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Rehabilitation and Physiotherapy after Discectomy

Nerve root pain in the leg, often known as sciatica, occurs in around five per cent of sufferers from low back pain, and is secondary to degenerative changes which occur in the disc, of which the disc between the fourth and fifth lumbar vertebrae is the most often affected. Splits develop in the outer covering of the disc wall, the annulus fibrosus, and at some point, perhaps due to a sudden stress, the wall breaches and part of the internal nucleus pulposus bulges out of the crack. This material can be both chemically irritating to and compress the nearby nerve travelling to the leg, setting up an inflammatory process in the nerve which is perceived as leg pain by the patient.

If nerve root pain in the leg does not settle over a period of six to eight weeks a spinal surgeon may consider a magnetic resonance imaging MRI scan to identify the disc prolapse more carefully. A nerve root block, a painkilling injection, may be attempted to try and settle the pain down before surgery is considered. Microdiscectomy may be performed to remove the disc bulge with the least damage and disturbance to the nearby tissues. In some cases open discectomy may be required.

After the operation the physiotherapist will review the operation notes for the surgeon''s instructions and assess the patient. The physio will ask about the pain the patient is presently complaining of and check the muscle power and sensibility of the legs. If the patient''s operation pain is under control the physio and an assistant will roll the patient onto their side, sit them up for a short time and stand them as soon as possible. If they feel well the physiotherapist will take them for a walk around before returning to the bed.

The patient is encouraged to get up regularly as they feel able but to sit for short periods only and in a good upright position. Gradual increases in the times of standing, walking or sitting can be progressed as the patient feels they area able. The physio may instruct the patient in core stability exercises or neural mobilisation movements to reduce the chances of the nerve developing adhesions which might hamper its movement. After six weeks may patients have rehabilitated themselves, with or without physio guidance, sufficiently to return to most of their previous activities although heavy activity may be delayed for a few months longer.

 

Author: Jonathan Blood-Smyth

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