SUBJECT: PRACTICAL NEURAL REHABILTATION

BY A.L.L: Handren Fatih Kh.

BACK PAIN
Back pain
It is one of the most common medical problems in the United
States.
It can range from a dull, constant ache to a sudden, sharp pain
Sometimes it can come on suddenly – from an accident, a fall, or
lifting something heavy or it can develop slowly because of age-
related degenerative changes to the spine.

Disc herniation
Herniated discs are one of the most common spine conditions,
There is a spinal disc between each of the vertebrae in the spine.
The discs have the function of absorbing shock and facilitating
movement.
Each disc is composed of a firmer outer layer and a gel-like inner
portion.

When the outer layer ruptures and allows the inner portion to
bulge out of its normal boundaries, it is known as a herniated
disc.

Herniated discs can narrow the space that the spinal cord
occupies, known as the spinal canal, causing it to press against
nerve roots or the spinal cord.

When the spinal canal is smaller than usual, it is called spinal

stenosis. Herniated discs are one possible cause of spinal stenosis,
but many other conditions can cause it.
Herniated discs most commonly occur in the lower spine, also
known as the lumbar spine. However, they can also occur in the
neck or upper back.

Herniated Disc Symptoms

The exact nature of herniated disc symptoms depends on the
location of the disc and the severity of the herniation.

In some cases, no symptoms occur, and the patient will be

unaware of the condition unless it is detected on an imaging exam
performed for other reasons. In other cases, the symptoms can be
severe, even debilitating.

Possible symptoms include:

Pain running down one or both legs
Numbness or tingling in one or both legs
Muscle weakness in the leg or legs
Back or buttock pain
Bowel or bladder incontinence

If you have symptoms of numbness or tingling or muscle

weakness, you should visit a physician promptly.
HOW IS A DIAGNOSIS MADE?
MAKING THE DIAGNOSIS USUALLY REQUIRES TAKING
A HISTORY OF THE PROBLEM, A NEUROLOGICAL
EXAMINATION, AND AN MRI SCAN

IMPORTANT QUESTIONS INCLUDE:

Has there been an injury?

Where is the pain?
Is there any numbness?
Is there any weakness?
Have you had the same or a similar problem in the past?
Have you had any weight loss, fevers, or illnesses recently?
Have you had cancer in the past?
Are there any problems when you urinate or open your
bowels?
Clinical tests for disc herniation

1. The straight leg raise test Lasègue’s Tes

2. The contra lateral (crossed) straight leg raise test
3. Bowstring test
4. Prone knee bending
5. Muscle Weakness or Paresis
6. Reflexes
7. Hyperextension Test The patient needs to passively mobilize
the trunk over the full range of extension, while the knees
stay extended. The test indicates that the radiant pain is
caused by disc herniation if the pain deteriorates.
8. Manual Testing and Sensory Testing Look for
hypoaesthesia, hypoalgesia, tingling or numbness
MRI FINDINGS FOR DISC HERNIATION
Physical therapy often plays a major role in herniated disc
recovery. Its methods not only offer immediate pain relief, but
they also teach you how to condition your body to prevent
further injury.
There are a variety of physical therapy techniques. Passive
treatments relax your body
Passive treatments relax your body and include deep tissue
massage and electrical stimulation (eg, TENS). Photo Source:
123RF.com.
Your physical therapy program will usually begin with passive
treatments. But once your body heals, you will start active
treatments that strengthen your body and prevent further pain.
Your physical therapist will work with you to develop a plan that
best suits you.
Passive Physical Treatments for Herniated Discs
Deep Tissue Massage: There are more than 100 types of massage,
but deep tissue massage is an ideal option if you have a herniated
disc because it uses a great deal of pressure to relieve deep muscle
tension and spasms, which develop to prevent muscle motion at
the affected area.
Hot and Cold Therapy: Both hot and cold therapies offer their
own set of benefits, and your physical therapist may alternate
between them to get the best results.
Hydrotherapy As the name suggests, hydrotherapy involves
water. As a passive treatment, hydrotherapy may involve simply
sitting in a whirlpool bath or warm shower. Hydrotherapy gently
relieves pain and relaxes muscles.
Transcutaneous electrical nerve stimulation TENS machine uses
an electrical current to stimulate your muscles. It sounds intense,
but it really isn't painful. Electrodes taped to your skin send a
tiny electrical current to key points on the nerve pathway. TENS
reduces muscle spasms and is generally believed to trigger the
release of endorphins, which are your body's natural pain killers.
Traction: The goal of traction is to reduce the effects of gravity
on the spine. By gently pulling apart the bones, the intent is to
reduce the disc herniation. The analogy is much like a flat tire
"disappearing" when you put a jack under the car and take
pressure off the tire. It can be performed in the cervical or
lumbar spine.
STRETCHING THE MUSCLES OF LOWER LIMB
Active Treatments You May Try in Physical Therapy
Active treatments help address flexibility, posture, strength, core
stability, and joint movement. An exercise program may also be
prescribed to achieve optimal results. This will not only curb
recurrent pain but will also benefit your overall health. Your
physical therapist will work with you to develop a program based
on your specific diagnosis and health history.
Hydrotherapy: In contrast to simply sitting in a hot tub or bath
like its passive counterpart, active hydrotherapy may involve
water aerobics to help condition your body without unnecessary
stress.
Muscle strengthening: Strong muscles are a great support system
for your spine and better handle pain.
Your physical therapist will teach you ways to condition and
strengthen your back to help prevent future pain. You may learn
self-care principles so you understand how to best treat your