29 Sep “Herniated”, “Slipped” & “Bulging” Discs
Posted at 13:49h
in Uncategorized
Possibly no injury is as common (and none more inquired about by friends and strangers) as back pain.
In adults most back pain falls into 2 categories: disorders of the discs and disc space (think herniated discs and stenosis or facet/disc degeneration) and sacroiliac pain which often is misdiagnosed.
Let’s talk about specifically herniated discs.
Herniated discs (‘slipped’ ‘perforated’ etc) is the loss of cushioning material or its displacement. In my experience this is one of the most difficult things people present with. Not because they are so difficult to treat for us, but because the patient is generally misinformed and misguided…most often by a spine specialist or orthopedist! The very people that should be helping are not.
Why? Orthopedists and spine specialists don’t know how to rehabilitate the back. They only know how to perform surgery, or use medicines. Their studies do not include rehabilitation. Even when they claim to know some therapy, they know only text book therapy.
Many physical therapists also do not know how to rehab the lower back. They learn the ‘cookbook’ type physical therapy as well. They do the minimum…which often does not work for herniated discs.
Most herniated discs need much more than some exercises, stretches and anti-inflammatories unfortunately. Sure, for some this works like a charm. For others it’s the tip of a very large iceberg.
What does a herniated disc need?
1. Manual therapy. Manual therapy. And then some more manual therapy. This includes deep tissue therapeutic massage (not a massage therapist although this may help short term), joint mobilizations, targeted stretching and strengthening.
2. Home program. This part is JUST as important as therapy. If you think you can let a therapist do the job and go home and do nothing, you are sorely (no pun intended) mistaken. If you are not consistent you will not improve. For many this is more important than the therapy itself. I cannot over emphasize the role of taking your pain into your own hands. Your back is used everyday all day. How you use it, when you use it and how you take care of it is crucial to getting better. Three hours a week of therapy will be nothing without 2 or 3 times a day of consistent stretching and a home program designed by your therapist. Again, some can get better without but if you find you are not improving, this is often why. The back needs to be taken care of at all times, not just in therapy. The longer you have had pain, the longer it may take to rid the pain and the more consistent you may have to be about your home program. It will pay off.
3. Self care: avoiding positions your therapists tells you to avoid and doing what they they ask you to do more of.
4. Accountability: Self care also means being personally accountable for your pain. You must understand that you can get better, but it will take effort and persistence on your part. It is not simply for your therapist or doctor to fix. THIS, in my opinion is why so many people don’t get better. They see fixing their pain as the job of someone else. The job is a team effort. You need to do be responsible for being part of that team.
5. Anti-inflammatories: Often this is part of the plan, but for those who do not like medications, ice and other modalities can be effective as well. This can also include steroid injections in worse cases or cases where the patient cannot stop the activity that is causing the problem (ie. sitting long periods for a business traveller).
6. Patience.
7. Patience.
8. Patience.
9. Patience.
10. Seeing a physical therapist that works manually and then gives you a home program that is short and sweet is the best way to have an approach tailored to your pain. Cookbook medicine does not work for most back pain sufferers, which is why at Dash we spend time one-on-one with you. We don’t use assistants or aides or simply watch you do your exercises. We do what you can’t do on your own. It’s targeted, practical, efficient and effective this way.