The Disc herniation is unusual prior to age 20 and is rare in the fibrotic discs of the elderly. There is localised pain in low back region only or referred pain to the hip , buttock or leg. Such pain increased on heavy lifting, bad postures, coughing and sneezing.

The disc anatomy consists of two main structures, the nucleus pulposus (NP) and the annulus fibrosus(AF). The nucleus pulposus is composed of water, type II collagen, chondrocyte-like cells, and proteoglycans. This unique composite allows the NP to be elastic, flexible under stress forces and to absorb compression. The composition of the AF is mainly concentric layers of collagen type I fibers, forming a fibrous tissue with helical disposition surrounding the NP, this structure is denser in the anterior part and is attached to the vertebral body by Sharpey fibers.

Multiple factors influence disc herniation process such as genetic, mechanical, and behavioral and cause the nucleus pulposus to prolapse, pushing the frayed and weakened annulus posteriorly. With severe disc disease, the nucleus may protrude through the annulus (herniation) or become extruded to lie as a free fragment in the spinal canal. Symptoms of a slipped disc include back pain, abnormal posture, limitation of spine motion (particularly flexion), or radicular pain. Dermatomal pattern of sensory loss or a reduced or absent deep tendon reflex is more suggestive of a specific root lesion than the pattern of pain. Motor findings (focal weakness, muscle atrophy, or fasciculations) occur less frequently than sensory or reflex changes.

Symptoms and signs are usually unilateral, but bilateral involvement does occur with large central disc herniations that compress several nerve roots at the same level.There are evidences that lumbar disc herniation with a nonprogressive nerve root deficit can be managed nonsurgically.MRI scan or CT-myelogram is necessary to establish the location and type of pathology.Simple MRI yields exquisite views of intraspinal and adjacent soft tissue anatomy.Bony lesions of the lateral recess or intervertebral foramen may be seen with optimal clarity on CT-myelographic studies. Asymptomatic disc protrusions are also common, and these abnormalities may enhance with contrast.Thesurgical procedure is a partial hemilaminectomy with excision of the prolapsed disc. Fusion of the involved lumbar segments is considered only if significant spinal instability is present (i.e., degenerative spondylolisthesis or isthmic spondylolysis)

HOMEOPATHIC ASPECT:

                According to our Master, Dr. S. C. F. Hahnemann in aphorism 29, 5^thedition of Organon of medicine, it is written: “…., when a Homeopathic cure of the vital force deranged by natural disease is accomplished by administration of a medicinal agent selected on account of an accurate similarity of symptoms,…..” this sentence includes many things, that the Homoeopathic treatment is gentle, rapid and permanent. It is also beneficial to manage patients of low back pain with use of Homeopathic medicines, auxiliary measurement and improvement in mode of living.

                Homeopathy is strongly recommended for acute or long lasting chronic low back pains. In acute cases of lumbago there is requirement of providing immediate relief with help of Homeopathic medicines along with auxiliary treatments. There is possibility of sudden disc herniation after injury. There are many Homeopathic remedies for such conditions.

                The Homeopathic medicine is selected after a full individualizing of the patient and case-analysis, which includes medical history, past history, family history of the patient, general and particular examination, physical and mental constitution,  etc.

There are following Homoeopathic remedies used for the treatment of lumbago:

(Alphabetically arranged)

Aesculus:

Source – Plant kingdom (Horse Chestnut)

Constitution- It is especially indicated for people with low back pain who also have a tendency toward venous congestion and hemorrhoids. AesculusHipocastinum is a great Homeopathic remedy for backaches that are caused by hard labor.

Characteristic particular-dull pain in the very low back (the sacral or sacroiliac areas), pain as if to break.

Modalities- Pain was worse, when standing up from a sitting position and from stooping. Patient cannot bend forward as it causes excruciating pain.

Arnica:

Source – Plant kingdom

Constitution – Arnica is a remedy with a well-known reputation for its usefulness in injuries and pain to soft tissue and muscles.

Ailments from – It is a great medicine for lumbago that occurs after falls and mechanical injuries.

Characteristic particular – There is great soreness and lameness in the lumbar region, bruised pain, feels as if it was beaten with sticks. 

Modalities – Worse by least touch, damp and cold weather. Pain is better by lying down with head low.

BryoniaAlb:

Source – Plant kingdom

Constitution – This remedy can be helpful for back pain after injury and during illness. Patient is tall slender persons having dark complexion. Patient is suffering from Rheumatic and gouty diathesis.

Characteristic particular – There is sharp and excruciating lower backache. It is indicated when the pain increases with slight movement and is relieved by rest. Stiffness of back is a very prominent feature of Bryonia.

Modalities –This remedy is indicated when back pain is worse from even the slightest motion. Changing position, coughing, turning, or walking may bring on pain. Pain is relieved by lying on a hard surface.

Colocynthis:

Source – Plant kingdom

Constitution – Patient becomes angry, indignant, and impatient because of pain. It is suited for irritable persons easily angered and women with copious menstruation, and sedentary habits.

Characteristic particular – It is used for left-sided sciatica. Drawing and tearing pain with shortening of tendons.

Modalities – Pain is worse from anger and indignation and better from warmth and hard pressure, pressure gives the most relief.

Hypericum:

Source – Plant kingdom

Ailments from – It is the great remedy for nervous injuries and puncture wounds. It relieves pain after operations. It is suited for injured nerves from bites of animals.

Characteristic particular – pressure over sacrum. There is spinal concussion. Patients are suffering with coccyx injury from fall, with pain radiating up spine and down limbs.

Modalities – pain worse in cold, dampness, in fog close room and better, bending head backward

Kali Carbonicum:

Source – Mineral kingdom (K₂CO₃)

Constitution – A chilly patient with backache after delivery clearly fits the description of Kali Carb.

Ailments from – It has never failed in a case of backache which has its origin since the last Child birth. Prolonged walking causes backache and the patient has to rest after walking for few minutes.

Characteristic particular – This kind of backache is quite typical, it occurs in the lower back and extends down into the back of legs. Small of back feels weak. There is lumbago with sudden sharp pains extending up down back and to thighs.

Modalities – Pain drives the person out of bed at night, making it necessary to get up to be able to turn over. Pain is usually worse on the right side of the lower back, worse around the menstrual period, and aggravated by sitting and by walking. Pain gets better by pressure.

Kalium Phosphoricum :

Source – Mineral kingdom (K₂HPO₄)

Constitution – The greatest nerve remedy. It is adapted to young but weak, tired persons become exhausted and prostration. Person is oversensitive, nervous and delicate worn out from long suffering, much sorrow and vexation.

Ailments from – Causes are excitement, over work and worry

Character of pain – There is pain in coccyx. Burning, bruised, sore, stitching and drawing pain in lumbar region.

Modalities – Pain aggravated during menses and sitting; ameliorated with gentle motion.

Concomitant – there are rheumatic and paralytic lameness of back worse after rest and aggravated on just commencing to move.

Kalmia:

Source – Plant kingdom

Constitution – A rheumatic remedy.

Ailments from – It is suited for lumbar pain of nervous origin.

Character of pain – Pain in upper three dorsal vertebras. Pain down back as if it would break in localized regions of spine. Pains shoots like lighting tear along the sciatic nerve. In rheumatic condition, pains are dull, tearing, crushing and pressing. Pain goes from lower to upper limbs.

Modalities – aggravated by motion.

Rhus Toxicodendron:

Source- Plant kingdom

Constitution – Patient is very chilly, susceptible to cold and rheumatic diathesis

Ailments from – Spraining, straining, over lifting, too much summer bathing in river, lying on wet and getting wet

Characteristic particular – There is aching pain and stiffness in small of back. Tearing, shooting and stitching pain, as if the flesh was torn loose from bones.

Modalities-Worse on initial movement and ameliorates with continued motion. Pain is aggravated in cold damp weather and relieved by warm applications, baths or showers, and massage.

Concomitant – Triangular red tipped tongue and bitter taste in mouth.

Ruta Graveolens:

Source – Plant kingdom.

Constitution-This remedy is indicated when tremendous stiffness is felt in the muscles or joints.

Ailments from – After sprains or twisting injuries by straining of back muscles or ligaments. Lifting of weights or overreaching to objects causing sudden straining of back.

Characteristic particular – There is lame and sore pain

Modalities- Amelioration from lying down and pressure.Worse inmorning before rising

Zincum Metalicum:

Source – Mineral kingdom

Constitution – it suited to nervous, extremely sensitive, excitable, and there is trembling, quivering and twitching of muscles.

Characteristic particular – pain in small of back. Patient cannot bear back touched. There is dull aching pain about last dorsal or first lumbar vertebra. There is burning pain along spine.

Modalities – Worse, at menstrual period, from touch, 5-7 pm, turning in bed, standing and better while eating and from discharges.

References:

• B.D. Chaurasia, B D Chaurasia’s Human Anatomy, 9^th edition, CBS Publishers and Distributors Pvt. Ltd.
• B. R. Walker, Devidson’s Principles & Practice of Medicine, 23^rd Ed, Elsevier.
• P. J. Mehta, P. J. Mehta’s Practical Medicine, 22^nd edition,  The National Book Depot
• Samuel Hahnemann, Organon of Medicine, 5^th edition, B Jain Publishers Pvt. Ltd.
• E. B. Nash, Leaders in Homeopathic Therapeutics, 6^th edition, B Jain Publishers Pvt. Ltd.
• Samuel Lilienthal, Homoeopathic Therapeutics, 1^st edition, B Jain Publishers Pvt. Ltd.
• S. R. Phatak, Materia Medica of Homoeopathic Medicines, revised edition, B Jain Publishers Pvt. Ltd.
• J. T. Kent, Lectures on Homeopathic Materia Medica, 2^nd edition, B Jain Publishers Pvt. Ltd.