If I have a herniated lumbar disc, can massage "press" it back?

Unfortunately, no!

The lumbar intervertebral disc is like an "elastic cushion" sandwiched between two adjacent vertebrae. It is composed of the central nucleus pulposus and the surrounding annulus fibrosus. It is both tough and elastic, and can play the role of connection, stability, increased mobility and buffering external shock. When the surrounding annulus fibrosus ruptures, the central nucleus pulposus will protrude outward from the rupture, eventually leading to the occurrence of intervertebral disc herniation.

1. What may cause lumbar disc herniation?

1) Degenerative changes in the lumbar spine: With age, the water content of the nucleus pulposus in the intervertebral disc decreases, the elasticity of the annulus fibrosus decreases, and rupture becomes more likely to occur.

2) Injury: A violent impact or sharp twisting of the waist, such as falling from a height or sudden sprinting, can easily cause damage to the waist tissue and lead to rupture of the annulus fibrosus. At the same time, the accumulation of chronic fatigue injuries caused by long periods of sitting, squatting, heavy physical labor, and sports can also cause damage to the intervertebral disc and induce nucleus pulposus herniation.

3) Lumbar vertebrae developmental abnormalities: Congenital developmental abnormalities such as lumbar sacralization, sacral lumbarization, and hemivertebra deformity cause abnormal stress on the lumbar spine, leading to increased intra-disc pressure, causing degeneration and damage.

4) Other factors: Heredity, pregnancy, obesity, diabetes, osteoporosis, etc. are also risk factors for lumbar disc herniation.

2. What are the clinical symptoms of lumbar disc herniation?

1) Low back pain: usually in the lumbosacral region, mostly with a sore and swollen feeling, aggravated by prolonged sitting or fatigue, and relieved by rest.

2) Radiating pain, numbness, and weakness in the lower limbs: usually on one side, aggravated when standing or walking.

3) Symptoms of cauda equina: When the intervertebral disc herniation compresses the cauda equina, pain in both lower limbs and perineum, decreased sensation, and even urinary and bowel dysfunction may occur.

3. Clinical diagnosis of lumbar disc herniation

A comprehensive judgment should be made based on clinical symptoms, physical signs and imaging examinations. Special physical signs examinations include standing examination, straight leg raising and strengthening test, straight leg raising test on the healthy side or femoral nerve traction test. Imaging examinations include X-ray, CT and MRI examinations. MRI examinations are recommended first, which can more clearly show the degree of intervertebral disc degeneration and its relationship with peripheral nerve roots.

4. Treatment of lumbar disc herniation

1) Bed rest: It is the first choice during the acute attack period, but long-term bed rest is not encouraged. Appropriate normal activities should be resumed as soon as possible after the symptoms are relieved.

2) Drug treatment: non-steroidal anti-inflammatory drugs, opioid analgesics, glucocorticoids, muscle relaxants, antidepressants, etc.

3) Sports therapy: core muscle strength training, direction-specific training, low back pain school, etc.

4) Epidural injection: Epidural injection of steroid hormones can improve symptoms in the short term.

5) Lumbar traction: including continuous traction and intermittent traction, which can relieve sciatica symptoms in the short term, but has no significant effect on improving low back pain symptoms.

6) Surgical treatment: including open surgery, minimally invasive surgery, lumbar fusion, and lumbar artificial disc replacement.

7) Others: Hot compress, acupuncture, massage, Chinese medicine, etc. have certain effects on relieving symptoms.

5. Prevention of Lumbar Disc Herniation

1) Maintain good body posture: avoid sitting or standing for long periods of time, bending over or squatting, and stand up and move around frequently.

2) Strengthen the functional exercises of the waist and back muscles: such as swimming, plank support, etc., to strengthen the waist muscles.

3) Control your weight and enhance your self-health awareness: Being overweight will increase the burden on your waist, so maintain a healthy weight range.

4) Pay attention to the intensity and posture of waist movements: avoid strenuous exercise and heavy physical labor, and do not bend over and stand up suddenly when carrying heavy objects.

References:

1. Spine Surgery Group, Chinese Orthopaedic Society, Chinese Medical Association. Orthopaedic Rehabilitation Group. Guidelines for the diagnosis and treatment of lumbar disc herniation[J]. Chinese Journal of Orthopaedics, 2020, 40(8): 477-487.

2. Chinese Medical Association Pain Branch, Spine Pain Group. Chinese pain expert consensus on the diagnosis and treatment of lumbar disc herniation[J]. Chinese Journal of Pain Medicine, 2020, 26(1): 2-6.

3. Basic Research and Translational Group of the Spine and Spinal Cord Committee of the Chinese Rehabilitation Medicine Association. Guidelines for the diagnosis, treatment and rehabilitation management of lumbar disc herniation[J]. Chinese Journal of Surgery, 2022, 60(5): 401-408.

4. Li Yuan, Zhu Yan. Etiology of lumbar disc herniation and the mechanism of action of exercise therapy[J]. Shandong Sports Science and Technology, 2003, 25(4): 27-30.