Patient History

According to Kester et al. (2002), the diagnosis of nerve compression due to disc herniation is mainly done by the history. Therefore, next to the general questions, it is important to ask about:

  • Age: Disc problems themselves occur between the age of 15 and 40 (Magee 2006), herniated discs between 30 and 50-55 years of age (Magee 2006; Jackson et Simpsons).
  • Pain pattern: Pain worse in the leg than in the back is a history finding relating to nerve root compression due to disc herniation (Kester et al. 2002).
  • Duration of symptoms: According to Kester et al. (2002), the duration of symptoms is an accurate diagnostic tool. Casey et al. (2007) states that the symptoms must be present more than a month for a diagnosis of disc herniation.
  • Onset: The onset is often reported to be a traumatic event (sudden forced flexion/ rotation movement), but symptoms can also start spontaneously (Patel 2010). Is it acute, subacute or chronic?
  • What is having an effect on the symptoms? Pain is stimulated by activity, increased pain on flexing, sitting, lifting, twisting, bending might be reported in case of a disc herniation (Magee 2006; Patel 2010), as well as pain increasing on coughing, sneezing or straining/laughing (Kester et al. 2002; Patel 2010). Chronic coughing might even be the cause of LSS (Foster 2012). Extension might relieve the pain (Magee 2006).
  • Occupation: Kester et al. (2002) found in their study a relation between nerve root compression and having a job with a predominance of standing, walking or lifting activities. Furthermore, driving causes an increased disc pressure, which puts truck drivers at a high risk of herniations as they often combine driving and lifting activities (Foster et al 2012).
  • Sitting habits: Sitting without lumbar support puts a lot of pressure on the disc and might cause herniations on long term (Foster et al 2012).
  • Smoking: Cigarette smoking increases the risk of disc degeneration and so of disc herniations (Kapur et al. 2012, Foster 2012).
  • Family history: Genetic factors might be involved, and some genes are thought to be associated with disc herniations (Bogduk et al. 2008). Recent evidence even indicates that genetic factors play a dominant role in disc herniation and that heavy physical loading is only a minor risk factor (Battié et al. 2004).

 

Assessment

Treatment

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