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

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–