prolapse may be smaller and not press on nerves, it may be almost asymptomatic. In fact, studies have shown that more of us walk around with prolapse without it affecting us at all (1). This depends on whether the prolapse presses against the nerves in the back or not. However, when it pinches nerves in the back, it can cause pain locally in the back, as well as numbness, tingling and radiating pain in the leg, lower leg or foot. It can also cause other symptoms such as poor balance, lack of fine motor skills and muscle loss (lack of nerve supply over time).

 

 



Cause: Why Do You Get Prolapse Of The Lumbar Spine? Possible Causes?

There are a number of factors that can determine if you are affected by prolapse, both epigenetic and genetic. Other causes can include prolonged fault loading, falls or other damage mechanisms.

 

Genes and Hereditary Causes: Mother and father may be directly involved in you having a lumbar spine prolapse. This is because curvature of the lower back is something you can inherit. A very straightened spine, for example, could lead to almost all the load ending up at the bottom of the lumbar spine and not being distributed over the other joints. The lumbosacral junction (LSO) is the name of the structure where the lumbar spine meets the pelvis and sacrum - better known as L5-S1. It is no coincidence that it is in this area that we most often suffer from lumbar prolapse. You can also be so lucky that you have inherited a thinner outer wall around the intervertebral disc in the lower back. A weaker wall will naturally have a higher risk of getting a disc injury and being affected by prolapse.

 

epigenetics: Epigenetics are factors around us that affect our lives and our health. An example is poverty - which can mean that you can not afford to see a clinician for help when the pain occurs. Instead, you bite the pain in yourself and avoid discovering that you have had a prolapse in the lower back. Other factors include diet, how active you are and whether you smoke. Many people are not aware that smoking leads to poorer blood circulation and thus slower damage healing.

 



Job / Load: Occupations that contain heavy lifting in unfavorable positions can give a higher risk of injury to the lower back discs. But it can also be a very static office job where you sit all day - and thus put pressure on the lower back throughout the day.

 

Who gets Prolapse in the lower back?

Due to the fact that the discs are softer at a younger age, it is especially the age group 20 to 40 years that is affected. As we get older, the soft mass will become harder and less mobile - which in turn lowers the risk of you getting a herniated disc. But unfortunately the danger is not over. As you get older, you can get wear and tear and osteoarthritis - which can lead to tight nerve conditions in the back (spinal stenosis)

 

Will a Prolapse Get Rid of Itself? Or should I get help?

A back prolapse is a disc injury. In short, the inner soft mass has seeped out and passed through the outer wall. At higher prolapse volumes, this inner mass can lead to compression and pinching of nearby nerve roots. A damaged disc can be healed - if the conditions are right for this. Among other things, one is dependent on reducing the pressure on the affected nerve and stimulating healing in the area. Active ergonomic self-measures, reduction of compression against the injured intervertebral disc and adapted rehabilitation exercises will all be able to contribute to faster and smoother improvement.

 

You can think of it as a mathematical formula. If your calculation goes in plus, the prolapse will gradually retreat and become good again, but if it goes in minus or in zero then it will either get worse or remain unchanged. Due to the potential for long-term ailments and pain, we generally recommend that everyone who suffers from a back prolapse seek professional help. Usually in the form of a modern chiropractor or physiotherapist.

 

3. Diagnosis: Diagnosis of Prolapse in the Lower Back

The diagnosis of prolapse is primarily based on history taking and a clinical examination. Here, the clinician will collect information about your symptoms and then examine functional as well as neurological tests. We are happy to divide the examination of back prolapse into three main categories:

  1. Functional Examination
  2. Neurological Tests
  3. Imaging Diagnostic Examination (If Indicated)

 

A publicly licensed clinician, usually a modern chiropractor or physiotherapist, will first begin by examining the function of the back muscles and joints. Here, the clinician will be able to uncover important information about which disc level has been affected, where the nerve may have been pinched and which movements appear to provoke the pain.

Neurological Testing of Lumbar Prolapse

Earlier in the article, we talked about what kind of neurological symptoms one can experience with prolapse with nerve root affection in the lower back. These included numbness, decreased strength and radiating pain down the leg. Among other things, a clinician will be able to examine your functional neurology by testing your strength in your legs, reflexes and sensation in the skin. Where the patient feels pain and symptoms may vary depending on which nerve or nerves are affected.

Image examination of vertebral prolapse

There are three different diagnostic methods that are suitable for giving us information about lower back prolapse. These are:

  1. CT examination
  2. MRI examination
  3. X-ray

It is no well-kept secret that an MRI scan is the best option to see a herniated disc clearly and distinctly. - but CT scanning is an option for those who have devices that are affected by electromagnetic radiation or metal in the body. An X-ray can provide information by ruling out fracture damage and showing how much joint wear or calcification there is in the area.

 



X-ray of Prolapse in the lower back

wear related-spinal stenosis-X-rays

This radiograph shows wear / osteoarthritis-related wear as a cause of nerve compression in the lower back. X-rays cannot visualize soft tissue well enough to indicate the condition of the intervertebral discs.

MR image of Prolapse in the lower back

MRI-spinal stenosis-in-lumbar

In the picture above, we see an MRI examination of a prolapse in the lower back. The picture shows a prolapse in L3-L4 where the soft mass clearly pushes backwards towards the spinal canal.

CT Image of Prolapse in the lower back

ct-with-contrast spinal stenosis

Here we see a CT image with contrast showing lumbar spinal stenosis - ie narrow nerve conditions in the back due to calcifications or major prolapse.

4. Treatment of Prolapse in the Lower Part of the Back

Conservative treatment of lower back prolapse involves relieving the pinched nerve and facilitating the quickest possible healing. This is done by improving the biomechanical function in affected muscles and joints, as well as weeding out bad habits that prevent the prolapse from receding. The treatment will thus have five main principles:

  1. Relieve the Affected Nerve
  2. Improve Muscle and Joint Function
  3. Reduce Nerve Pain
  4. Strength Nearby Muscles and Soft Tissue
  5. Stimulate Healing and Repair

Treatment methods for Prolapse in the lower back

The key to faster healing for a disc herniation lies in reducing compression and improving healing conditions. Precisely for this reason, specially adapted mobilization, traction treatment, muscular techniques and laser therapy can be good treatment methods. The treatment should always be performed by a clinician with public authorization - chiropractor, physiotherapist or manual therapist.

 

Five of Our Preferred Treatment Methods for Back Prolapse:
  1. Traction therapy (Spinal decompression)
  2. Intramuscular acupuncture
  3. Laser Therapy
  4. Mobilization
  5. Rehabilitation exercises

 

Physiotherapy and Prolapse in the Lower Back

A physiotherapist can help you get started with customized training, as well as provide symptom relief with muscular techniques and massage. The physiotherapist will do an evaluation and then set up an exercise program to stimulate healing around your injured disc.

 

Modern Chiropractic and Prolapse

Can a chiropractor help me with a lower back prolapse? Yes - and with neck prolapse also. A modern chiropractor works holistically. This means that they investigate and treat pain and damage to muscles, joints, tendons and nerves. Their 6-year education also includes 4 years of neurology which makes them the most competent clinicians to help you with optimal treatment of your prolapse. A chiropractor uses muscle work, adapted joint mobilization, traction and effective nerve mobilization techniques to provide better space for the nerve (2). They also have the right to refer to image examinations should the need arise - and will instruct you in home exercises to strengthen the affected areas.

 

Doctor and Prolapse

Your GP will be able to advise you on the use of painkillers - which can help you relieve your worst pain. Your doctor will also be able to help you find a physiotherapist or chiropractor nearby who has significant expertise in the diagnosis and treatment of prolapse.

 

5. Surgery and Surgery of Lumbar Prolapse

Neurosurgeons and orthopedic surgeons in the public sector work in accordance with national and clinical guidelines - which means that they are very strict about whether you should have surgery or not. The reason why they make such high demands is that the surgical operations themselves involve a high risk - and especially in the long term. There are especially certain criteria that must be considered orthopedically:

  • Significantly Impaired Neurological Function in Both Legs (Red Flag - Must Be Assessed by Emergency Department)
  • foot drop
  • Symptoms and Pain that will not improve for 6 months
  • Loss of Bladder and Anal Sphincter Function (Signs of Cauda Equina Syndrome - contact a doctor or emergency room immediately if you experience this)

Research has shown that many operations can show a good short-term effect, but that it can actually lead to an increase in symptoms and pain in the long term. Injury and scar tissue in the operated area is the most common cause of this - and can not be operated on away after it has occurred. Lumbar surgery also involves a certain risk associated with the operation itself - and that the surgeon can damage the nerves, which thus causes worsening symptoms. Although this only occurs very rarely, it is worth knowing about.

 



6. Self-measures, Exercises and Training against Prolapse in the Lumbar Spine

Many of our patients ask us about self-measures they can take themselves to get functional improvement and symptom relief. Here we often have to give advice based on which phase and to what extent the patient is affected. But self-measures that help reduce the pressure and compression against the lower discs will be recommended. Three simple self-measures, which are easy to use, can therefore be used coccyx when sitting, pelvic pillow when sleeping and use of trigger point ball to loosen up tense muscles in the seat and back (the links open in a new reader window).

 

Tip 1: Ergonomic Coccyx

As modern humans, we spend many hours of the day in a sitting position. Sitting causes increased compression and strain on the discs in the back. Ergonomic tailbone cushions are specially designed to distribute the load outwards and thus provide better seating conditions for the back. For you with prolapse in the lower back, this can be a very good self-measure. Click on the image or here to read more about the tailbone pillow.

 

Tip 2: Pelvic cushion

Many people with back prolapse suffer from poor sleep and difficulty finding a good sleeping position. You may be aware that many people with pelvic pain use a pelvic pillow to get a more proper sleeping position on their back and pelvis? Well, it turns out that this is also at least as beneficial for you with prolapse in the back, as it puts less strain on the lower back. Click on the image or here to read more about the pelvic pad.

 

Tip 3: Trigger point ball

A nice self-treatment tool for working into muscle tension in the back and seat on your own. By using the ball against tense muscles and pain-sensitive areas, you can contribute to increased circulation and pain relief.

 

Exercises and Training for Back Prolapse

It is important that the training is adapted to you, your pain and your capacity. That is why we recommend that you get help to set up the right exercise program for you via a physiotherapist or modern chiropractor. Earlier in the video, we showed you two videos with generalized exercises that may be suitable for you with prolapse of the lower back - so scroll up again and look at them if you have not already done so. One of the most important things about exercises for prolapse in the lower back is that they help you relieve the pinched nerve, contribute to increased blood circulation and repair in the area, and that they contribute to nerve mobility (ie that the nerve becomes more mobile and less irritated).

 

VIDEO: 5 Exercises against Sciatica and Sciatica

As you are probably familiar with (unfortunately), the spinal cord often causes irritation and pinching of the sciatic nerve. This nerve can then cause radiating pain and numbness down the legs, to the legs and down to the feet. In the video below you will see five exercises that can help you reduce sciatic nerve pressure, relieve nerve pain and provide better back movement.


Join our family and subscribe to our YouTube channel for free exercise tips, exercise programs and health knowledge. Welcome!

VIDEO: 5 Strength Exercises Against Back Prolapse

A spinal collapse may be due to a gradual overload over an extended period of time or an acute, high failure overload. Regardless of the cause, it is very important that you regain control of your back pain through customized exercise. In the video below you will see a training program consisting of five custom strength exercises that are suitable for you with back prolapse.

Did you enjoy the videos? If you took advantage of them, we would really appreciate you subscribing to our YouTube channel and giving us a thumbs up on social media. It means a lot to us. Thank you very much!

 

Feel free to share knowledge about prolapse

Knowledge among the general public and health professionals is the only way to increase focus on the development of new assessment and treatment methods for prolapse problems - a problem that bothers many people. We hope you take the time to share this further on social media and say thank you in advance for your help.

Feel free to press the button above to share the post further.

 

7. Questions? Or do you want to book an appointment at one of our affiliated clinics?

We offer modern assessment, treatment and rehabilitation training for prolapse problems.

Feel free to contact us via one of our specialized clinics (the clinic overview opens in a new window) or on vår Facebook-side (Vondtklinikkene - Health and Exercise) if you have any questions. For appointments, we have XNUMX-hour online booking at the various clinics so that you can find the consultation time that suits you best. You can also call us within the clinic's opening hours. We have interdisciplinary departments in Oslo (included Lambert seats) and Viken (Raw wood og Eidsvoll). Our skilled therapists look forward to hearing from you.

 

"- Get in touch if you want help with taking back the active everyday life."

 

Click here to see an overview of our affiliated clinics with specialist expertise in spinal prolapse:

(click on the link above to see the different departments - or via the direct links below)

Telephone: 62 80 90 30

E-mail: [email protected]

Website: Lambertseter Chiropractor Center and Physiotherapy (Lambertseter, Oslo) / Eidsvoll Chiropractic Center and Physiotherapy (Eidsvoll Sound, Viken) / Råholt Chiropractor Center and Physiotherapy (Råholt, Viken)

 

With the best wishes for good back health further,

The interdisciplinary team at Vondtklinikkene

 

NEXT PAGE: - You should know this about Osteoarthritis of the back

osteoarthritis

Click on the image or link above to read more about it spinal osteoarthritis, abrasions and calcifications in the back.

 

8. Frequently Asked Questions Regarding Prolapse of the Lumbar Spine and Disc Injuries

Should you get sick leave in case of lower back prolapse?

Whether you need a sick note or not depends entirely on the prolapse and the work you do. Due to the fact that you are advised to keep moving, it is normally not recommended to take full sick leave - except if the pain is of such a nature that you cannot work. The solution for many is a graded sick leave in the acute phase of the disc prolapse. This also gives them enough time to rest and exercise - in addition to being able to continue working.

Is laryngeal prolapse dangerous?

To a certain extent, prolapse in the lower part of your back can be dangerous, but it all depends on your prolapse problem. A prolapse can be dangerous if it is of such a serious nature that it squeezes your spinal cord and leads to Cauda Equina Syndrome - which can mean, among other things, that you lose the feeling in the skin at the back of the buttocks (breeches paresthesia), control over your anal sphincter (stools goes straight into your pants) and that you are unable to start a urine stream. This is a rare but very serious case, which will require decompression surgery and removal of the pressure from the affected nerves. Signs of Cauda Equina Syndrome are classified as red flags and require you to call your doctor or emergency room immediately. Prolapse can also be dangerous in the sense that it can lead to lifelong nerve damage in both sensory and motor components if not taken seriously (3).

 

Pregnant with Prolapse in the lower back

If you are pregnant and pregnant, you can still get help and treatment for lower back prolapse. One of the only differences is, of course, that you can not get painkillers in the same way as those who are not pregnant. When you are pregnant, the changed pelvic position (forward tip) will also lead to a higher pressure against the lower discs in your back. Some also experience that they get a prolapse after birth - which can be directly related to the incredibly high abdominal pressure you go through at delivery.

Can prolapse of the lower back be hereditary?

One can inherit certain anatomical factors that make one have a higher risk of developing a prolapse in the lower back - so indirectly one can say that prolapse in the lower back can be hereditary. You can inherit a very straight back from your father - or a weaker slice structure from your mother.

 

What does it mean to have a lower back prolapse in levels L4-L5 or L5-S1?

Lumbar prolapse can occur at different levels. The lumbar spine is divided into five vertebrae - from L1 (upper vertebra) and down to L5 (lower vertebra). S1 is the term used for the first sacrum vertebra. A prolapse in L4-L5 thus means that the disc injury is localized to between the fourth and fifth lumbar vertebra. If the level is L5-S1 then this means that there is a disc prolapse in between the lower vertebra and the sacrum.

 

What is the lumbar spine in English?

Prolapse of the lower back is called lumbar disc herniation in English if translated from Norwegian. The radiating pain you experience is called radiculopathy - and the sciatic nerve is called the sciatic nerve. And sciatica is called sciatica in English.

 

How can you tell if you have a beginning laryngeal prolapse?

The precursor to a prolapse is called disc flexion. This means that the soft gel mass inside one of the intervertebral discs presses out against the outer wall, but without the surrounding wall having cracked yet. If disc bends have been detected on image examinations, it may be advisable to be extra aware of back health and exercise.

 

Can children have prolapse in the lower back?

Yes, children can also suffer from prolapse of the lower back, but it is very rare. These are also usually treated only conservatively - unless it is a very unusual case.

 

Can a dog also have a lumbar spine?

Like us, dogs are made of muscles, joints and a bunch of other biomechanical components. A dog can also be affected by a prolapse in the lower back - and the symptoms may vary depending on the size of the prolapse.

 

Can you have a double prolapse in the lower back?

Some are so lucky that they get what we call a double prolapse in the lower back. A double prolapse means that you have two different prolapse at different levels of the back. The most common is that these occur next to each other. For example, the most common double prolapse is that you have a prolapse in L4-5 and another prolapse in L5-S1. This can make the healing and treatment more extensive than if it had only been a prolapse. Double prolapse. Double joy.

 

Can prolapse cause pain in the knees and skins?

Yes, prolapse of the lower back can refer to pain down to the knees and calves. This will usually occur on one side only, as a prolapse is often right or left. If you experience pain on both sides, there is less chance that it is a prolapse in the lower back. Although this can also occur with central prolapse that presses against both nerve roots. Normally, such pain will be accompanied by other nerve symptoms / ailments, such as numbness, tingling, tingling and muscle weakness.

 

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Sources:
  1. Ropper, AH; Zafonte, RD (26 March 2015). "Sciatica." The New England Journal of Medicine.372 ( two:10.1056/NEJMra1410151.PMID 25806916.
  2. Leininger, Brent; Bronfort, Gert; Evans, Roni; Reiter, Todd (2011). "Spinal Manipulation or Mobilization for Radiculopathy: A Systematic Review". Physical Medicine and Rehabilitation Clinics of North America. 22 ( two:10.1016 / j.pmr.2010.11.002. PMID 21292148.

 

2 replies
  1. Elin Askildsen says:

    Great explanation, would like to know more about anti-inflammatory laser treatment. Regards Elin Askildsen

    SVAR
  2. Great Vera says:

    Very informative and interesting. What I also wonder about is the combination of psyche and prolapse. That is, stress, housework and negative experiences. How does the prolapse experience it? For example, can a life on the sunny side improve the porolapse? Conversely, can bullying, financial stress and pressure aggravate prolapse? I had a prolapse a long time ago.

    It improved and I got rid of it. But in 2013 - 2014, I received increased care and increased housework for a family who were my friends and who needed me. This aggravated the prolapse so that I can now not train and exercise the way I want. Back pain stops me from walking for a long time and standing for a long time. I have to rest and sleep a lot. Sometimes I can lie down all day after a good night's sleep. I did not have this so strongly or not at all last year while living and studying in Spain. After arriving in my home village of Fagernes in Valdres, I have had the repercussions and injuries after the hardships and relocations in life.

    SVAR

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