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Engin ÇETIN Physcal Theraphy and Rehabilitation Faculty 4.Course 5.Group

• Vertebral column (spin) consists of 33 vertebrae • Spine is divided into thoracic, lumber, cervical • Each section of spine containing 5-12 vertebrae

Herniated disk
• A herniated disk refers to a problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine. • A spinal disk is a little like a jelly donut, with a softer center encased within a tougher exterior. Sometimes called a slipped disk or a ruptured disk, a herniated disk occurs when some of the softer "jelly" pushes out through a crack in the tougher exterior.

• The ruptured nucleus will often come incontact with and press on nerves near the disc. • This can result in severe pain • About 90% of herniated discs occur in the lumbar region. The discs in the cervical region are affected about 8%, those of the thoracic region only about 12% • Herniated disks are one of the most common causes of back pain

Cervical Herniated Disc
• Arm pain from a cervical herniated discis one of the more common cervical spine conditions treated by spine specialists. It usually develops in the 30 - 50 year old age group. Although a cervical herniated disc may originate from some sort of trauma or injury to the cervical spine, the symptoms, including arm pain, commonly start spontaneously. • The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present due to a cervical herniated disc.

• The two most common levels in the cervical spine to herniate are the C5 - C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the C4 - C5 level, and rarely the C7 T1 level may herniate. • The nerve that is affected by the cervical disc herniation is the one exiting the spine at that level, so at the C5-C6 level it is the C6 nerve root that is affected.

Thoracic Herniated Disc
• A herniated disc in the upper back can occur when the inner gelatinous material of an intervertebral disc leaks out of the inside of the disc. • Specific symptoms of a thoracic herniated disc are usually different depending on where the disc herniates, as the herniated disc material in the upper back can either impinge on an exiting nerve root or on the spinal cord itself. • The most common location for thoracic disc disorders is at the thoracolumbar (the thoracic and lumbar parts of the spinal column) junction (T8-T12) in the mid back.

Lumbar Herniated Disc
• As a disc degenerates, it can herniate (the inner core leaks out), which is known as a disc herniation or a herniated disc. The weak spot in the outer core of the disc is directly under the spinal nerve root, so a herniation in this area puts direct pressure on the nerve, which in turn can cause sciatica. Pain that radiates down the leg and is caused by a herniated disc is called a radiculopathy. • Approximately 90% of disc herniations will occur toward the bottom of the spine at L4- L5 (lumbar segments 4 and 5) or L5- S1 (lumbar segment 5 and sacral segment1), which causes pain in the L5 nerve or S1 nerve, respectively.

The most common signs and symptoms of a herniated disk are:
• Arm or leg pain. If your herniated disk is in your lower back, you'll typically feel the most intense pain in your buttocks, thigh and leg below the knee. It may also involve part of the foot. If your herniated disk is in your neck, the pain will typically be most intense in the shoulder and arm. This pain may shoot into your arm or leg when you cough, sneeze or move your spine into certain positions. • Numbness or tingling. People who have a herniated disk often experience numbness or tingling in the body part served by the affected nerves. • Weakness. Muscles served by the affected nerves tend to weaken. This may cause you to stumble, or impair your ability to lift or hold items.

• Disk herniation is most often the result of a gradual, aging-related wear and tear called disk degeneration. As you age, your spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist. • Most people can't pinpoint the exact cause of their herniated disk. Sometimes, using your back muscles instead of your leg and thigh muscles to lift large, heavy objects can lead to a herniated disk, as can twisting and turning while lifting. Rarely, a traumatic event such as a fall or a blow to the back can cause a herniated disk.

Risk factors
• Factors that increase your risk of a herniated disk may include: • Age. Herniated disks are most common in middle age, especially between 35 and 45, due to aging-related degeneration of the disks. • Weight. Excess body weight causes extra stress on the disks in your lower back. • Occupation. People with physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disk.

Tests and diagnosis
• In most cases of herniated disk, a physical exam and a medical history are all that's needed to make a diagnosis. If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests. Imaging tests • X-rays • CT scan • MRI • Myelogram Nerve tests Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This can help pinpoint the location of the nerve damage.

• The first thing that should be done is to rest and stay away from activity the agitate the symptoms • Then the application of ice and heat
• This acts to relax the muscles in the back which can calm pain and any muscle spasms

• Physical Therapy
– Although performing physical Therapy does not directly help the disks, it does strengthen the muscles around it, so as to increase stability, which can help prevent herniated disks in the future

• Pain relievers are often given to patient to alleviate pain • Anti-inflammatory drugs are given to reduce swelling • Although not all patients report having back pain

Physical Therapy Exercises
• Exercise #1 while lying on back bend your left knee up. Clench abs and butt, keeping back in neutral position. • Raise your other leg about 12in off floor, while knee is straight • Hold the position for 3 seconds • Then lower leg, do for 10 reps • Repeat the same with your other leg

Physical Therapy Exercises
• Exercise #2 Start with both knees on floor, clench abs and butt, back is straight • Put your hands on your hips. • Pickup your right foot and place on floor in front of you, while your left knee is still on floor • Lunge forward,. • Hold your position for 3-5 seconds • Return your right knee to floor • Do for 10 reps • Then repeat with the other leg

Alternative Treatments for Herniated Disc
• A herniated disc occurs when the inner portion of the disk pushes into the spinal canal through a rupture in the outer protective layer of the disk. A herniated disk can result in a great deal of pain or weakness that can radiate from the back to the legs and arms. Conventional treatments include physical therapy, pain medication and surgery, though many patients have experienced considerable relief from alternative treatment methods.

• Chiropractic treatment is one of the most popular alternative treatment methods for back pain, including pain caused by a herniated disk. Chiropractic treatment usually involves manual manipulation of the spine to achieve correct positioning of the vertebrae and improve spinal movement. Many doctors do not recommend chiropractic care for herniated disk patients because they feel it has few benefits when compared to possible risks, including spinal cord injury and worsening of joint problems.

• Acupuncture does not attempt to treat the herniated disk itself, but instead focuses on pain relief. Acupuncture involves several thin needles inserted into the skin at various pressure points. Many back pain patients have experienced a great deal of relief from acupuncture treatments, but several treatments are often necessary to maintain the desired results. How acupuncture actually works is unknown, though most medical experts believe it is due to the release of endorphins, the blockage of pain sensations in the central nervous system, alteration of brain chemistry or a combination of these elements.

• Acupressure is similar to acupuncture in that its goal is pain relief, not treatment of the herniated disk. Acupressure uses the same pressure point techniques as acupuncture, but instead of needle insertion acupressure practitioners use their hands, fingers and elbows to apply pressure to certain areas. Many people who experienced initial pain relief from acupuncture but found the effects to subside over time may find acupressure to be a suitable follow-up treatment. Some acupressure points can cause miscarriage and spikes in blood pressure, so pregnant women and people with high blood pressure should not undergo this treatment.

Massage Therapy
• Massage therapy provides pain relief and muscle relaxation to many herniated disk sufferers. Pain relief via massage therapy is often short-term, but many herniated disk patients find it extremely helpful, especially in the first few weeks following the injury. Massage therapy is generally low-risk, but those with back arthritis, deep vein thrombosis, skin infections or osteoporosis should not receive massage therapy.

• Massage is applied on either side, at the level of the herniated disc space. Massage involves providing gentle strokes in the lateral direction. Initially begin with gentle pressure and gradually increase the pressure depending upon the pain tolerance levels • Massaging will increase the blood circulation in the affected disc space and also hasten healing process • As a precaution, it is important to avoid any direct pressure on the spine or the inter-vertebral disc space. This can aggravate the problem.

Deep Tissue Massage For Herniated Disc
• Massage therapy when used in conjunction with aroma oils aid in reducing muscle spasm which in turn in helpful in reducing pain in the affected area • Best massage therapy for herniated disc include deep tissue massage or trigger point massage which depends on the severity of the problem.