Homeopathy for prolapsed intervertebral Disc (Slipped Disc)

                Homeopathy for prolapsed intervertebral                      Disc (Slipped Disc)

  When you have a prolapsed disc (commonly called a slipped disc). a disc does not actually 'slip'. What happens is that part of the inner softer part of the disc (THE nucleus pulposus) bulges out (herniates) through a weakness on the outer part of the disc. A prolapsed disc is sometimes called a herniated disc. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc. Any disc in the spine can prolapse, however, most prolapsed discs occur in the lumbar part of the spine(lower back). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.

Introduction: 

 The human spine consists of 33 vertebrae, but some of them grow together in adults. There are 7 cervical(neck), 12 thoracic(chest region), 5 lumbar (lower back), 5 sacral(hip region), and 4 coccygeal(tailbone region) vertebrae. Most vertebrae have fibrous intervertebral disks between them to absorb shock and enable the spine to bend. 

 The intervertebral discs are a prevalent source of lower back pain as they are one of the most frequently injured spinal structures. The discs connect adjacent spinal vertebrae together and provide a degree of shock absorption in the torso. 

 As per get older, the inner part of an intervertebral disk, the tissue that lies between the vertebrae, is likely to stick out through the outer part and presses on nerves, this called slipped disk. 

Structure of Disc: 

  Each disc has two basic components- a central nucleus pulposus & a surrounding annulus fibrosis. The nucleus pulposus is a semi-fluid gel, containing cartilage cells & irregularly arranged collagen fibers. As it is fluid it cannot be compressed but transmits force as well as dissipating it all around. The annulus fibrosis is a series of collagen layers with fibers running obliquely at right angles to each other, These layers control the direct movement at a vertebral level; all the fibers in one lamella are parallel with each other. 

 Functions of the Disc: 

 - Allows movement of the vertebra. 
 - Transmits load
 - Provides height to the vertebral column 

Pathology: 

Extrusion: A split in the annulus fibrosis and since the nucleus is under tension the fluid moves into the split. 

  The direction of movement of nuclear fluid: 

  The nucleus may extrude upwards into the vertebral body above, through holes in the cartilage end plate covering the inferior surface. This causes Schmorl's nodes and can see a radiograph. This tends to occur in 15-18 years old but is often symptoms less until later when degenerative changes problems. 

  The nucleus may extrusion centrally backward but tends to be limited by the posterior longitudinal ligament. This ligament is narrowest over L4-L5, L5-S1 and so the muscles may extrude backward at these sites. 

 The nucleus extrudes posterolaterally into the spinal canal. If the spine is forcefully flexed the nucleus fluid can bust through the annulus with resultant damage to nerve roots, dura matter and possibly ligaments. 

Protrusion: 

 The annulus may become weakened, the nuclear fluid then bulges into annulus posterolaterally or laterally and causes a bulge. This alters the mechanics of segments, two consequences of this may be, 

1. A sudden burst in the annulus so that the nucleus extrudes. 
2. Formation of osteophytes at the margins of the vertebral bodies, the annulus pulls on the periosteal attachments around the vertebral body margin and osteoblasts lay down bone at the traction sites. 

Clinical features of Lumbar Disc Lesions: 

History: 

Pain: 

  The pain pattern varies greatly, sharp pain in the back can arise suddenly as a result of bending, twisting and lifting stress. Clinically the patient is unable to straighten up and is "stuck", often having heard or felt something go. Sometimes it appears gradually after several minor episodes of exercise or unaccustomed activity. In this case, it starts as a niggle until gradually the patient becomes very aware of increasingly constant pain. A long journey can result in a central backache and the patient cannot straighten up. The site of the pain may be
. Central in the back.  
. Diffused over the lumbosacral area.
. Referred down one or both legs. 

The referred pain is mainly of two types. 

. Dull poorly defined ache over the back, sacroiliac joint, buttock, and thigh. This is thought to be due to pressure in stress on ligaments, muscles, and fascia. 
. Searing, sharp, stabbing pain shooting down the leg, thought to be irritation of inner root, Generally, the pain aggravated by movements especially flexion/extension and eased by lying down.

Paraesthesia or Numbness: 

 Pains and heedless may be felt in a nerve root distribution and numbness may be detected when tested by touch, pinprick or temperature test tubes. There may be feeling of weakness, these are considered to be due to nerve root compression or irritation.  

Muscle weakness: 

 Compression of a nerve root that interrupts impulse transmission results in weakness of the muscles supplied by that nerve. 

Tendon Reflex Changes: 

 The quadriceps(L3-L4) and tendocalcaneal (L5-S1) reflexes are diminished when there is pressure in the corresponding nerve root. 

Spinal Movements: 

 Flexion is very limited, erector spinae stands out in spasm and the movement that occur usually deviates to one side. 

Side-flexion is generally free to one side with some discomfort and restricted to the opposite side. The extension is not possible, beyond straightening of the lumbar spine, especially where there is a protrusion that cannot be compressed. 

Standing Posture: 

 The spine is held rigid and in scoliosis. This is termed an antalgic posture because straightening or correcting the position aggravates the pain in the leg. Eight to ninety percent of the body pain is taken on the nonpainful leg. 

Sitting: 

 The patient does not like to sit and on trying to do to take the weight of the trunk by pushing up on the fists. Standing up from sitting takes and the patient walks the hands up the thighs. 

Lying:

 The patient likes to lie flat and the spine straightens out. A hard matter usually provides the best relief. 

Sleep:

 This is reasonably uninterrupted but the patient is stiff on waking and has to struggle to get moving. 

Walking: 

 There is limp because the patient cannot take a normal stance on the affected leg. The pace is slow with no normal arm swing.

Sciatic nerve stretch:

This is often slightly reduced on the unaffected leg and very limited on the affected leg. 

Passive neck flexion:

 This may aggravate the back pain and may aggravate the leg pain as well. 

Coughing and sneezing: 

 Back pain keg is provoked by both coughing and sneezing. The later is more painful because it is involuntary whereas the patient can often prepare to cough. The pain is related to the raised abdominal pressure moving the affected segment and tending to force the nucleus backward. 

Tenderness: 

 Palpation over the lumbar spine provokes tenderness and when pressure is applied can increase spasm. The skin may be slightly warmer and moist over the site of the lesion. In a patient with repeated back problems, the skin may be thickened and tethered. 

Investigation: 

. X-ray Lumbo-sacral spine
. Narrowed disc spaces
. Loss of lumbar lordosis
. Compensatory scoliosis

CT scan lumbar spine: 

Outline of soft tissues
Bulging out disc

MRI Lumbar spine: 

 Intervertebral disc protrusion
Compression of nerve root. 

Homeopathic treatment & Homeopathic remedies for Prolapsed Intervertebral Disc (Slipped Disc): 

 Homeopathic treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because of homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. 

Agaricus M.: 

 Crick in back. Violent shooting, burning pains, deep in the spine. Painful pulsation in the spinal canal. Backaches disturbing sleep at night; cannot find a position to lie in, with heat. pain in back, as after continued stooping. Pain along spinal column when stooping. Every motion, every turn of the body, causes pain in the spine. The great weakness in muscles of the back can hardly sit straight when stooping, spine pains as if too weak to support. The sensation of ants creeping along the spine, burning, biting on back. Violent pains in first and second lumbar vertebrae when turning. Violent pains in limbs especially left hip under gluteal muscles. In left buttock violent tearing with the sensation of coldness, wakening him out of sleep. Twitching of gluteal muscles.The icy coldness from glutei down to feet, most in big toes, with numbness and twitches. Crossing legs causes pain in thighs. Electric stitches or spasmodic pain in anterior part of the thigh. 

Ammon Mur: 

 A backache, especially at night. Pain in small of the back, as if bruised or crushed, during rest or motion, also at night in bed could neither lie on back nor side. Stiffness in small of back & severe pain in the lumbosacral region. pain in left hip as if tendons were too short, must limp when walking. Hamstring painful when walking, as if too short cramp like a contraction in the lower part of left leg. 


Arnica Montana: 

 Great soreness of back, fullness, and pressure in the lumbar region. The sensation of great weight across lower parts of loins, and feeling of being drawn in, as if a cord was tightly drawn across. Tingling in back spine pains as if not capable of carrying the body. Small of back pains, stitches when coughing, breathing deeply, or walking. A peculiar painful sensation extending down back, as comes sometimes from continued stooping in hard work, in rising from bed in morning, drawing pressing pains in the left hip joint, thigh being extended, when sitting. This is a very useful remedy for sciatica due to over-exertion. The acute pains are followed by sensations as if bruised. pain in thighs when walking, as from a blow, or contusion.

Bryonia: 

 Contractive cramp-like pain all over the back, shooting in the loins and in the back. Painful stiffness in the small of the neck, compelling him to walk and sit crookedly. Shooting under the left shoulder- blade, extending to the heart, greatly aggravated by a cough and respiration. Pressure on the shoulder, with shooting on breathing deeply. It is best adapted to persons or persons of a gouty or rheumatic diathesis, prone to so-called bilious attacks, Bryonia patients are irritable, include being vehement and angry, dark or black hair, dark complexions, firm muscular fiber, dry nervous, slender people. Pains stitching, tearing, worse at night < by motion, inspiration, coughing> by absolute rest, and lying on painful side. Excessive dryness of mucous membranes of the entire body. 

Calc- Carb: 

 Pain in the back, intolerable pain in the back, the spine pains on bending backward. Painful stiffness in the spine, with indolence and heaviness in the legs, in the morning on waking, and after rising. Pain as if wrenched in both sides of the back. Stitches in the back. Bruised pain in the back and chest. Spasmodic, jerking pain, extending from the left of the back to the anus. Painful jerks in the right side of the back, on breathing, with chilliness, and cold. Drawing pain between the shoulder-blades. Pressive between the shoulder blades, which on motion impedes respiration. Pressive pain in the spine, between the shoulder blades, with short breath and aggravated by breathing, with painfulness in the bones of the spine on touch. Burning sticking pain in the back, between the shoulders. Cutting pain between the shoulder-blades, during rest. Single fine stitches in the upper part of the back, during inspiration. Pain in the small of the back, from lifting a heavyweight. 

Kali-Carb: 

 Stiffness in the back, she is unable to stop. Stiffness and lameness in the back, and small of the back. Rheumatic pains in the back, chest, shoulders, and arms, worse on moving them. Attack of constrictive pain in the back, during rest, after physical effort. Contractive pain in the back, during rest, after physical exertion. Some sharp biting, pinchings on the posterior of the ribs on both sides of the back. A violent backache, the pressure in the when swallowing. Burning pressure in the back, worse when walking in the open air. Tensive pressure like excessive fatigue extending from the right scapula along the side of the back into the small of the back, recurring without cause, and also in the morning in bed, but especially when riding in a carriage. Drawing pressure in the back. Pain in the back as from a sprain. Stitches on the right side of the spine, above the small of the back. 

Lachesis: 

 Burning in the back, spasms in muscles of the back. Painful stiffness from loins to hip, as if muscles were too short, insupportable nocturnal pains in the back, in loins, hip, and knee. Pain in the small of the back with constipation, intermittent fever, palpitation of the heart or dyspnoea. Pain in the coccyx, when sitting down one feels as if sitting on something sharp. 
Want of strength in back and knees, which forces the patient to stoop when walking. Pain as from dislocation. Persons of a less melancholy temperament, dark eyes, and a disposition to low spirits and indolence. Women of choleric temperament, with freckles and red hair. 

 Phos: 

 Paralysed sensation in the upper sacrum and lower lumbar vertebrae. Contusive pain in loins and back(as if the back were broken), especially after having been seated a long time, hindering walking, rising up, or making the least movement. Pain in small of the back when rising from a stooping position. Burning in the back or small of the back when rising from a stooping position. Sensitiveness of spinous processes of dorsal vertebrae to pressure. Softing of the spine. Heat or burning in back, between scapula. Pain in coccyx impending easy motion. 

Rhus-Tox:

 Rheumatic tearing between scapulae, not affected by movement, worse by cold, better by heat. Tearing between shoulders, drawing together from both sides. Transient coldness in back. Contusive pain in loins, especially on touching the parts, and during the response. Pain in small of back when sitting still or when lying, better when lying on something hard or from exercise. Bruised pain in sacrum when he lies still on it or sits still, feels nothing of it when moving. Painful rigidity in loins. Painful exostosis on the sacrum. Distortion of the vertebral column. Pains in loins, in back, and nape, as from lifting too great a weight. Drawing and stitches in back, especially when seated and no stopping. 

Ruta: 

 Pressure on the inside of right scapula. Pricking itching between scapulae, not better by rubbing. Constructive pains in back and loins, often with oppressed respiration. Pain in loins and sacrum as from contusion. Shooting in loins when walking and when stopping, or only when seated, better by pressure and when lying down. A backache better lying on back. Pain in lumbar vertebrae as if bruised. 

Sepia: 

 Stiffness at the back of the neck, pains in loins and back, with burning tearing. Throbbing in loins. Weakness in loins when walking. Incisive pains pressure, digging and spasmodic tearing in back. The rigidity of back and nape. Sprained pain in the hips, in evening in bed and afternoon. Shivering in back. Stitches posteriorly above right hip, she could not lie on right side, and when touched it felt sore, stitches in the back when coughing. 

Thuja:

 Cracking in cervical vertebrae on making certain movements with the head. Spinal curvature. Painful drawing in sacrum, coccyx, and thighs. While sitting, after a long time prevents standing erect. pain as of a fracture and stiffness in loins, back, and nape, especially in morning, after rising. Drawing in back and loins when seated, boring in back. Pulsation in the spine.