Physiotherapy for the treatment of 4 and 5 lumbar protrusion Physiotherapy is considered one of the most important and effective non-surgical methods for the treatment of lumbar disc protrusion of the 4th and 5th vertebrae. This method is used with the aim of reducing pain, improving the movement of the spine and strengthening the muscles around the waist. When the disc protrudes, there is a lot of pressure on the spinal nerves and this causes severe pain, numbness and even weakness in the legs. Physiotherapy with a combination of different techniques such as corrective exercises, stretching, electrotherapy and strengthening exercises, helps to reduce the pressure on the nerve. The physiotherapist first examines the patient's condition and designs a specific treatment plan based on the severity of the protrusion. Also, the use of physiotherapy devices such as laser therapy or ultrasound therapy can reduce inflammation and pain. Non-steroidal anti-inflammatory drugs or NSAIDs are one of the most widely used drugs in the treatment of pain caused by 4 and 5 vertebral disc protrusion. These drugs relieve pain by reducing the inflammation around the disc and reducing the symptoms of lumbar disc rupture. Their mechanism of action is based on the inhibition of certain enzymes that are involved in the process of causing inflammation. The most common drugs in this group include ibuprofen, naproxen and diclofenac. Doctors usually prescribe these drugs for short-term periods, because long-term use can cause side effects such as gastrointestinal problems (stomach ulcers and bleeding), kidney damage, or increased blood pressure. For this reason, the use of these drugs should be done under the supervision of a doctor and with proper dosage. Epidural injection to treat the 4th and 5th lumbar vertebra Epidural injection is one of the interventional methods for the treatment of lumbar disc protrusion of the 4th and 5th vertebrae. In this method, the doctor injects steroid anti-inflammatory medicine directly into the epidural space of the spine; The space around the spinal nerves. By reducing the inflammation around the nerve under pressure, this medicine reduces pain and improves the patient's movement. Epidural injections are usually recommended when drug and physical therapy treatments fail to control the pain. This method is very effective especially for patients who have sciatica pain and pain spreading to the leg. The injection process is done with the help of imaging devices such as fluoroscopy to determine the exact location of the drug. Is massage effective for the treatment of the 4th and 5th vertebral disc? Massage therapy is one of the complementary methods for treating lumbar disc of l5 s1 vertebra and 4th and 5th vertebra. Although massage alone cannot cure disc protrusion, it can reduce the painful symptoms to a great extent by reducing the tension of the muscles around the spine and improving blood circulation. In many patients, muscle spasm is one of the aggravating factors of back pain. By relaxing these muscles, massage helps to reduce the pressure on the back nerves. Also, by improving blood flow, more oxygen and nutrients reach the damaged area, which helps the healing process. On the other hand, massage can reduce the patient's stress and anxiety and improve the quality of sleep, which play an important role in the treatment process. Surgery to treat 4th and 5th vertebral hernia Surgery is usually performed for the treatment of lumbar disc protrusion of the 4th and 5th vertebrae when other non-surgical methods such as medicine, physiotherapy and injection cannot control the patient's symptoms or the person suffers from severe muscle weakness and bladder and bowel incontinence. The main goal of surgery is to remove pressure from the spinal nerve and restore the normal function of the spine. There are different methods for lumbar disc surgery, the choice of which depends on the condition of the patient, the amount of disc protrusion and the opinion of the surgeon. The most common methods are: ### Microscopic lumbar disc surgery In this procedure, the surgeon removes part of the protruding disc using a surgical microscope and fine instruments. This reduces pressure on the nerve and improves symptoms quickly. The main advantage of this method is its minimal invasiveness; This means that the surgical incision is smaller, the damage to the surrounding tissues is less, and the patient has a shorter recovery period. ### Open surgery Open lumbar disc surgery is one of the oldest and most common methods for treating herniated discs. In this procedure, a larger incision is made in the back so that the surgeon can directly access the disc. This method is suitable for severe and complex cases, as it allows full observation of the affected area. Although the recovery period in open surgery is longer and the patient may need to be hospitalized for several days. ### laparoscopic surgery Laparoscopic or minimally invasive surgery is one of the newest methods of treating lumbar disc protrusion of the 4th and 5th vertebrae. In this method, several small incisions are made on the body and the surgeon removes the damaged part of the disc using specialized tools and a camera. The advantage of this method is the reduction of bleeding, reduction of postoperative pain and short hospitalization. Patients are usually able to return to light activities within a few days. However, this method requires advanced equipment and high skill of the surgeon and is not suitable for all patients.