Common Questions and Concerns regarding the Treatment of Lumbar and
Cervical Disc Problems Levitt Chiropractic Center 8955 SW 87th Ct, Ste 101 Miami, Fl 305-233-5700
In order to provide you with the necessary information you need regarding the treatment from disc problems, we have created this handout to answer the most common questions. Well-informed patients often have better outcomes.
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There are 26 spinal bones, known as vertebrae, each separated by cushions, known as discs. The discs allow movement between the bones and create a separation between the bones (or vertebrae) so the nerves have a clear and spacious exit route between the vertebrae. The disc itself is made of cartilage, like the material that lines all of the joints. The disc material can become irritated (inflamed), torn (herniated) or a piece of torn disc material can actually separate itself from the disc (sequestered). The source of your pain can come from the irritated disc material itself, but commonly comes from indirect pressure on the nearby nerve, which is extremely sensitive. A little pressure on the nerve will produce pain, while greater amounts of irritation can produce numbness, tingling and weakness. It is the normal function of nerves to allow your muscles to properly contract, giving you a sense of strength, A further normal function of nerves to allow your skin to experience full sensation, which when decreased, results in numbness or tingling.
Disc problems are fairly common. The good news is they generally resolve with proper care and the passage of time. They most commonly occur in 20 to 40 year olds and affect twice as many men as women. Remember, however, these are just statistics and there are always exceptions. We regularly see disc problems in patients that tend to sit for a living and / or who are otherwise sedentary, or who use their back more rigorously, particularly with bending, twisting and lifting while at work or play. While genetic factors may play a role, we feel lifestyle plays a more important role. Just because your mom or dad had disc surgery, you shouldn’t expect to follow their path.
Only about one third of the patients complaining of symptoms related to irritated discs, report an acute onset attributable to a particular event, such as heavy lifting. Much more commonly a small movement, such as picking up a sock, can be the precipitating event. More patients have a gradual onset of neck or low back pain, followed by arm or leg pain (sciatica). These patients generally have experienced many episodes of similar pain within the previous 2 to 5 years.
Specific stressors related to the onset of back pain related to an irritated disc include:
• Twisting and repetitive flexion
• Sedentary occupations or lifestyles
• Prolonged driving of motor vehicles
• Cigarette smoking
• Undue stress
• Lack of strength and flexibility
Generally speaking, disc problems, heal very well with conservative non- operative care, such as chiropractic treatment. Studies show 98% of people recover without surgery. The worse case scenario for you with a disc problem (inflammation, herniation or sequestration) is that it would require surgery. In those rare cases where surgery is strongly indicated, the outcomes are generally very good, resulting in a pain free lifestyle.
Rarely, (less than 1/10th of one percent), the spinal cord can be jeopardized or pressurized by a large centrally extruded herniated disc. An extruded disc is torn to the degree that a large part is now outside of the confines of the normal disc size. This condition is knows as cauda equina. If you experience loss of bowel, bladder control, or sexual function, along with pain and numbness and severe weakness in both legs, you need to immediately go to the emergency room as this is a medical emergency that will most likely require surgical intervention.
The good news is less than 2% of people with disc problems causing nerve irritation and leg pain require surgery to fix their problem. Even if you are experiencing nerve irritation (numbness, tingling, sharp or burning pain in the legs and/or a sense of weakness) you can have a very favorable outcome in 4 to 6 weeks with conservative therapy, such as chiropractic care and physical therapy.
You can expect resolution within 4 weeks for a simple problem, whereas a very severe problem may require therapy for several months, even extending 6 to 12 months depending upon the severity. Care is more frequent during the first few weeks and then becomes much less frequent in the following few months. Once symptoms have resolved and you are able to do more of your normal activities without pain flaring up, your care is considered complete. After that point, simple daily exercises are critical to decrease the chance of the problem recurring. We will do our very best to make sure you understand the importance and proper technique for particular exercises.
During the early and painful stages of disc irritation, the nerves become super-sensitized. This may mean that your skin becomes very sensitive, or you might feel sharp or burning pain in the buttock, groin or leg area, leaving you with a preference not to have any pressure on the area. The muscles may have more of a tendency to cramp or spasm. These are normal consequences of nerve irritation. Successful treatment will reduce these problems completely.
If you have neurological challenges (i.e. numbness, tingling, pain or weakness in your arms or legs), this suggests your case may be more complicated and may require additional care. Following are suggested time lines for full recovery for particular conditions. The most important thing to realize, however, is that ongoing care only occurs if you show measurable improvement both in how you feel and how your body functions.
• 6 to 12 weeks – for mild sensory loss with or without mild muscle weakness.
• 3 to 6 months – for moderate muscle weakness and loss of reflex.
• Up to 12 months – for severe motor loss (i.e. leg or arm weakness).
There are more studies positively supporting the effective management and relief of back pain through manipulation (the primary tool used by chiropractors) as compared to any other approaches, including surgery, physical therapy, and medication.
Some patients may feel nervous about their initial treatment with a chiropractic physician, particularly if they are not familiar with what happens during a session in a chiropractic office. We will explain our procedures and provide care that is comfortable and effective. The majority of our patient's feel very comfortable with and enjoy their treatment, and have excellent outcomes.
Despite our success, all therapies or medical procedures produce some mild and temporary side effects. Following is a list of these side effects or types of temporary discomfort that may occur after manipulation:
• Local discomfort at the site of treatment 53%
• Fatigue 11%
• Radiating discomfort into the leg or arm 10%
While this may not make sense at first glance, a patient with a larger disc herniation does not necessarily have a worse prognosis than a patient with a small herniation. Studies with people, who have shown large sized herniations on their MRI, show better cure rates. The point we want to make here is we cannot assume just because a disc herniation is large, that the person will have a better or worse prognosis that a patient with a smaller herniation.
Studies show there is no difference between the outcomes of patients who either had surgery or tried non-surgical treatment (chiropractic care) at 4 and 10 years following the time of the surgery or treatment. This suggests patients will often feel the same after 4 or 10 years regardless if they had surgery or not.
Other studies show if you can handle the discomfort for 30 days, it is far more beneficial to try and complete the suggested trial of conservative chiropractic care because of the chance of resolution of the problem. We realize there is a small percentage of patients that will absolutely require surgery. We have very good working relationships with both the orthopedic and neuro surgical community and will make every effort to ensure you get the best care.
The following are excellent suggestions to help you recover:
• First of all, trust your body’s ability to heal.
• Be as active as you possibly can, letting pain be your guide. Movement is your friend.
• Bed rest is only necessary if it is the only place you can get any relief. Even with this situation, you will need to try to get up and do your exercises regularly, despite discomfort.
• For low back problems, sleeping on your back with a pillow under your knees or on your side with a pillow between your knees generally result in the least discomfort.
• For neck problems, a pillow under your neck that allows it to extend backwards is much better than a pillow that props up your head in bed.
• In the vast majority of situations, increased pain does not necessarily mean more injury.
• Drink plenty of water and get reasonable rest, including adequate sleep.
• Eat enough fiber (fruits and vegetables) to reduce constipation, which can increase back pain. If this continues to be problem, consult your physician for further suggestions.
• Pay close attention keeping your pelvis in a neutral and safe position. When seated, be sure to sit way back in your chair, while supporting your back by the seat back. A small pillow between your low back and chair can minimize disc swelling. You may benefit from a half roll placed behind your back while sitting.
• Do the exercises prescribed to increase the strength of the core pelvic muscles or the front of your neck, depending on whether you are having back or neck problems . You are the only one in control of this very important component of your healing. We will provide you handouts so you will not forget the key aspects of any of the exercises and gladly review them as needed.
• Avoid heavy lifting for a few weeks and learn to ask for help. Give your spine 4 to 6 weeks to recover before you begin heavy lifting.
• Feel free to discuss your life stressors (at home and work) with us, so those issues can be effectively addressed. Reducing stress will allow you to heal more effectively.
• Please take your medications as prescribed by your family doctor to reduce your pain, inflammation or spasm. Studies show that a patient with better pain management will heal faster in the long run. It takes energy to put up with pain, energy you could better use to help heal. (Chiropractors do not prescribe medication and rely on your family doctor to properly manage your pain pharmaceutically.)
• Research shows poor sleep, poor attitude toward recovery, lack of proper nutrition, unmanaged stress, worry and fear all contribute to increased levels of pain. Our job is to encourage you to take the proper steps in those areas to ensure efficient and effective recovery.
• Focus on letting the disc heal by doing the specific exercises provided which focus on decreasing the swelling and pressure on the disc.
• Following are three specific actions if you are having back pain. These should be done on a regular basis during the early phase if your treatment.
• While lying on your back, put your legs up on a chair or couch so your back and thighs are at 90 degrees. Simply relax, breathe and hold this posture for 5 to 10 minutes, once in the morning and then at the end of your day. This helps stretch the connective tissue of the back and neutralize the pressure on the disc.
• If you have a relatively strong upper body, stand in between two stable chairs (placed apart about the width of your body) placed back to back to each other. Place your hands on the top of the back rest. With arms kept straight, slowly bend your knees and let the weight of your legs and low back “sag” down as you feel a sense of traction on your low back. Hold this for 5 seconds and repeat several times, perhaps 3 to 4 times each day.
• Lastly, lie head down for a minute or two on an incline board that has the top of the board securely elevated 2 feet off the floor. Putting your arms over your head can increase the traction.
• Following are two specific actions if you are having neck pain. These should be done on a regular basis during the early phase if your treatment.
• While lying on your back without a pillow, gently direct your visual gaze downwards towards your navel. Be careful not to lift your head off the table or bed. Hold for one second then relax your gaze. Repeat 10 times slowly.
• When the first exercise is well tolerated, add the following motion. After fully completing the gaze towards your belly button, while making sure your chin stays tucked towards the table or bed, slightly lift the forehead towards the ceiling, making sure to lift only 2 to 3 inches. Hold this posture for 1 to 2 seconds only. Drop the head making sure the chin is held is a tucked posture the entire time. Repeat this 3 to 10 times depending on how well you can do this exercise. This should be done 2 to 4 times a day.
Every person has a particular comfort level for medication and nutritional supplements. We have attempted to outline common suggestions for patients with back pain but, each case is unique and specific recommendations will be discussed as necessary.
If you have severe leg pain, we may recommend that your medical doctor consider a short course of corticosteroids. This is a very powerful anti-inflammatory and can reduce the swelling of the disc so you can begin to do your exercises more effectively.
NSAIDS (non steroidal anti inflammatories) along with analgesics (pain killers)
These may be recommended by your medical doctor to help in the initial phases to reduce the pain and swelling.
This use is considered somewhat controversial because of the potential for habituation, (meaning that over time, they become ineffective).
However, they have proven to be useful if your pain is severe enough to prevent you from standing straight.
These prescription drugs may be reserved for patients with severe pain and great care is taken to reduce the chance of addiction, constipation and sedation – all which are common side effects. We will talk to your medical doctor about these options, as our goal is to begin recovery and reduce your pain as soon as possible.
During the acute phase of pain, (generally the first week or two) proteolytic enzymes may be helpful in reducing inflammation of the disc tissue, and subsequently reducing the nerve pain. Unlike the medications described above, you can purchase these enzymes in health food stores easily without a prescription. Studies on proteolytic enzymes show them to reduce the healing time for disc herniations and show no reported secondary side effects. These enzymes improve local circulation and reduce edema (swelling). Following are the suggested types of enzymes and dosages:
If your sleep is disrupted, consider sleep aids such as valerian root (300 to 500 milligrams of valerian 1 hour before bed).
Glucosamine Sulphate/ MSM
One of the best-researched supplements is a glucosamine sulphate supplement. This product contains the constituent for the material that makes up the disc material. It is best to combine glucosamine with another supplement known as MSM. Typically distributors will combine these two supplements. You can find this in any health food store or larger retail stores such as Costco or Publix, CVS and Walgreens. Many of these supplements will also include chondroitin sulphate. Literature suggests that chondroitin sulphate is not as critical an element for disc improvement or pain relief.
However, if you are a diabetic or allergic to shellfish, chondroitin sulphate is safe for you to take. Some studies have shown the glucosamine to minimally raise glucose blood levels and because it is commonly derived from shells, those patients allergic to shellfish may choose to do a trial of chondroitin sulphate alone.
The therapeutic dose of glucosamine is 1500 milligrams per day and should be continued for 3 months. At the end of three months, when your condition stabilizes and your pain is well under control, you can reduce the dosage to 1000 milligrams per day. While some say you should take 500 milligrams, 3 separate times per day, if you find it difficult to remember to take the supplements 3 times a day, it is better to take the entire dose in the morning.
If you have a particular question that is not answered in this handout, please be sure to ask us. Knowledge is power and assists in the healing process.
Thank you for taking the time to read this information and allowing us to help you recover from this challenging condition. We have great confidence we can provide you with care that will allow you an excellent chance of recovery.