What Does the Low Back Pain Future Look Like After a Lumbar Disc Herniation (LDH)? | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

What Does the Low Back Pain Future Look Like After a Lumbar Disc Herniation (LDH)?

The Spinal Forecast

Lumbar disc herniation(LDH) is an event, which could be progressive or instantaneous, whereby the nucleus pulposus of an intervertebral disc slips out of place. 

Normally, a healthy disc borders the nucleus with a fence-like structure called the annulus fibrosis. However, under abnormal loading, the fence cannot contain the nucleus any longer, and there is breach—allowing the nucleus to escape beyond its contained borders. This is called disc herniation, and it is often seen in the lumbar region of the human spine. See the video below.

Low back pain (LBP) is becoming increasingly common and challenging to treat. Its prevalence is increasing globally and is thought to be related to risk factors such as obesity, sedentary behaviours at home and work, phone and computer usage and overall life expectancy.1

Lumbar disc herniation, which can precede LBP, is prevalent in young adults that do not have back pain yet. It is estimated as much as 20% have asymptomatic lumbar disc herniations.2


After a literature review looking at 15 studies that were good enough to review, 2019 patients demonstrated that the chances of developing lower back pain after a lumbar disc herniation (compared to not having a disc herniation) were higher than expected. In lumbar disc herniation patients, these people had a 46.2% chance of developing long-term lower back pain compared to the general population of only 11.9%.3

Dynamic Disc Designs

At ddd, we create models demonstrating disc dynamics to educate the patients on the biomechanical principles of disc dynamics over a lifetime. In the case above, lumbar disc herniation is also often preceded by some element of clinical instability which can be detected by an astute clinician paying attention to the presenting symptoms. After disc herniation occurs, understanding load management can help slow the disc height loss that likely contributes to those cases that go on to develop chronic lower back pain. Our models can help with dynamic education. Explore.

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