{"id":2126,"date":"2025-07-13T10:05:27","date_gmt":"2025-07-13T08:05:27","guid":{"rendered":"https:\/\/osteopathe-sendao.fr\/?p=2126"},"modified":"2025-07-13T10:27:21","modified_gmt":"2025-07-13T08:27:21","slug":"comprendre-la-hernie-discale-evolution-des-connaissances-et-des-soins","status":"publish","type":"post","link":"https:\/\/osteopathe-sendao.fr\/index.php\/2025\/07\/13\/comprendre-la-hernie-discale-evolution-des-connaissances-et-des-soins\/","title":{"rendered":"Hernie discale : \u00e9volution des connaissances et des soins"},"content":{"rendered":"\t\t
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Ou comment on a (presque) tout remis en question<\/em><\/p>

Les ann\u00e9es 70 : abdos, posture et th\u00e9orie de l\u2019\u00e9volution<\/h2>

Le paradigme de l\u2019\u00e9poque<\/h3>

Dans les ann\u00e9es 1970, la compr\u00e9hension du mal de dos \u00e9tait relativement simple :
on pensait que les douleurs lombaires \u00e9taient le prix \u00e0 payer pour notre passage de la quadrup\u00e9die \u00e0 la bip\u00e9die. R\u00e9sultat ? Un dos trop cambr\u00e9, des vert\u00e8bres qui se \u00ab\u00a0pincent\u00a0\u00bb\u2026 et des douleurs in\u00e9vitables.<\/p>

La solution : rectitude et renforcement abdominal<\/h3>

La logique m\u00e9dicale dominante \u00e9tait alors la suivante :
si le dos fait mal, c\u2019est parce qu\u2019il n\u2019est pas assez droit. Il faut donc le redresser.<\/strong><\/p>

On prescrivait alors :<\/p>

  • du renforcement abdominal pour r\u00e9duire la cambrure lombaire,<\/p><\/li>

  • des coussins semi-lunaires pour \u00ab\u00a0casser\u00a0\u00bb la lordose en position couch\u00e9e,<\/p><\/li>

  • une posture rigide et tr\u00e8s droite en toute circonstance.<\/p><\/li><\/ul>

    Et \u00e9tonnamment\u2026 \u00e7a fonctionnait !
    En r\u00e9alit\u00e9, ce n\u2019est pas tant la posture droite qui aidait, mais le renforcement de la ceinture abdominale<\/strong>, qui permet une meilleure r\u00e9partition des charges. Car si cette ceinture est faible, toutes les contraintes s\u2019accumulent au seul point d\u2019attache osseux entre le haut et le bas du corps : les vert\u00e8bres lombaires<\/strong>.<\/p>

    Les ann\u00e9es 80-90 : la r\u00e9volution McKenzie<\/h2>

    Un accident heureux<\/h3>

    C\u2019est en Nouvelle-Z\u00e9lande que Robin McKenzie, kin\u00e9sith\u00e9rapeute, d\u00e9couvre par hasard une nouvelle piste. Un patient souffrant du dos reste allong\u00e9, le dos en extension sur une table d\u2019examen\u2026 et repart soulag\u00e9, alors m\u00eame que cette position allait \u00e0 l\u2019encontre de toutes les recommandations de l\u2019\u00e9poque.<\/p>

    Un nouveau paradigme : l\u2019extension<\/h3>

    McKenzie d\u00e9veloppe une hypoth\u00e8se novatrice :
    le mal de dos ne viendrait pas d\u2019un \u00e9crasement osseux, mais d\u2019un d\u00e9placement du disque intervert\u00e9bral.<\/strong><\/p>

    Sa th\u00e9orie :<\/p>

    • en flexion (pench\u00e9 en avant), la pression pousse le disque vers l\u2019arri\u00e8re, comprimant les nerfs,<\/p><\/li>

    • en extension (pench\u00e9 en arri\u00e8re), le disque se recentre, soulageant la douleur.<\/p><\/li><\/ul>

      Cette m\u00e9thode domine alors la kin\u00e9sith\u00e9rapie pendant plus de 30 ans, appuy\u00e9e par des \u00e9tudes affirmant que la flexion augmentait jusqu\u2019\u00e0 300 % la pression sur les disques.<\/p>

      2015 : la d\u00e9construction des certitudes<\/h2>

      Les \u00e9tudes de Brinjikji<\/h3>

      En 2015, une m\u00e9ta-analyse du Dr Brinjikji et son \u00e9quipe bouleverse notre vision du dos.
      Ils r\u00e9alisent des IRM sur des personnes sans douleurs lombaires<\/strong>\u2026 et les r\u00e9sultats sont \u00e9difiants :<\/p>

      Changement observ\u00e9<\/th>20 ans<\/th>30 ans<\/th>40 ans<\/th>50 ans<\/th>60 ans<\/th>70 ans<\/th>80 ans<\/th><\/tr><\/thead>
      Discopathie d\u00e9g\u00e9n\u00e9rative<\/td>37 %<\/td>52 %<\/td>68 %<\/td>80 %<\/td>88 %<\/td>93 %<\/td>96 %<\/td><\/tr>
      Perte de signal discal<\/td>17 %<\/td>33 %<\/td>54 %<\/td>73 %<\/td>86 %<\/td>94 %<\/td>97 %<\/td><\/tr>
      Perte de hauteur discale<\/td>24 %<\/td>34 %<\/td>45 %<\/td>56 %<\/td>67 %<\/td>76 %<\/td>84 %<\/td><\/tr>
      Bombement discal<\/td>30 %<\/td>40 %<\/td>50 %<\/td>60 %<\/td>69 %<\/td>77 %<\/td>84 %<\/td><\/tr>
      Protrusion discale<\/td>29 %<\/td>31 %<\/td>33 %<\/td>36 %<\/td>38 %<\/td>40 %<\/td>43 %<\/td><\/tr>
      Fissure annulaire<\/td>19 %<\/td>20 %<\/td>22 %<\/td>23 %<\/td>25 %<\/td>27 %<\/td>29 %<\/td><\/tr><\/tbody><\/table>
      \u00a0<\/div><\/div><\/div><\/div>

      Ce que \u00e7a change<\/h3>

      • La d\u00e9g\u00e9n\u00e9rescence est normale<\/strong> : \u00e0 30 ans, plus d\u2019une personne sur deux pr\u00e9sente d\u00e9j\u00e0 des anomalies discales\u2026 sans douleur.<\/p><\/li>

      • Une hernie discale ne veut pas dire souffrance<\/strong> : la plupart des anomalies sont asymptomatiques.<\/p><\/li>

      • Vieillir n\u2019est pas une pathologie<\/strong> : ces changements sont des marqueurs du temps, comme les rides sur le visage.<\/p><\/li>

      • L\u2019IRM n\u2019est pas une condamnation<\/strong> : elle doit \u00eatre confront\u00e9e \u00e0 l\u2019examen clinique, pas prise comme v\u00e9rit\u00e9 absolue.<\/p><\/li><\/ul>

        La remise en question des \u00e9tudes anciennes<\/h2>

        Une m\u00e9thodologie douteuse<\/h3>

        Les fameuses \u00e9tudes des ann\u00e9es 70-80 sur la pression intra-discale, qui servaient de r\u00e9f\u00e9rence pendant des d\u00e9cennies, \u00e9taient\u2026 faites sur des cochons morts<\/strong>. Oui, des disques intervert\u00e9braux porcins, perc\u00e9s de capteurs et mesur\u00e9s \u00e0 froid.<\/p>

        Peut-on extrapoler \u00e7a \u00e0 un humain vivant, mobile, vibrant, sensible ? Bien s\u00fbr que non.<\/p>

        Encore aujourd\u2019hui, en 2025, nous n\u2019avons pas de m\u00e9thode fiable et \u00e9thique<\/strong> pour mesurer la pression discale chez l\u2019humain vivant.<\/p>

        O\u00f9 en est-on aujourd\u2019hui ?<\/h2>

        Ce que l\u2019on sait<\/h3>

        • L\u2019\u00e2ge et la g\u00e9n\u00e9tique sont les principaux facteurs d\u2019\u00e9volution discale<\/strong>.<\/p><\/li>

        • L\u2019activit\u00e9 physique, la s\u00e9dentarit\u00e9, le stress, le tabac jouent aussi un r\u00f4le.<\/p><\/li>

        • Une \u00ab\u00a0belle\u00a0\u00bb IRM n\u2019exclut pas la douleur. Une \u00ab\u00a0mauvaise\u00a0\u00bb IRM ne la justifie pas forc\u00e9ment.<\/p><\/li><\/ul>

          McKenzie version 2.0 : la pr\u00e9f\u00e9rence directionnelle<\/h3>

          Aujourd\u2019hui, la m\u00e9thode McKenzie a \u00e9volu\u00e9 :
          on ne cherche plus \u00e0 imposer un mouvement<\/strong>, on teste ce que le patient tol\u00e8re et am\u00e9liore<\/strong>.<\/p>

          En ost\u00e9opathie, cela se traduit par un principe simple :<\/p>

          on travaille dans le sens de la non-douleur, apr\u00e8s avoir test\u00e9 toutes les directions.<\/strong><\/p><\/blockquote>

          Quand faut-il s\u2019inqui\u00e9ter ? Les drapeaux rouges<\/h2>

          Certaines situations n\u00e9cessitent une consultation m\u00e9dicale urgente :<\/p>

          • perte du contr\u00f4le des sphincters (urines, selles),<\/p><\/li>

          • faiblesse motrice majeure,<\/p><\/li>

          • paralysie progressive ou perte de sensation brutale.<\/p><\/li><\/ul>

            Conclusion : l\u2019humilit\u00e9, notre meilleure alli\u00e9e<\/h2>

            L\u2019histoire de la hernie discale est un cas d\u2019\u00e9cole.
            On a d\u2019abord dit : \u00ab\u00a0faites des abdos\u00a0\u00bb<\/strong>, puis \u00ab\u00a0faites de l\u2019extension\u00a0\u00bb<\/strong>, avant de r\u00e9aliser que la r\u00e9alit\u00e9 est bien plus complexe.<\/p>

            Aujourd\u2019hui, on travaille avec humilit\u00e9, nuance et bon sens.<\/strong><\/p>

            • Chaque patient est unique<\/p><\/li>

            • L\u2019\u00e9coute clinique prime sur les protocoles<\/p><\/li>

            • La science \u00e9volue<\/p><\/li>

            • Il faut parfois savoir dire : \u00ab\u00a0Je ne sais pas (encore).\u00a0\u00bb<\/strong><\/p><\/li><\/ul>

              \ud83e\udde0 Et la prochaine fois qu\u2019on vous dit que votre douleur vient \u00ab\u00a0forc\u00e9ment de votre hernie\u00a0\u00bb, posez-vous la question : \u00e0 quelle \u00e9poque se sont arr\u00eat\u00e9es ses connaissances ?<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

              Ou comment on a (presque) tout remis en question Les ann\u00e9es 70 : abdos, posture et th\u00e9orie de l\u2019\u00e9volution Le paradigme de l\u2019\u00e9poque Dans les ann\u00e9es 1970, la compr\u00e9hension du mal de dos \u00e9tait relativement simple :on pensait que les douleurs lombaires \u00e9taient le prix \u00e0 payer pour notre passage de la quadrup\u00e9die \u00e0 la […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"","ocean_second_sidebar":"","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"","ocean_custom_header_template":"","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"","ocean_menu_typo_font_family":"","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"","ocean_post_oembed":"","ocean_post_self_hosted_media":"","ocean_post_video_embed":"","ocean_link_format":"","ocean_link_format_target":"self","ocean_quote_format":"","ocean_quote_format_link":"post","ocean_gallery_link_images":"on","ocean_gallery_id":[],"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2126","post","type-post","status-publish","format-standard","hentry","category-non-classe","entry"],"yoast_head":"\nHernie discale : \u00e9volution des connaissances et des soins - 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