Disc protrusions are highly frequent, especially with the advancement of age. One of the most frequent back pain reasons is a disc protrusion. The vertebral column is constituted by 33 vertebrae. For simplicity’s sake, we could say that each of the vertebrae is constituted by:
- A round-like vertebral body, which is the anterior portion of the vertebrae.
- Spinous processes, which are bony structures that project outwards from the posterior part of each vertebra.
Between these two structures is the spinal cord, which runs from top to bottom. The spinal cord gives rise to the spinal nerves, which go through the limbs and trunk. However, the movement of the spine is conditioned by structures that allow the sliding of one vertebra over another. These structures are:
- Facet joints: are the contact points of the upper vertebrae and the vertebra immediately below it.
- Longitudinal ligaments: these ligaments add stability to the spine and keep its shape as a whole.
- Intervertebral discs: are cartilaginous structures located between one vertebra and another. Their function is to avoid friction and help buffer movements and added pressure, acting as a cushion and a stabilizing factor.
They are made of two parts:
– Nucleus pulposus: it has a gelatinous consistency and is designed to absorb compression forces.
– Fibrous rings: are made of collagen. It surrounds the nucleus pulposus and limits rotation.
A vertebral protrusion occurs when the fibrous annulus bulges out of its natural space between two vertebrae, causing pressure on nerve roots that are projecting out. There is a natural protective mechanism that prevents this type of injury which are the back’s muscles. When the back makes an effort, the muscles contract in coordination, allowing them to distribute and stabilize the load.
There are several circumstances that can directly generate a protrusion. The most frequent is erosion of the vertebrae. Thus, over the years, the vertebral disc loses strength and elasticity and ends up yielding to physical forces. It can also happen due to acute overload, for example, when bending over, carrying too much weight and getting up abruptly. Finally, vertebral protrusion can occur by a single powerful hit to the back, however, this is really rare.
In addition, there are some circumstances that predispose the individual to suffer a protrusion. They are, old age, obesity, lack of physical activity and weak back muscles. It also predisposes the person when spending a lot of time sitting, especially leaning forward, as the vertebral disk goes backwards in this position.
Vibrations such as driving a tractor and certain genetic predispositions are also considered risk factors.
Many times, the severity of the protrusion is mild enough to not compress the nerves. In these cases, it may not cause pain or discomfort, but when it generates symptoms, there is usually pain in the back, the neck and in the lumbar area, depending on where the protrusion is located. This pain can radiate to the arms if the origin is cervical or to the leg if the origin is lumbar. This is because the nerves that innervate the extremities originate from the spinal cord.
Classically, it was considered that the vertebral protrusion should always be treated with surgical intervention. However, it is now known that a more conservative approach should be tried. This consists of postural hygiene, meaning, adopting correct or proper postures. It is also recommended to perform some types of exercise that promote supporting the back and abdominal musculature. You can also visit a specialist so they can provide you with the most efficient and recommended exercises.