Why do you have lumbar disc herniation at a young age? It's because you haven't seen the world yet.

My husband, classmate Y, is a 34-year-old financial worker. He loves fitness in his spare time while typing and writing materials during the 996 working hours. His squat performance has continuously broken through his own limits, from 20 kg to 100 kg, leaving everyone far behind. That day, he came back from leg training with great pride, and it was obvious that he had achieved another great result. But why did he put his hands on his waist when squatting to put on his shoes?

This thought only occupied my mind for 0.1 second, because during the upcoming National Day holiday we are going to rent a car and travel around Taiwan by car, how exciting!

On the third day of the trip, my waist was so tired from sitting in the rented car. The driver, classmate Y, complained even more. He complained about waist pain every day even though he was usually patient. I bought him some pain-relieving ointment, and he got better after sleeping for a night (yeah), but it broke down again after driving for a day (covering his face).

With a bad premonition, I rushed him to the hospital for a lumbar spine MRI after the short holiday. Oh my god, the excellent classmate Y was indeed very prominent, with lumbar disc disease!

Standing out at a young age?

It's all because the intermediary has never seen the world

Lumbar disc herniation is not an old age disease. It is most common in people aged 30 to 50 years old, with a male to female ratio of 2:1.

According to statistics, 80% of people have experienced low back pain. Apart from serious problems such as lumbar spinal stenosis, spondylolisthesis and fracture, the most common cause is lumbar disc herniation.

The root cause of the disease lies in the degenerative changes of the intervertebral disc, commonly known as "wear and tear".

The human spine is like a stack of bricks. The vertebral body is the short cylindrical structure in the front half of each vertebra, which is the load-bearing wall of the torso building.

The intervertebral disc is located between the upper and lower vertebrae and is tightly connected to them. We can imagine a normal intervertebral disc as a pie, with the filling being the "nucleus pulposus" and the skin being the "annulus fibrosus".

The nucleus pulposus helps to retain water, supporting and buffering the pressure on the spine, while the annulus fibrosus tightly wraps the nucleus pulposus.

Normal intervertebral disc from above | New England Journal of Medicine (reference 3)

When the nucleus pulposus squeezes the annulus fibrosus for a long time and with great force, the annulus fibrosus will be slowly worn away. When the nucleus pulposus finally breaks through the embrace of the annulus fibrosus, intervertebral disc herniation occurs.

The compressed nucleus pulposus wears away the annulus fibrosus | Nucleus Medical Media

We often say that young people’s faces are full of collagen, and the same is true for intervertebral discs.

The nucleus pulposus of young and middle-aged people is rich in water, full and tough. Just like the crust of a pie is easily broken when the filling is full and hard, the annulus fibrosus is really under great pressure when facing the young nucleus pulposus.

On the contrary, the aged, dehydrated and atrophied nucleus pulposus is more gentle, just like a pancake with small filling is not easy to break. Therefore, intervertebral disc herniation is relatively rare in the elderly.

Why me among so many young people? As mentioned earlier, the intervertebral disc is a cushion. According to Newton's third law, the intervertebral disc bears the same pressure as the vertebral body. Isn't it amazing? Just like we squeeze a pie repeatedly, as long as we work hard enough, there will always be a day when the filling is squeezed out. Too much weight will cause trouble.

In the process of evolution from crawling to upright walking, the entire weight of the upper body was placed on the small lumbar intervertebral discs. Abnormal posture and movement will increase this burden.

For example, bending forward from a standing position can increase pressure by 50 percent, while sitting in a relaxed position without a backrest can increase pressure by 80 percent.

Therefore, long-term desk work, driving, and upper body weight (lifting or obesity) will increase the possibility of lumbar disc herniation. In addition, strenuous exercise and smoking may also increase the risk of lumbar disc herniation, and genetic factors also play a role.

Not sure if you have protrusions? Here are three tips for screening:

1. Paresthesia, which may include pain in the red area and numbness in the blue area; common paresthesia areas associated with lumbar disc herniation | Reference 3

2. Weakness, common symptoms include difficulty standing up from a squat or walking on heels or toes; 3. Straight leg raising test, which needs to be performed with the help of a friend or doctor. If pain or discomfort occurs in the lower back or legs when the straight leg is passively raised 30°~70°, it may be a problem with the lumbar intervertebral disc. Straight leg raising test | Reference 5

The above self-screening is for reference only. If you think you may be infected, you should see a doctor in time.

Don't be afraid of herniation, we have a solution! Most cases of herniated disc are benign, and 87% of patients can be relieved within 3 months. There is no need to take an X-ray at the beginning. MRI and CT examinations are only used for patients with severe symptoms, progressive symptoms, or those who have not responded to conservative treatment for 4 to 6 weeks.

Accordingly, conservative treatment is usually recommended within 6 weeks of symptom onset, and oral nonsteroidal anti-inflammatory drugs can be used for pain relief.

Although you may have back pain and leg pain, doctors do not encourage you to stay in bed completely. You can stand or walk moderately. If sitting is not too uncomfortable, you can try more activities.

Of course, if the symptoms are severe, don't endure it. About 10% of lumbar disc herniation requires surgical treatment, usually for patients with severe neurological deficits who have not responded to 6 weeks of treatment.

Finally, and most importantly, prevention! Prevention! Prevention!

Basic version: Avoid sitting for long periods of time, make your desk and chair comfortable, increase lumbar support, and keep every part of your body in the position it should be.

Advanced version: Perform core muscle functional training, flexibility training, and participate in yoga, Pilates, and Tai Chi.

The story at the beginning can be summarized as follows: After a long three-month rest, Student Y gradually got rid of the nagging back pain. While purchasing a waist pad for his car, he always paid attention to standing like a pine tree, sitting like a clock, and staying away from Ge You's lying posture. He also diligently did basic core muscle strength training for a long time. In the following year or so, the back pain never came back, and he also gained the faint abdominal muscles.

You can also have such luck.

References

[1].Jordan JL, Konstantinou K, O'Dowd J. Herniated lumbar disc[J]. BMJ clinical evidence, 2011, 2011.

[2].Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J]. The Spine Journal, 2014, 14(1): 180-191.

[3].Deyo RA, Mirza S K. Herniated lumbar intervertebral disk[J]. New England Journal of Medicine, 2016, 374(18): 1763-1772.Amin RM, Andrade NS, Neuman B J. Lumbar disc herniation[J]. Current reviews in musculoskeletal medicine, 2017, 10(4): 507-516.

[4].Ricardo OG, Cristiano Gomes. Prevalence and Associated Factors of Osgood-Schlatter Syndrome in a Population-Based Sample of Brazilian Adolescents. The American Journal of Sports Medicine[J] ,2010,39(2):415-20

[5]. “Rehabilitation treatment of lumbar disc herniation” Chinese expert consensus[J]. Chinese Journal of Rehabilitation Medicine, 2017(2).

Author: Merak

Editor: Little Gold Teeth

Title image: David Donald