Lumbar Disc Annular Protrusion

A lumbar disc annular protrusion occurs when the outer ring (annulus fibrosus) of an intervertebral disc in the lower back bulges outward beyond its normal boundary, without the inner nucleus pulposus breaking through. This focal bulge can compress nearby nerve roots or the spinal cord, leading to pain, sensory changes, or motor weakness. Annular protrusions are an early stage in the spectrum of disc herniations and often reflect degeneration of disc fibers due to aging, mechanical stress, or injury.

Lumbar disc annular protrusion—often called a contained disc herniation or bulging disc—occurs when part of the soft nucleus pulposus pushes outward against the surrounding fibrous ring (annulus fibrosus) but does not break through it Radiology AssistantOrthobullets. The annulus fibrosus is made of concentric collagen layers that both contain the nucleus and allow for spinal flexibility. When internal disc pressure increases—due to age-related wear, repetitive strain, or sudden load—the nucleus indents the annulus, causing a bulge that can press on nearby nerve roots, leading to pain, numbness, or weakness in the lower back and legs NCBI.

---

Anatomy of the Annulus Fibrosus

Structure

The annulus fibrosus is a multilamellar, fibrocartilaginous ring that surrounds the soft, gelatinous nucleus pulposus at the center of each intervertebral disc. It consists of 15–25 concentric lamellae—layers of collagen fibers arranged at alternating angles—that provide tensile strength and contain the nucleus under pressure. Each lamella integrates with the cartilaginous endplates above and below, forming a continuous load-bearing structure.

Location

Annulus fibrosus lies between the vertebral bodies of L1–L5. In the lumbar region, discs bear the majority of axial load and allow for flexion, extension, and limited rotation. The posterior portion of the annulus is thinner and less reinforced by the posterior longitudinal ligament, making it the most common site of annular protrusion.

Origin

Embryologically, the annulus arises from the mesenchymal cells surrounding the notochord, which differentiate into chondrocyte-like and fibroblast-like cells. By the end of gestation, these cells organize into the lamellar collagen arrangement that characterizes the mature annulus fibrosus.

 Insertion

The outermost lamellae of the annulus attach firmly to the ring apophyses of adjacent vertebral bodies and blend into the Sharpey’s fibers of the vertebral endplate. This anchorage distributes compressive and shear forces between vertebrae and discs.

Blood Supply

In the mature disc, only the outer one-third of the annulus fibrosus has a direct blood supply via small branches of the segmental spinal arteries, which penetrate the outer lamellae. The inner two-thirds are avascular, relying on diffusion through the cartilaginous endplates for nutrient exchange.

Nerve Supply

Sensory nerve fibers (nociceptive and proprioceptive) enter the outer annulus via the sinuvertebral nerves and branches of the ventral rami. These fibers transmit pain when the annulus is overstretched or torn, explaining why annular protrusions can be painful even without major nucleus extrusion.

 Functions (Key Roles)

1. Load Bearing: Resists compressive forces across the spinal column.

2. Tensile Strength: Withstands multidirectional tensile and shear stresses.

3. Containment: Maintains the location and pressure of the nucleus pulposus.

4. Flexibility: Allows controlled motion (flexion, extension, lateral bending).

5. Shock Absorption: Distributes impact forces evenly across vertebral bodies.

6. Joint Stability: Works with ligaments and facet joints to stabilize the spinal segment.

---

Types of Annular Protrusion

Annular protrusions are classified by morphology and severity:

1. Broad-based Bulge: Circumferential, non-focal outward displacement of ≥25% of the disc circumference.

2. Focal Protrusion: Localized bulge affecting <25% of the disc perimeter; the base of the protrusion is wider than its depth.

3. Extrusion (incipient): The protruded material’s depth exceeds the base; however, the annular fibers still contain the nucleus.

4. Contained vs. Uncontained: A protrusion is “contained” if the outermost fibers remain intact; once they rupture, it becomes an extrusion or sequestration.

---

Causes of Lumbar Disc Annular Protrusion

1. Age-related degeneration: Over decades, collagen fibers fragment and lose elasticity, making the annulus less able to resist nucleus pressure.

2. Mechanical overload: Repetitive heavy lifting or high-impact sports strain the annulus, promoting microtears.

3. Poor posture: Chronic slouching increases uneven disc pressure, accelerating annular fiber fatigue.

4. Genetic predisposition: Variations in collagen gene expression can weaken annular structure from birth.

5. Smoking: Nicotine impairs microcirculation to the outer annulus, reducing nutrient delivery and repair capacity.

6. Obesity: Excess body weight raises axial spinal load, hastening disc fiber breakdown.

7. Occupational hazards: Jobs involving vibration (e.g., heavy machinery) or prolonged sitting increase disc stress.

8. Acute trauma: Falls or car accidents can cause sudden annular fissures or bulges.

9. Degenerative joint disease: Facet joint arthritis can alter biomechanics, shifting extra load to discs.

10. Poor core stability: Weak paraspinal and abdominal muscles fail to offload spine during movement.

11. Microtrauma: Repetitive minor disc strains over years accumulate annular fiber damage.

12. Inflammatory conditions: Systemic inflammation (e.g., rheumatoid arthritis) may weaken connective tissues.

13. Metabolic disorders: Diabetes mellitus accelerates glycation of collagen, reducing annular tensile strength.

14. Disc dehydration: Loss of proteoglycans in the nucleus reduces internal pressure balance, stressing the annulus.

15. Congenital anomalies: Schmorl’s nodes or dysplastic vertebral endplates alter disc containment.

16. Spinal alignment issues: Scoliosis or spondylolisthesis changes load distribution across discs.

17. Steroid use: Chronic corticosteroid therapy impairs collagen synthesis and repair.

18. Poor nutrition: Deficiencies in vitamin C or manganese hinder healthy collagen cross-linking.

19. Hormonal changes: Menopause or androgen deficiency can affect disc metabolism and resilience.

20. Prior spine surgery: Fusion or decompression procedures may shift mechanical stresses to adjacent discs.

---

Symptoms of Annular Protrusion

1. Localized low back pain: Deep, aching pain near the affected vertebral level, worse with flexion.

2. Radicular pain (“sciatica”): Sharp, shooting pain radiating down the buttock and leg along a dermatome.

3. Paresthesia: Tingling or “pins and needles” in the thigh, calf, or foot distribution.

4. Weakness: Difficulty dorsiflexing or plantarflexing due to nerve root compression of L4–S1.

5. Reflex changes: Diminished knee-jerk (L4) or ankle-jerk (S1) reflex on the affected side.

6. Muscle spasm: Involuntary contraction of paraspinal or hamstring muscles as a protective mechanism.

7. Limited range of motion: Stiffness with forward bending or twisting due to pain and muscle guarding.

8. Postural abnormalities: Antalgic lean or flexed posture to reduce nerve stretch.

9. Gait disturbances: Foot drop or cautious walking to minimize nerve irritation.

10. Back stiffness after rest: Pain and rigidity upon standing after prolonged sitting or lying.

11. Pain aggravated by coughing/sneezing: Valsalva increases intradiscal pressure, worsening protrusion symptoms.

12. Nocturnal pain: Discomfort that awakens from sleep due to sustained positions.

13. Change in bladder/bowel habits: Rare, severe protrusions can impinge on cauda equina—medical emergency.

14. Leg heaviness: Sensation of leg dragging secondary to sensory-motor disruption.

15. Numbness: Complete loss of sensation in specific dermatomal territory.

16. Trophic changes: Skin or nail changes in chronic cases due to autonomic nerve involvement.

17. Referred pain: Pain felt in the groin or hip due to shared innervation.

18. Sciatic claudication: Leg pain brought on by walking, relieved by rest.

19. Hip flexor weakness: Difficulty bringing thigh toward chest if L2–L3 roots are involved.

20. Loss of balance: Proprioceptive deficits from nerve root irritation causing unsteadiness.

---

Diagnostic Tests

A. Physical Examination

1. Inspection and Posture Analysis: Observe spinal alignment, muscle tone, and antalgic postures.

2. Palpation: Identify tender paraspinal muscles or spinous processes.

3. Range of Motion (ROM): Measure flexion, extension, lateral bending; restrictions often signal pain-provoked guarding.

4. Straight Leg Raise (SLR) Test: With the patient supine, raising the straight leg between 30–70° reproducing sciatic pain suggests L5–S1 nerve root irritation.

5. Crossed SLR Test: Pain in the opposite leg during SLR indicates a large central or posterolateral protrusion.

6. Slump Test: Seated slouched posture with neck flexion stretches the neural tissues; reproduction of leg pain implies neural tension.

7. Femoral Nerve Stretch Test: Prone knee flexion with hip extension; anterior thigh pain suggests upper lumbar nerve involvement (L2–L4).

8. Valsalva Maneuver: Deep breath and bearing down increase intraspinal pressure; exacerbation of back/leg pain indicates intraspinal lesion.

B. Manual Neurological Tests

9. Manual Muscle Testing (MMT): Assess strength of major muscle groups innervated by affected roots (e.g., tibialis anterior for L4).

10. Dermatomal Sensory Testing: Light touch and pinprick in dermatomal distribution to map sensory deficits.

11. Reflex Testing: Patellar (L4) and Achilles (S1) reflexes to detect hypo- or areflexia.

12. Tinel’s Sign at the Spine: Percussion over the spinous processes; localized pain may indicate facet joint involvement rather than disc.

13. Gait Assessment: Heel‐and‐toe walking to evaluate motor root function and balance.

14. Functional Tests: Single‐leg stance or sit‐to‐stand transfers to observe compensations and strength deficits.

C. Laboratory & Pathological Tests

15. Complete Blood Count (CBC): Rule out infection or systemic illness presenting with back pain.

16. Erythrocyte Sedimentation Rate (ESR)/C‐Reactive Protein (CRP): Elevated in infectious or inflammatory etiologies (discitis, spondylitis).

17. HLA‐B27 Typing: In younger patients with back pain, to evaluate for ankylosing spondylitis.

18. Discography (Provocative): Injection of contrast into the nucleus under pressure reproducing pain localizes symptomatic disc but has limited routine use.

D. Electrodiagnostic Tests

19. Electromyography (EMG): Detects denervation changes in muscles supplied by compressed nerve roots, confirming chronicity and root level.

20. Nerve Conduction Velocity (NCV): Measures conduction speed along peripheral nerves; slowed conduction suggests demyelination or severe compression.

21. Somatosensory Evoked Potentials (SSEPs): Record cortical responses to peripheral nerve stimulation; useful in complex cases or surgical monitoring.

22. Motor Evoked Potentials (MEPs): Assess corticospinal tract integrity; primarily used intraoperatively.

E. Imaging Tests

23. Plain Radiographs (X-ray): Lateral and AP views assess bony alignment, disc height loss, osteophytes, and structural abnormalities.

24. Magnetic Resonance Imaging (MRI): Gold standard for visualizing annular bulges, nerve root compression, and degree of disc degeneration.

25. Computed Tomography (CT): Detailed bony anatomy and calcified protrusions; often combined with myelography.

26. CT Myelogram: Contrast in the thecal sac outlines nerve roots and cord, highlighting indentations by protruded disc.

27. Ultrasound: Emerging for paraspinal muscle assessment, but limited for direct disc visualization.

28. Disc Height Measurement: On MRI/CT, quantifies disc degeneration severity.

29. Dynamic Flexion-Extension X-rays: Detects instability or spondylolisthesis that may accompany annular weakness.

30. High‐Resolution T2‐Weighted MRI: Differentiates annular tears (high‐intensity zones) from normal fibers.

Non-Pharmacological Treatments

Non-drug approaches are first-line for annular protrusion, aiming to relieve pain, restore function, and promote healing without medication MDPINYU Langone Health. Below are 30 evidence-based options, grouped by modality.

A. Physiotherapy & Electrotherapy

1. Transcutaneous Electrical Nerve Stimulation (TENS)

   • Description: Small electrodes deliver low-voltage electrical pulses to the skin.

   • Purpose: Block pain signals before they reach the brain.

   • Mechanism: Activates inhibitory nerve fibers and promotes endorphin release Physiopedia.

2. Mechanical Spinal Traction

   • Description: Motorized table gently stretches the spine.

   • Purpose: Decompress spinal structures and widen intervertebral spaces.

   • Mechanism: Reduces intradiscal pressure, easing nerve root irritation PMC.

3. Therapeutic Ultrasound

   • Description: High-frequency sound waves applied via a handheld probe.

   • Purpose: Promote tissue healing and reduce muscle spasm.

   • Mechanism: Creates micro-vibrations that increase blood flow and collagen extensibility.

4. Interferential Current Therapy

   • Description: Two medium-frequency currents intersect in the tissue.

   • Purpose: Deep pain relief with minimal skin irritation.

   • Mechanism: Produces low-frequency stimulation internally, blocking pain signals.

5. Low-Level Laser Therapy (LLLT)

   • Description: Low-intensity lasers applied to skin surface.

   • Purpose: Reduce inflammation and promote cellular repair.

   • Mechanism: Photobiomodulation stimulates mitochondrial activity.

6. Shortwave Diathermy

   • Description: Electromagnetic energy heats deep tissues.

   • Purpose: Relieve muscle spasm and improve tissue extensibility.

   • Mechanism: Increases blood flow and metabolic activity in deep tissues.

7. Electrical Muscle Stimulation (EMS)

   • Description: Pulsed currents cause muscle contractions.

   • Purpose: Strengthen atrophied muscles and improve circulation.

   • Mechanism: Activates motor nerves to trigger muscle work.

8. Non-Surgical Spinal Decompression

   • Description: Computer-controlled traction alternating pull and relaxation.

   • Purpose: Encourage disc fluid movement and nutrient exchange.

   • Mechanism: Creates negative intradiscal pressure, drawing herniated material inward journal.parker.edu.

9. Extracorporeal Shockwave Therapy

   • Description: Focused acoustic pulses delivered to painful area.

   • Purpose: Promote tissue regeneration and pain relief.

   • Mechanism: Induces microtrauma that triggers healing cascade.

10. Heat Therapy

    • Description: Continuous low-level heat packs or lamps.

    • Purpose: Relax muscles and increase local blood flow.

    • Mechanism: Vasodilation and reduced muscle spindle activity.

11. Cold Therapy (Cryotherapy)

    • Description: Ice packs or cold compresses.

    • Purpose: Decrease inflammation and numb pain.

    • Mechanism: Vasoconstriction reduces edema and slows nerve conduction.

12. Spinal Mobilization (Manual Therapy)

    • Description: Therapist-applied gentle oscillatory movements.

    • Purpose: Improve joint mobility and relieve pain.

    • Mechanism: Stimulates mechanoreceptors to inhibit pain pathways.

13. Myofascial Release

    • Description: Sustained pressure on fascial restrictions.

    • Purpose: Reduce stiffness and improve soft-tissue glide.

    • Mechanism: Modifies fascia viscoelasticity and pain receptor thresholds.

14. Therapeutic Massage

    • Description: Hands-on soft-tissue manipulation.

    • Purpose: Alleviate muscle tension and improve circulation.

    • Mechanism: Increases venous and lymphatic flow, reduces stress hormones.

15. Kinesio Taping

    • Description: Elastic tape applied to skin over target muscles.

    • Purpose: Support joints, reduce pain, and facilitate muscle function.

    • Mechanism: Lifts skin to improve microcirculation and proprioception.

B. Exercise Therapies

16. McKenzie Extension Exercises

    • Focused back-extension movements to centralize pain by mobilizing the disc.

17. Core Stabilization

    • Gentle strengthening of abdominal and lumbar muscles to support the spine.

18. Hamstring Stretching

    • Sustained stretches to relieve posterior thigh tightness and reduce disc load.

19. Pilates-Based Lumbar Control

    • Low-impact mat work targeting spinal alignment and muscle endurance.

20. Gentle Yoga

    • Controlled poses to enhance flexibility, balance, and relaxation.

21. Aquatic Therapy

    • Water-based exercises that unload the spine while facilitating movement.

22. Walking Program

    • Gradual, pain-free walking to boost circulation and overall conditioning.

23. Tai Chi

    • Slow, coordinated movements improving posture, balance, and mind-body awareness.

C. Mind-Body Therapies

24. Mindfulness-Based Stress Reduction (MBSR)

    • Guided meditation and awareness techniques to reduce pain catastrophizing.

25. Biofeedback

    • Real-time monitoring of muscle tension to teach voluntary relaxation.

26. Cognitive Behavioral Therapy (CBT)

    • Psychological strategies to reframe pain thoughts and improve coping.

27. Guided Imagery & Relaxation

    • Mental visualization to induce a relaxation response and lower muscle tension.

D. Educational Self-Management

28. Pain Neuroscience Education

    • Teaching the biology of pain to reduce fear and encourage active recovery.

29. Ergonomic Training

    • Instruction on proper workplace and home posture to prevent aggravation.

30. Activity Modification & Pacing

    • Strategies to balance rest and activity, avoiding flare-up triggers.

---

Pharmacological Treatments

Medications complement non-drug approaches by targeting pain pathways, inflammation, or muscle spasm. All dosages and timing are general guidelines; individual needs vary.

---

Dietary Molecular Supplements

These may support disc health and modulate inflammation; quality and purity vary.

1. Glucosamine Sulfate (1500 mg/d)

   • Function: Supports cartilage matrix.

   • Mechanism: Provides substrate for glycosaminoglycan synthesis.

2. Chondroitin Sulfate (1200 mg/d)

   • Function: Maintains disc proteoglycans.

   • Mechanism: Inhibits degradative enzymes in cartilage.

3. Curcumin (500–2000 mg/d)

   • Function: Anti-inflammatory antioxidant.

   • Mechanism: Inhibits NF-κB and COX-2 pathways.

4. Omega-3 Fatty Acids (2–4 g/d)

   • Function: Modulate inflammatory mediators.

   • Mechanism: Compete with arachidonic acid to reduce pro-inflammatory eicosanoids.

5. Vitamin D₃ (1000–2000 IU/d)

   • Function: Bone and muscle health.

   • Mechanism: Regulates calcium homeostasis and muscle function.

6. Magnesium (300–400 mg/d)

   • Function: Muscle relaxation and nerve conduction.

   • Mechanism: Acts as a calcium antagonist in muscle fibers.

7. MSM (Methylsulfonylmethane, 1–3 g/d)

   • Function: Joint support and anti-inflammatory.

   • Mechanism: Donor of sulfhydryl groups for antioxidant enzymes.

8. Collagen Peptides (10–15 g/d)

   • Function: Promote connective tissue repair.

   • Mechanism: Stimulates fibroblast activity and extracellular matrix synthesis.

9. Boswellia Serrata (300–600 mg/d)

   • Function: Inhibits leukotriene synthesis.

   • Mechanism: Blocks 5-lipoxygenase enzyme.

10. EGCG (Green Tea Extract, 300–400 mg/d)

    • Function: Antioxidant and anti-inflammatory.

    • Mechanism: Scavenges free radicals and downregulates inflammatory cytokines.

---

Advanced “Drug” Therapies

These biotherapies aim to regenerate or protect disc tissue:

1. Alendronate (70 mg weekly)

   • Function: Bisphosphonate for bone turnover.

   • Mechanism: Inhibits osteoclast-mediated bone resorption.

2. Risedronate (35 mg weekly)

   • Similar to alendronate, with once-weekly dosing.

3. Zoledronic Acid (5 mg IV yearly)

   • Potent bisphosphonate infusion to maintain bone density.

4. Teriparatide (20 µg daily)

   • PTH analog stimulates osteoblasts and new bone formation.

5. rhBMP-2 (Bone Morphogenetic Protein-2, 1.5 mg)

   • Promotes spinal fusion by inducing osteogenesis at surgical site.

6. Platelet-Rich Plasma (PRP) Injection

   • Autologous growth factors to stimulate tissue repair.

7. Hyaluronic Acid Injection (2 mL of 1% solution)

   • Viscosupplementation to improve joint lubrication and disc hydration.

8. Mesenchymal Stem Cell Therapy (106 cells/site)

   • Harvested MSCs injected to modulate inflammation and regenerate disc matrix.

9. Stromal Vascular Fraction

   • Adipose-derived cells delivered to injury site for regenerative support.

10. Autologous Chondrocyte Implantation

    • Cultured patient chondrocytes implanted to rebuild disc cartilage.

---

Surgical Options

Surgery is reserved for severe or refractory cases.

1. Microdiscectomy

   • Procedure: Microscope-assisted removal of disc fragment.

   • Benefits: High relief of leg pain, rapid recovery.

2. Open Discectomy

   • Traditional removal of herniated disc via small incision.

3. Laminectomy

   • Removal of the lamina to decompress nerve roots in spinal stenosis.

4. Spinal Fusion

   • Titanium hardware plus bone graft fuses two vertebrae to eliminate motion.

5. Endoscopic Discectomy

   • Minimally invasive, with small endoscope and instruments.

6. Artificial Disc Replacement

   • Prosthetic disc preserves motion at the diseased segment.

7. Percutaneous Nucleoplasty

   • Radiofrequency energy creates channels in the nucleus to reduce pressure.

8. Chemonucleolysis (Chymopapain Injection)

   • Enzymatic dissolution of nucleus pulposus fibers.

9. Radiofrequency Ablation

   • Heat-based inactivation of pain-transmitting nerve fibers.

10. Facet Joint Fusion

    • Targeted fusion to stabilize painful facet joints adjacent to herniation.

---

“Dos & Don’ts”

Do

1. Maintain neutral spine posture during sitting and lifting.

2. Use lumbar support when driving or working at a desk.

3. Take short walking breaks every 30–60 minutes.

4. Apply heat before activity, cold after flare-ups.

5. Perform daily gentle stretching.

6. Sleep with a bolster under the knees when supine.

7. Keep active within pain-free limits.

8. Wear low-heeled, supportive shoes.

9. Hydrate well for disc health.

10. Follow an ergonomically sound workstation setup.

Avoid

1. Heavy lifting above shoulder level.

2. Twisting the torso under load.

3. Prolonged sitting without breaks.

4. High-impact activities (e.g., running on hard surfaces).

5. Sudden bending or jerking motions.

6. Sleeping on a sagging mattress.

7. Carrying heavy bags on one shoulder.

8. Smoking (impairs disc nutrition).

9. Ignoring persistent or worsening symptoms.

10. Self-prescribing strong opioids without guidance.

---

Prevention Strategies

1. Strengthen Core Muscles: Protects the spine by stabilizing the torso.

2. Maintain Healthy Weight: Reduces compressive forces on discs.

3. Ergonomic Lifting: Bend at hips and knees, keep load close.

4. Postural Awareness: Use lumbar rolls and adjust screens.

5. Regular Low-Impact Exercise: Swimming, cycling to maintain flexibility.

6. Balanced Nutrition: Support disc matrix with protein, vitamins.

7. Stay Hydrated: Discs need water to maintain height.

8. Quit Smoking: Improves disc nutrition.

9. Periodic Stretch Breaks: Avoid tissue shortening.

10. Use Supportive Footwear: Absorb ground forces.

---

When to See a Doctor

• Red-Flag Pain: Severe, unrelenting back pain unrelieved by rest.

• Neurological Deficits: New numbness, weakness, or loss of reflexes in legs.

• Cauda Equina Signs: Saddle anesthesia, bladder/bowel changes—emergency.

• Fever or Weight Loss: Suggests infection or malignancy.

• Failed Conservative Care: No improvement after 6–8 weeks of non-surgical management.

---

Frequently Asked Questions

1. What is an annular protrusion?
   A contained bulging of the disc’s inner gel against its outer ring, often causing back or leg pain.

2. How does it differ from a herniation?
   Protrusion keeps the annulus intact; herniation breaks through it.

3. Can it heal on its own?
   Many bulges improve with time, rest, and non-surgical care.

4. Is imaging always needed?
   Not initially—clinical exam guides most of the early management.

5. How long does recovery take?
   6–12 weeks for most people, with full recovery in up to 6 months.

6. Will I need surgery?
   Only if severe nerve compression or no improvement after 6–8 weeks of conservative care.

7. Are opioids recommended?
   Reserved for short-term, severe pain and always under medical supervision.

8. How often should I exercise?
   Daily gentle stretching and core exercises, under guidance.

9. Can I work through the pain?
   Light activity is encouraged, but avoid heavy lifting or twisting.

10. Are supplements effective?
    Some (e.g., glucosamine, omega-3) may help, but evidence is mixed.

11. What role does posture play?
    Good posture reduces disc stress and prevents recurrence.

12. Can stress make it worse?
    Yes—stress increases muscle tension and pain perception.

13. What is pain education?
    Learning the science of pain to reduce fear and encourage active recovery.

14. Is cold or heat better?
    Cold for acute flares (first 48 hr), then heat to relax muscles.

15. When should I worry about neurological signs?
    Seek urgent care if you develop leg weakness, numbness, or bladder/bowel changes.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 17, 2025.