The Non-Surgical Approach To Disc Herniations: Part 3

Welcome back to part 3 of this special series on my non-surgical approach to disc herniations. As mentioned previously, the information in this blog is for INFORMATION ONLY. Please DO NOT attempt any movements that have not been approved by your doctor. Failure to listen to this advice could potentially cause you more pain if used inappropriately, or in use with a mis-diagnoses.

So, with that said, I am now going to introduce to you a movement that has brought me a tremendous amount of success with patients with disc herniations. I don’t take credit for this movement, originally learned through Robin Mckenzie, a renowned physical therapist who introduced flexion and extension based therapies for spinal dysfunctions.

This movement, along with what I have been talking about all along, is focused on improving extension in your spine, which is ideal for relieving pressure on spinal discs, particularly of the posterior disc bulge variety. In this video, I will explain how to perform the movement:



As you have seen, there are a few progressions to this movement. It is CRITICAL to make sure you start with the MOST appropriate level of the movement based on your pain levels and to the degree that your disc is bulging. This movement at times can create quite a bit of discomfort if done with too much intensity, even if it is the best thing for you.

When giving this protocol, I usually start off with the following protocol:

1. Lay face down for 3-10 minutes to allow muscles to relax and pain levels to diminish
2. If you feel better, then slowly begin to work yourself up onto your forearms, and relax there for 30 seconds to 60 seconds, depending on comfort.
3. You may then rest for 30 seconds, and repeat for 3-6 reps, or move to the next movement.
4. Prop yourself up onto your elbows, then repeat the procedure as outlined in #3
5. Lastly, begin performing the pushup to tolerance and/or upper body endurance, repeated for 10 repetitions.

There may be a stage between each of these steps by 1-7 days, depending on the severity of the condition. If all done on the same day, proceeding through the steps as sort of a “warm up” procedure, then each set (from 1-5) is only done once.

This procedure may be done as frequently as every hour on the hour, especially if you work at a seated postion all day, as compressive loads during sitting are one of the worst for disc bulges.

Again, this is ONLY a general outline. When using this in my practice, often times it will be INDIVIDUALIZED with EVERY patient, depending on pain levels, severity of the condition, and VERY importantly, how well they are sticking to the lifestyle outlines!

The Non-Surgical Approach To Disc Herniations: Part 2

If you have not read through and been practicing the pelvic tilting drill from part one of this series, then do NOT go further until you have done so!! (Click here for part 1) For those of you who have, welcome back. Hopefully you have gained some useful insight as a result of practicing your pelvic tilting motions throughout the day. Most people will notice a few things here:

1. Correcting your posture every hour on the hour is a pain in the a##. (No pun intended!)

3. Pain relief is directly correlated to the pelvic position you are in.

Here is a video re-cap:

More Lifestyle

As I mentioned, LIFESTYLE adjustments are the most important factors to consider when working with a disc herniation. Structural problems with the spine take time, so the most important thing to focus on is essentially to not “add insult to the injury”.

The lifestyle factors I am about to deliver here may be at first seem drastic, and you may feel tempted to follow only the ones you feel like, but you have to trust me on these.

When doing a consultation, I will NOT work with a disc herniation patient unless they are fully committed to these lifestyle changes, and have their spouse assist them in the process.

Why?

Well, because it only takes ONE STUPID choice to lift something improperly, or bend over the wrong way, etc. in order to blow the disc. Then you have to

start all over again, or its off to the operating table!

Take care of these lifestyle recommendations, and you will have success. Failure to follow them may result in long term and repeated setbacks in the healing process.

So, don’t say I didn’t warn you!

Training and Taping Of The Lumbar Curve

Here is a quick video:

One of the best tricks I picked up was taping the lumbar spine. This is a cool little trick for teaching you how to stay in the ideal position for pain relief, and it also functions as a “warning light” as to when you are unconsciously flexing your lumbar spine.

You will need someone to assist you will this process.

First, lay face down on the ground. Naturally, you will have some extension in your lower back which is good.

Next, perform an anterior pelvic tilt as far as you can comfortably go. Then, from the end of the range of motion, allow your pelvis to move back toward neutral just a hair. This is the position in which you will hold for the taping.

Then, have your helper run two strips of tape from just below your PSIS bones to about T-11/T-12. (Just above your last ribs).

I highly suggest using some “pre-tape” here. This makes it easier to remove later without ripping your skin or hair off if you happen to have some on your lower back.

Find GOOD tape here:
http://www.optp.com/Departments/Taping/All-Varieties-of-Tape.aspx

Run about 2 strips up each side of the spine, and make sure they are securely in place.

Now, here is the fun part….

Since the tape is now holding your spine into a light extension, you will need to get up onto your hands and knees, then get to a standing position without pulling the tape off! You will now find it VERY easy to know when you are flexing your lumbar spine. Whenever that tape begins to tighten, it will be a signal that you need to watch out in that particular position or activity for increased disc pressure.

It is a fabulous learning tool, sometimes aggravating, but VERY necessary in the process of reducing disc herniation pressure and pain.

The tape will naturally wear as you shower and move with it, but in some cases, it will stick as long as a week, depending on the type of tape you buy, your skin type, and how securely you applied it.

That’s it for part 2! Baby steps, baby steps. Remember, with disc herniations, you have nothing but time, and a focus on NOT adding further insult to injury! Now, get out there and do some taping!

See you next time for Part 3!

-Sam Visnic NMT

L-5 Disc Herniation Treatment

Inflammation and Back Pain

The Non-Surgical Approach To Disc Herniations: Part 1

Disc herniations are most common in the age range of 35-55, due to the beginning of fluid loss in spinal discs. Contrary to what is popularly assumed, it is actually one of the lesser causes of lower back pain. Typically, the only recommendation that most medical doctors make for this condition includes surgical intervention, which may include disc-ectomy or spinal fusion. Other than that, the usual pharmaceutical route is taken for decreasing pain.

Pretty weak, right??

I have seen more cases than I care to count. Most people with disc pathology initially start off with quite a bit of pain. In an effort to find a solution, they visit their primary care physician, who essentially only proves them with either a written prescription for pain medication, or a referral to an orthopedic surgeon. They opt to wait, but in the meantime, the pain is not decreasing, mostly due to the fact that disc herniations take a WHILE to get better, sometimes up to 18 months if significant tearing in the annular fibers has occurred. The doctor and/or physical therapist generally doesn’t teach the lifestyle factors that are necessary to heal, such as how to lift properly, what TO do and what NOT to do, and exercises plus stretches that are necessary to correct body alignment and therefore relieve spinal disc pressure.

So, at this point, it appears that surgery is the only option. Once the surgery is performed, as statistics have ADAMANTLY shown, pain is only resolved in a SMALL population of post-surgical back pain sufferers. As many as 2/3 are in MORE pain!

Now, the situation becomes clear. The spine does not move as it was originally intended. Muscle imbalances that were present PRIOR to the surgery are usually worse now, due to the fact that now many key spinal stabilizer muscles are inhibited (shut off) due to the surgical intervention, pain, and the gut stress caused by anti-inflammatory medications.

Unfortunately, these back pain sufferers, now tainted by the medical community, try one alternative therapy after another, ultimately seeking to find effective pain relief that will actually LAST. Most of these therapies do NOT address the underlying mechanisms that are responsible for the pain, and focus mostly on symptom relief only.

I have a soft spot for such cases. I can’t possibly understand the EXPERIENCE of your situation, but know VERY WELL your frustration with a lack of answers to your pain. With that said, I have put together some essentials that you MUST know if you are seeking relief from disc herniations or bulges.

Lifestyle Vs. Therapy?

One of the most important things to keep in mind with spinal derangements is that they should be treated with MUCH greater caution and care than simple muscle imbalance generated lower back pain. Spinal derangements such as disc bulges take TIME to heal, rather than a simple manual therapy technique, exercise, stretch, etc.

The focus on disc issues should be on LIFESTYLE awareness. Most people do just fine when in their therapist’s or doctor’s office, but typically end up making their situation worse in the home or work environment. Keep in mind, no matter how GOOD your 60 minute therapeutic exercise or manual therapy session is, it simply will NOT compete with 23 hours of bad postural alignment, horrendous inflammation-producing eating habits, and chronic stress.

Now that you understand that LIFESTYLE is first and foremost, lets start there….

Understanding the Basic Rule:

The majority of disc herniations are of posterior protrusion, which means that the disc is bulging toward your back side, rather than toward the front of your body, which would be called an anterior disc bulge. Anterior disc bulges are somewhat rare unless you have had some sort of trauma such as car accident, or having something dropped on you from above. Based on this, I will be mostly focusing on POSTERIOR disc problems.

Most posterior disc bulges cause pain when flexion occurs, which is bending forward, allowing your back to round. In this situation, the disc moves posteriorly, thus compressing on the spinal nerves.

Obviously, this is the position you want to avoid at ALL costs. Now, traditionally, the treatment for such disc bulges would be extension therapy. That would focus you on extending your spine to reduce disc pressure. On most occasions, this works, however, in some cases, because of how the disc has bulged, even extension may cause pain initially.

That essentially leaves 2 options. Either perform an extension based program for relief, OR stay in NEUTRAL spinal alignment until the situation improves, then attempt extension based therapy. It really depends on the situation, but when in doubt, NEUTRAL spine is the place to be! If you don’t move, then you won’t hurt more!

Here is a quick video:

Obviously at first, this one homework assignment may be enough for most disc herniation patients. Why? Well, you need to LEARN how to move your pelvis into anterior and posterior pelvic tilt (which moves the spine!) in order to find out if extension hurts, and exactly where neutral spine actually IS.

Locating Neutral Spine:

First, tilt your pelvis into anterior pelvic tilt. As you can see in the pic below, this involves ARCHING your lower back, thus increasing your lumbar curve. With most disc herniations, this is the most comfortable position to be in.

Then, GENTLY tilt your pelvis posteriorly. To do this, gently squeeze your glutes and move your pelvis as if “tucking your tail”. If you have a disc herniation, too much posterior pelvic tilt, which causes your lumbar spine to flatten, may cause increased disc pressure and thus pain. Do NOT go too far in this motion.

Now find the region that is mid-way between anterior and posterior pelvic tilt. This is called NEUTRAL. The neutral zone is pretty large, and the best place is the one that causes you the least discomfort.

Now that you understand how to move your pelvis, thus influencing your lumbar curve, the key is to find the place between NEUTRAL and ANTERIOR Pelvic Tilt that decreases your pain the MOST. This is the position you want to spend MOST of your time in.

Focus on finding this position every hour on the hour as an assignment. This is step one!

Then come back for part 2!

Sam Visnic NMT–

Pelvic Tilt Measurement

A common email question I receive is about measuring pelvic tilt. The best way to measure pelvic tilt is with a specialized set of calipers that were developed by neuromuscular therapist Paul Chek. These can be quite pricey, and are only usually found in the offices of skilled therapists.

The other way to measure pelvic tilt, which is quick, cost-free, and easily done is home is by looking at your belt line in the mirror. Usually, the front of your belt line rests either slightly above, or slightly below the Anterior Superior Iliac Spine, which is the small bony protuberance just above your thigh. The backside of your belt line usually rests again just above or below the Posterior Superior Iliac Spine, which are found about 2 inches to the side of the spine.

When you look in the mirror at your side view, you will look at the angle of the belt line. For men, the line should be parallel to the ground, with neither the front or the backside higher than the other, with normal measuring 0-5 degrees. For women, the angle should be slighter lower on the front side than the backside within approximately 7-10 degrees being normal.

It is important to note, that these are the “textbook” normal values for pelvic tilt. It should not be the ONLY evaluation for normal function and balance of the core muscles. You should also evaluate the range of motion and strength of all the associated muscles in order to really test total function of this area. You do NOT have to be perfect, but close enough to be out of pain!

Sam Visnic–

Free Program: Strategies For The Correction Of Anterior Pelvic Tilt

Anterior pelvic tilt is the most common postural dysfunction affecting back pain sufferers. I’ve created a brief report and intro program for assisting in the correction of anterior pelvic tilt.

Download it by clicking here: Enjoy!

4-essential-strategies-for-the-correction-of-anterior-pelvic-tilt

What Does Vitamin D Have To Do With Your Back Pain?

Recently, I have been reading much more into the topic of Vitamin D, and its apparent influence on chronic musculoskeletal pain. Various research papers have been appearing showing that vitamin D deficiency is EXTREMELY common in general, but an even MORE common finding with those suffering from lower back pain.

There are a number of reasons for why vitamin D deficiency can cause chronic pain.

1. Vitamin D deficiency causes a reduction in calcium absorption.
2. Production of parathyroid hormone is increased to maintain blood calcium levels
3. Parathyroid hormone results in increased urinary excretion of phosphorus, which leads to hypophosphatemia.
4. Insufficient calcium phosphate results in deposition of unmineralized collagen matrix on the endosteum (inside) and periosteum (outside) of bones.
5. When the collagen matrix hydrates and swells, it compresses the sensory-innervated periosteum, resulting in pain.

(excerpt from Musculoskeletal Pain: Expanded Clinical Strategies, by Alex Vasquez, DC)

Now, what all that jargon basically means is that vitamin D deficiency creates a widespread state of pro-inflammation in the body. This situation is completely reversible with proper vitamin D supplementation.

In a few studies done, a very impressive percentage of back pain sufferers either improved dramatically or had complete resolution of their pain with vitamin D supplementation. It is important to note, however, that the individuals who received these results had chronic, undiagnosed pain. Meaning, the pain was not attributed to any mechanical diagnosis, such as disc herniation.

However, that does not mean that vitamin D can’t help you with back pain if you do have a mechanical cause.

Based on this new, exciting information, it would be worthwhile to have your doctor check your Vitamin D3 levels for deficiency. Correcting it may be your ticket to back pain relief!

Sam Visnic–

Thoracic Kyphosis: The “Hunch-back” Posture

What Is Thoracic Kyphosis?

Kyphosis refers to a natural curvature of the portion of the spine called the thoracic spine.  The opposite curvature, called the lordosis typically occurs in the cervical and lumbar spine.

Since kyphosis is natural in the spine, we have to identify what excessive kyphosis is, which is generally the problem.  Generally speaking, a normal for a thoracic kyphotic curve measures between 30 to 35°.  In excessive kyphosis would be greater than 35°.

Many times, however, it’s important to realize that the thoracic curvature is only greater than 35° when you’re slouching, and in many cases corrects into the normal range as you stand upright.  So a quick test involves this: stand sideways in the mirror, and look at your curvature in your thoracic spine.  Now, imagine that you have a look attached underneath your sternum and it is pulling up to the sky.  As you perform this motion, notice what happens to your thoracic curve, when you look in the mirror.

A second test can be performed, which may determine whether there is a lack of mobility in the thoracic spine.  In this test, you will perform the exact same movement, with the exception that you will lift your arms up and behind your head and as far as you can comfortably go, and notice what happens to your curve.  Typically, the thoracic spine, should decrease in curvature by approximately 14°, or be straight.  Oftentimes this is difficult to eyeball, that is when the clinic to use special calipers to measure this.  However, since you don’t have these, eyeballing it will have to do.

If you are not able to reduce your curve enough, there may be some rigidity in your thoracic spine and may need mobilization work. 

Pic of excessive thoracic kyphosis

What Causes Kyphosis?

Excessive thoracic kyphosis can be caused by some random things such as nutritional imbalance as a child, such as vitamin d deficiency, or problems with growth plates.  The majority of excess kyphotic postural problems occur frankly from slouching!  Bad postural alignment today is rampant, particularly since we spend so much more time on the computer. 

Another cause for kyphosis involves a strong mental-emotional component.  Emotional states such as depression, worry, anxiety, lethargy, and hopelessness lead to a slouching of posture.  Many times, however, if the kyphosis can be completely corrected by standing upright, and these emotions are present, they may need to be addressed as the root cause.

Treatment for Kyphosis:

Excessive thoracic kyphosis can be treated in a number of ways naturally.  Its important to realize, however, that correction of kyphotic posture takes time.  It involves exercises, stretches, mobilizations, as well as continual postural correction.  You’re looking at anywhere from 3 months to 1 year to make significant progress on reducing excessive postural kyphosis. 

Kyphosis Exercises:

The Prone Extension:  This is a drill that I include in the “End Your Back Pain Now!” DVD set.  It is a lying down exercise that focuses on strengthening the muscles of the upper back, which over time, can reduce the excess kyphotic curve in the thoracic spine.

Brugger Relief Position:  The Brugger relief position is essentially a combination of postural “cues” that can assist you in getting into good postural alignment, which can reduce strain on muscles, and give you temporary relief from pain.  Here is how to do it:

1.        Sit at the edge of a chair.

2.       Move your knees apart a bit, and make sure your feet are under your knees.

3.       Perform a slight anterior pelvic tilt.

4.       Externally rotate your arms so that your palms face forward.

5.       Separate your fingers and point your thumb backward.

6.       Retract your head so that it is in alignment with the rest of your body.

7.       Hold this position for as long as possible, while breathing naturally. 

8.       Do this throughout the day on a regular schedule, such as every hour on the hour.

Kyphosis Stretches:

While it is essential to strengthen the muscles that are causing the slouching of the thoracic spine to occur, it is also important to stretch the muscles that are holding the postural dysfunction in place.  Two muscles that can significantly contribute to excess thoracic flexion include the abdominals, as well as the diaphragm. 

Abdominal stretching:  Stretching your abs can help tremendously in reducing thoracic kyphosis, because at the same time you stretch them, you are mobilizing your spine.  One of the best ways to stretch your abs is by laying over a swiss ball.  Its important to make sure you relax as you do this stretch, and breath naturally, as this will serve to improve the release you get. 

Foam rolling the thoracic spine:  This technique involves laying over a foam roll, like what you find in the gym, for the purpose of mobilizing your spine.  Basically this means stretching it backwards over the roll.  This technique can be quite tender on your spine at first, particularly at those spinal segments that are not moving very well, but can improve quickly over about 2 weeks with consistent work on the roller.

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