What Is a Lumbar Disc Herniation?
The spine is made up of bones called vertebrae stacked on top of each other. The disc is a connective tissue structure that acts as a cushion between two vertebrae. The outer layer of the disc is hard and called the annulus fibrosus, while the center is jelly-like and called the nucleus pulposus. With aging, the central part of the disc loses water and loses its cushioning function. This leads to the central part of the disc protruding through the outer layer, causing a herniation. Most lumbar disc herniations occur between the L4-L5 (4th and 5th lumbar vertebrae) and L5-S1 (5th lumbar and 1st sacral vertebrae) discs.

The herniated disc presses on the nerve, causing pain, numbness, and weakness in the legs known as sciatica. Sciatica is more common between ages 30 and 50, with a prevalence of about 1-2%.

What Causes Lumbar Disc Herniation?
Although lumbar disc herniation is most common in middle age, it can occur at any age. It affects men and women equally.

Being overweight is a cause of disc herniation. Since the spine carries the body’s weight, excess weight puts pressure on the discs, leading to wear and deformities in the bones and discs.
Daily activities involving pushing, pulling, and improper heavy lifting can cause disc herniation. In particular, bending while lifting combined with twisting of the lower back poses a high risk.
Jobs that require heavy physical work, frequent heavy lifting, or prolonged exposure to vibration (such as driving cars, buses, or trucks), as well as prolonged standing or sitting, increase the risk of herniation.
Athletes engaged in sports like football, weightlifting, rowing, and wrestling are also at higher risk.
With age, the blood vessels that nourish the discs and the water content in the discs decrease, causing the discs to shrink and increasing the risk of herniation.
Genetic factors also play a role in susceptibility to lumbar disc herniation.

What Are the Symptoms of Lumbar Disc Herniation?
The most common symptom is pain in the lower back and legs. Other symptoms include:

• Numbness and tingling in the feet,
• Limited range of motion,
• Difficulty walking and sitting,
• Limping while walking.

In advanced cases, symptoms may also include leg paralysis, sexual dysfunction, difficulty urinating or defecating, or loss of bladder control.

Treatment of Lumbar Disc Herniation
Treatment depends on the severity of nerve compression caused by the herniated disc. If the patient only has back and leg pain without numbness, weakness, or movement restrictions, the herniation is considered in an early stage. In this case, muscle relaxants and painkillers are prescribed along with bed rest, which should not be prolonged. Exercises that do not put strain on the back are usually recommended.

Additionally, treatments like ultrasound, electrical stimulation, heat and cold therapy, and massage are used to relieve muscle spasms. Sometimes, a back brace may be recommended. Manual manipulations are generally not advised as they can worsen the herniation.

In the early stages, gentle stretching exercises and posture corrections are recommended. As the pain decreases, more comprehensive and strengthening exercises are introduced. These exercises should also be performed at home and incorporated into the patient’s lifestyle for long-term benefit.

In cases of severe acute pain, local anesthetic or steroid injections can be applied to sensitive areas. Epidural injections or spinal blocks may also be necessary for serious pain.

If pain persists despite medical and physical therapy treatment, and if there is weakness or muscle wasting in the legs, or if the patient has difficulty controlling urination, these indicate an advanced stage of herniation and require surgical consultation.