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!
Welcome back!
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!)
2. Getting into neutral or anterior pelvic tilt has shown you how far out of neutral you really are, or how flat your spine really is.
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!
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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
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–
What Is A Disc Herniation?
A disc herniation is a condition that affects the spine in which a tear in the outer fibrous ring of a spinal disc allows the soft central portion to bulge out. But disc herniation is the progression of a previously existing disc protrusion, a situation in which the outermost layers of the annulus fibrosis are still intact, but can bulge when the disc is under pressure.
The disc is a section that lies in between each of the bones of your back. Problems can occur when part of the disk either bulges or moves out of its usual space. It either presses on or comes close to nerves that go down your legs. Pain can possibly result in some cases even if the disk is not actually compressing the nerve but only comes close in proximity.
Disc bulges can occur in one of two different ways:
1. A bulge occurs when the fluid inside a disc is displaced. Bulging discs usually don’t cause any symptoms, because they may not be pressing on the nerve roots as they exit the spine.
2. A herniation occurs when the fluid inside a disc bulges toward the back of your body and breaks through the disc wall’s outer ring, called the annulus fibrosis.
What is interesting to note is that many disc bulges come and go, usually even without treatment, and sometimes can resolve within 4-6 months. Disc herniations, however, can be a significant source of lower back pain, due to the fact that when the bulge compresses on a nerve root as it exits the spine, it can create pain down your butt, hips, and legs, and usually requires treatment of some sort to resolve.
What Causes Disc Herniations?
Disc bulges and herniations are less common with individuals under the age of 30, due to the fact that the disc contains much more fluid and elasticity. As we age, we lose the elasticity in these discs. Most disc herniations occur when a person is in their 30s or 40s, when the nucleus pulposus (the center of the spinal disc) is still a gelatin-like substance. After about age 50, the discs become harder and less elastic, and contain less fluid, therefore becoming less frequently herniated.
Disc herniations can occur from general wear and tear, jobs or acquire constant sitting over long periods of time, and can be the result of long-term muscle imbalances. Lumbar disc herniation occurs 15 times more than the cervical and thoracic portions of the spine.
More often than not, poor postural alignment is usually present with this condition. A flat lumbar spine (measuring less than 30 degrees), combined with a posterior pelvic tilt are usually characteristic.
Maintaining this “office worker” posture over time, causes increased disc pressure, particularly since sitting puts the MOST pressure on spinal discs, especially when there is a rounded back posture, as with “hunching over” at a computer for 8 hours per day!
It is also thought that long term dehydration, may be a contributing factor for spinal disc problems. There may be some truth to this, considering the fact that the majority of the fluid in the disc is WATER! In fact, the nucleus is a soft water attracting substance, comprising up to 25% of the total disc area!
Herniated Disc Symptoms
Spinal disc herniation symptoms can be a little tricky, so you need to be able to accurately describe your symptoms in order to figure out if a disc herniation is causing your pain or not. I mention this because frequently, most medical doctors use visual diagnostics such as MRI’s, X-rays, and sometimes CT scans to diagnose back pain conditions.
This can be VERY mis-leading, considering the fact that both back pain sufferers, and those with NO back pain may have abnormalities show up on these tests. It is important to correlate your symptoms with the findings on the test reports in order to arrive at an accurate diagnosis.
An MRI of a lumbar disc herniation between L4 and L5
Symptoms of a Bulging or Herniated Disc may include:
1. Numbness or tingling going down your butt, hips, legs or feet
2. Sharp or shooting pain referring down your butt, hips, legs or feet
3. Pain upon flexing your spine (bending forward with a rounded lower back). This may reproduce symptoms with a posterior disc bulge.
4. Pain that is worse in the morning, but then gets better as the day goes on. (This is because your spinal discs are MOST hydrated in the morning, and due to this, can be pressing more on the nerve root).
5. More pain in sitting position than in standing. (Sitting increases disc pressure dramatically more than standing).
Disc Herniation Treatments
Most people get better within 2 to 3 months of conservative treatment. The great majority of disc herniations can be treated using nonsurgical, conservative management such as combination of corrective exercises and stretches for muscular imbalance, spinal manipulation techniques, and time.
Most treatments for disc herniations are surgically based, however, there are some natural correction techniques that can help you avoid the potential pitfalls of surgical intervention.
Herniated Disc Exercises and Stretches:
Corrective exercises and stretches, and physical therapy for a herniated disc should not be prescribed haphazardly. Due to the fact that spinal flexion aggravates MOST disc bulges, corrective exercises should target the muscles that extend your spine, thus contributing to anterior pelvic tilt, OR focus on strengthening your spine and pelvis into the “neutral” position. Corrective stretches should target the muscles that create flexion in your spine, as well as posterior pelvic tilt.
There is plenty of evidence showing that movement can be effective for treating disc problems. A program that emphasized skill-based exercise therapy for the spine effectively treated the affected lumbar discs (Saal and Saal 1989) and rehabilitated football players with back injury (Saal 1988). The program aimed to restore automatic control of muscular stabilization of the trunk by teaching subjects to maintain a correct lumbar pelvic position while performing progressively more complex tasks.
You DEFINITELY need to know what you are doing when performing exercises when you have a herniated disc or bulge. Exercises that axially load the spine, reduce a person’s height through discal compression — squat exercises and weight training, for example, can create compression loads in the L3 L4 segment of 6 to 10 times body weight (Cappozzo et al. 1985). Clearly, exercises that involve this degree of spinal loading or unsuitable for individuals with discal pathology.
Mckenzie Extension Protocol:
Renowned physical therapist Robin Mckenzie has a fabulous program for the assessment and treatment of “spinal derangements”. This includes disc bulges.
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