There are many terms used to describe spinal disc pathology and associated pain, such as ‘herniated disc', ‘pinched nerve', and ‘bulging disc', and all are used differently and, at times, interchangeably.
- Disc pain. When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain.
- Pinched nerve. When a patient has a symptomatic herniated disc, the disc itself is not painful, but rather the material that is leaking out of the inside of the disc is pinching or irritating a nearby nerve. This type of pathology produces pain called radicular pain (e.g., nerve root pain) leading to pain that may radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm.
Incidence in India compared to worldwide
Symptomatic intervertebral disc degeneration is being commonly seen in younger population. Additionally, it has been found to be more common in certain families. Conventionally, it has been considered to be occurring due to aging-related degenerative changes.
Low back pain is a major socioeconomic and health problem in modern society. In accordance with the report of World Health Organization in 2002, low back pain constituted 37% of all occupational risk factors which occupies first rank among the disease complications caused by work.
Cervical spondylosis, according to modern concept, is a degenerative disorder. Sometimes injury to the neck region may lead to pain in cervical region. Lumbago is similar to cervical spondylosis. Injury to the lower back region may lead to lumbar disc protrusion.
The pain is common in pregnancy. Exposure to cold and damp weather may precipitate pain in chronic sufferers of lumbago.
In sciatica, pain start from the lower back and there is radiation towards legs. In Ayurveda, the disease is known as gradursi. Sciatic nerve is the thickest nerve of the body. Inflammation (swelling) of the nerve may lead to pain in the leg.
Intramuscular injections may irritate sciatic nerve and result in sciatica. Benign prostate hypertrophy may lead to the incidence of sciatica.
Signs and Symptoms
In cervical spondylosis pain is presented in two forms:
- Confined to neck only (upper cervical).
- Radiating to the arms (lower cervical).
- In chronic phase, the patient complains of pain, which may be worse at night and after neck movement.
- Morning stiffness is a characteristic feature.
- The disease is exaggerated in cold weather.
- There may be tingling and numbness along the arms. This is due to compression of the nerves by protrusion of the disc.
- Vertigo is common.
In lumber spondylosis
- Disc protrusion at lumbar level may lead to paralysis of legs and urinary blabber.
- In severe cases pain may start from lumbar region and radiate throughout the leg.
- Lifting of weights in standing position may lead to attack of lumbago.
- Pain is worse at night and after back movements.
- There may be tingling and numbness along lower back.
- Urinary retention is the main problem.
In sciatica, the pain stars from the lower back and radiates to hip, thigh, leg and feet. There is sensory and motor loss across the leg.
- CT scans
There is no solution in Allopathic system of medicine to reverse the process of spondylosis as it is a degenerative process. The basic treatment of spondylosis is aimed at the treating neck-pain and back-pain, which are due to spondylosis. Hence, the treatment of spondylosis is similar to the treatment of neck-pain and back-pain.
Available treatments fall into several categories:
- adjunctive therapies (chiropractics and acupuncture).
- minimally invasive procedures such as injections.
- physical therapy.
- self-care exercise.
- Extension ad flexion exercises are recommended.
- For weakness and parasthesia in the arms, Ekangveerrasa, one tablet, twice a day is given for seven days.
- Gentle massage with Vishagarbha taila is helpful in reducing morning stiffness.
- Mahayograja guggul is the drug of choice of treatment of cervical spondylosis. Two tablets, twice a day, are recommended with hot water.
- Treatment is best by immobilisation of the neck in flexion in a cervical collar.
- The treatment is same as that of cervical spondylosis.
- Extreme case may require hospital admission.
- Prasarni-taila is official Ayurvedic remedy for massage in lumbago.
- Bed rest is of prime importance.
- Nirgundi is the drug of choice in treating sciatica. Three teaspoonfuls (15 ml) of the decoction, twice a day are helpful in reducing pain.
- Ajmoda-adi-churana, one teaspoonful (5g), with warm water, thrice a day is effective in treating sciatica.
- Decoction of Parijata or harsingara is popular remedy for the treatment of sciatica. Six teaspoonfuls (30 ml), of the decoction are valuable in relieving pain.
- Nirgundi-taila, warmed slightly is used for massage.
Ayurveda Clinical Studies
A total of 119 patients were registered for the study, out of which 102 patients completed the treatment: Group A had 52 patients treated with Nirgundi Ghan Vati and Group B had 50 patients treated with Nirgundi Ghan Vati and Matra Basti. The results show that both treatments had an effect on Gridhrasi. It was noted that there was more relief from signs and symptoms in Group B and concluded that both Nirgundi Ghan Vati and Matra Basti may contribute in the patient’s recovery at different levels.
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Konstantinou K, Dunn KM (2008) Sciatica: review of epidemiological studies and prevalence estimates. Spine (Phila Pa 1976) 33:2464–2472.
Gibson JNA, Waddell G (2007) surgical interventions for lumbar disc prolapse. Cochrane Database of Systematic Reviews CD001350.
Frymoyer JW Back pain and sciatica. N Engl J Med 1988; 318:291-300.
Ali M, Shukla VD, Dave AR, Bhatt NN. A clinical study of Nirgundi Ghana Vati and Matra Basti in the management of Gridhrasi with special reference to sciatica. Ayu 2010; 31(4): 456–460.