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2007-12-01 1:16 PM

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Subject: Herniated Disc in lower back
Anyone have any experience with this? I am seeing a very good Chiropractor and he has me on Ice / Ibuprofen and 2 a week adjustments. It seems to be great so far. He is suggesting I take it easy for a month and see how I feel. Says it can take up to 6 months for it to fully heal. There goes my HIM and IM this year. If it gets rid of the pain, no problem here.


2007-12-01 2:32 PM
in reply to: #1078353

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Champion
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Subject: RE: Herniated Disc in lower back

I had a herniated disc back about 11 years ago. I was told there are three types, ones you can live with and have options which is 90% of cases, one line mine which was pinching a nerve so I could no longer lift my foot which requires surgery soon about 5%, and those that pinch a nerve so you lose function of your bladder/bowels which means you need urgent surgery less than 1%.

I had surgery within a week of when I herniated my disc. Was in constant pain after for 7-8 years worse in the morning. I lost weight and got fit and now my back doesn't hurt but maybe 7-10 days a year. When I started tri'ing I wasn't sure I could even ride a road bike due to my back, but I can and ride a lot.

I'd suggest going to see a sports Orthopedic Doctor to get a second opinion. 

2007-12-01 3:31 PM
in reply to: #1078353

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Subject: RE: Herniated Disc in lower back
He says it isn't pinching a nerve, but it pushing on it. It gives me some pain in my legs but goes away after icing and being adjusted. We are hoping to avoid surgery as I am only 25 and 175lbs, I'm too young for a bad back!! ahhh
2007-12-01 3:56 PM
in reply to: #1078353

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Master
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Subject: RE: Herniated Disc in lower back

I've got four of them.  MRI pix to prove it.

Set realistic goals. 

Take things on a day-to-day basis.  Swim if you can't bike, Bike if you can't swim, Run if you can't bike (at times I cannot bike but can run). 

Pills can be a good thing (many will disagree), expecially those who don't have to crawl to the bathroom at 3 am.

Yoga!  My saving grace. 

Don't give up.  Never, ever.  You'll be fine.  Day at a time.

2007-12-01 6:22 PM
in reply to: #1078353

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Coach
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Subject: RE: Herniated Disc in lower back
Your chiropracter is giving you good advice.

I had one that required surgery due to acute loss of function of my righthamstring and calf.

I had surgery 3 1/2 years ago. did one sprint tri prior (without training), then began my "real" tri training about 6 months after surgery after losing 20 pounds. That's when I discovered BT!

Hang in there, keep ups posted.

FYI, I was 36 when I had surgery. My brother had the same surgery at age 16 and then 34, my dad at age 40, and his twin brother avoided it until about age 63...surely there is some genetic componenet to physical build, skeletal structure, or just a desire for activities that are stressful on teh spine! I had "chronic" back pain and and off since about age 24 when I did something "really bad" to my back while kayaking. I managed to continue kayaking, climbing & running until the injury at age 36 which required surgery about 4 months later...and 3-4 days after suffering the loss of function. I guess it finally gave up the ghost and exploded.

If I could rewrite my back history, I would have started yoga and done balanced strenghthing & stretching for my entire extensor mechasm (hamstrings, gluts) as well as abs.

Edited by AdventureBear 2007-12-01 6:25 PM
2007-12-04 8:32 PM
in reply to: #1078353

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Subject: RE: Herniated Disc in lower back
I am 30 years old and I have 3 bad disc in my lower back, I went for 2 weeks where honestly I could not put my socks or shoes on (I have a good wife.) My wife works for a neurological itstitute and she got me an appointment with a doctor and he gave me a steroid injection in the spine. It hurt like hell but within a few days the pain was gone. I went back in two weeks to get a second one and the pain went away totaly for about 8 months. Eventualy you will do something that will inflame it but with the injections the pain usualy only lasts for a couple of days instead of months. The doctor told me to get the injections it would prolong going under the knife.

Good luck,
Hope it gets better!


2007-12-04 10:43 PM
in reply to: #1083528

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Subject: RE: Herniated Disc in lower back
skipg - 2007-12-04 7:32 PM

I am 30 years old and I have 3 bad disc in my lower back, I went for 2 weeks where honestly I could not put my socks or shoes on (I have a good wife.) My wife works for a neurological itstitute and she got me an appointment with a doctor and he gave me a steroid injection in the spine. It hurt like hell but within a few days the pain was gone. I went back in two weeks to get a second one and the pain went away totaly for about 8 months. Eventualy you will do something that will inflame it but with the injections the pain usualy only lasts for a couple of days instead of months. The doctor told me to get the injections it would prolong going under the knife.

Good luck,
Hope it gets better!


Thanks for the advice. This sounds more like putting a band-aide on it instead of trying to fix the problem.

Talked to my LBS and he recommended another Doc I think I'm going to get a second opinion from just to be safe. He also recommend this device (he has one) and says it's amazing. Maybe I'll try out his before I spend 400 bones.

http://www.stretching.com/products/backrev.asp

Says it takes off the pressure from the spine to let stuff heal. 15 mins / twice a day for a while works wonders apparently. Make sense that you can relieve pressure, get blood in there for healing etc.

I am starting to feel better. Hopefully a few more weeks off and I'll feel much much better.
2007-12-06 2:11 AM
in reply to: #1078353

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Subject: RE: Herniated Disc in lower back
95% of people with the type of discomfort you describe will have their pain 100% gone within 6-8 weeks regardless of of what treatment they seek...chiropractic, PT, pills, no pills, massage, no massage....

The modalilty of treatment makes little difference in an acute low back injury. Nearly all of them will get better with time...you are right, your body heals itself.

Obviously there are cases where it wont. Your disk will never stop bulging (if that's what it's doing right now) until you are old and grey and it gets dehydrated.

If you MRI a bunch of people, you will find many, many people with bulging and heriated disks that have no back pain. you will find many people with 100% normal MRIs that have back pain, even with pain radiating down their leg.

What is it that you want a second opinion on? your Chiro is following the most conservative plan that exists (aside from the manipulation).

Save your $200, give your body another 6 weeks and then decide if you need to see another doc.

Since we like evidence on BT, a quick review of the cochrane database shows the following:

Bed rest: Not helpful
Traction: Not helpful
Heat: possibly helpful in the short term (immediately after application)
Accupuncture: No improvement for acute pain. Possible improvement for chronic pain
Muscle Relaxers: Some short term relief. Significant side effects.
Spinal Manipulation: No improvement
Herbal Medicines: Devil's Claw - better than placebo (as helpful as Vioxx)
Herbal Medicines: Willow Bark - better than placebo (as helpful as Vioxx)
Herbal Medicines: Topical Capsicum - better than placebo
Note on herbals- all poor quality studies
Massage - Helpful for pain lasting weeks to months. No evidence for acute pain.
NSAIDS - better than placebo
Exercise for acute back pain - "as effective as no treatment", for sub actute & chronic LBP - some benefit


So from teh above list, the treatments, based on reviews of all the published evidence, that are BETTER than placebo or no treatment for acute low back pain are... NSAIDS & muscle relaxers.



Edited by AdventureBear 2007-12-06 2:34 AM
2007-12-06 4:04 AM
in reply to: #1078353

Elite
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Subject: RE: Herniated Disc in lower back

I have one, too. You are partially right that steroid injections will not "fix" the problem. It is for pain relief. However, from what I've read on the topic, and I've read a lot, chiropractic manipulation won't fix it either. The gooey stuff inside your disc has been pushed out. The only way to fix it is to push it back in, or remove it surgically. Given the anatomy of the back, there is no physical way a chiro can manipulate your spine from the outside to push the goo back in. I must admit that I am extremely skeptical about chiropractic and simply don't believe in it. Don't mean to offend anyone but that's the way I am.

Having said that, he's given you decent advice. You're 25 years old. Odds are that you'll heal on your own. In my case, I opted for not having surgery. At 39, I probably heal a tad slower than you. Plus, I'm fairly certain that I've injured this disc before, probably more than once, so it's been battered. My MRI showed that it was a big rupture. I'm going on one year post-injury and I still have pain, but I can live with it. From what I've read, in about another year I should be better. By then, my body will have essentially disposed of the gooey disc material that's pushing on my nerve. This injury can take time to heal.

I've had two steroid injections and they helped, but obviously didn't take the pain away completely. Whoever said that they hurt ws right. But it's not the big needle going in your back that hurts. They give you anesthetic for that. It's the steroid making contact with an already irritated sciatic nerve that sends pain shooting down your leg. After my first one they said I was white as a ghost. For the second one, I asked for sedation.

You should continue with light exercise such as walking or bike riding. The one good thing about this injury is that movement helps. Once you get past your teenage years, you no longer have blood vessels in your discs, so your discs depend on the contractions of the surrounding muscles to get nutrients and hydration.

For now, I can swim, bike, run, even lift some weights. Lifting can be painful but I still do it. They are currently working on a treatment that uses stem cells from your own bone marrow which would be injected into your disc and will actually regrow a new disc. Unfortunately, this treatment won't be available for about 5-10 years. I'm willing to wait that long for the chance to regrow new discs. 

2007-12-08 7:35 PM
in reply to: #1078353

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Subject: RE: Herniated Disc in lower back
So another question, I'm starting to feel better and we're going to be talking about rehab exercises soon. What of our 3 sports would be ok to start with. Swim and bike but keep off running for a while? I'm ok with taking it easy.
2007-12-09 12:00 AM
in reply to: #1078353

Elite
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Subject: RE: Herniated Disc in lower back
Swim and bike are both good, and stay away from running.


2007-12-11 1:20 PM
in reply to: #1078353

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Master
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Subject: RE: Herniated Disc in lower back

Trained with a really bad herniation at L5-S1 for 2 years. Almost constant pain. Did some conservative treatments during a particularly bad flair up. PT, muscle relaxers, hydros. When they finally did an MRI to see what was going on my nuerosurgeon was in awe of the impingement on my sciatic nerve. It was so shrouded with the disc he had to point to the sciatic nerve on the right side at that level and say "trust me when I say that same thing is on the left side."

I was in surgery about 3 weeks later.

To say I am 100% pain free would be lying. Fact is the last couple of days I have had some problems. My surgeon told me that due to the damage done to my nerve from the constant grinding of the herniated disc that I will probably have problems forever. It is tolerable and only lasts a few days and only happens a few times a year.

Makes me question the route of conservetive treatment a bit. I went through the pain for 2 years! It took that long before someone finally thought an MRI was warranted. What if that herniation had been seen 6 months, or a year after the injury. Would the long term damage be worse? Better? Who knows.

I did an OLY 7 months after surgery. A marathon 15 months after surgery. A HIM 19 months after surgery. And if things go well I will be an Ironman 28 months after surgery. Keep inmind there were morning I physically could not get out of bed without assistance.

As for chiro for a herniated disc? Never did it. Dont want to get into that debate.

2007-12-12 9:32 PM
in reply to: #1095445

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Regular
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Subject: RE: Herniated Disc in lower back
4 years ago I blew up my back. Major pain, couldn't stand up straight, couldn't lift anything, sucked for sure. Started seeing a Chiro, very litte relief, but some, and over the course of 3-4 months, it was slightly improved....until I stood up wrong and ended up on the floor screaming in pain. Next day, when back to the chiro. Last time I saw him was when the EMT's shut the doors of the ambulance that took me from his office to the ER. So I found a great doctor who started with an MRI. Turns out I had ruptured 3 discs in a row, L5-S1 had extruded fragments that were causing severe pain down left leg, and loss of some function of my foot. He started me with the steroid injections. Those got me to where I could stand. The next step was a microdiscectomy...to remove the extruded pieces of disc that were pushing on my nerve. (think about a rock in your running shoe, with your foot being a nerve)
I was pain free the day after surgery, and back to normal, plus a lot of PT 2 weeks later.

Here's the deal, as some have mentioned, it will usually get better on its own. It is a personal matter of how bad the pain is, how much it hinders your ability to have a life, and a multitude o other things. My back still flares up, and will for the rest of my life. (hurts like mad right now)

The one constant for me is ICE!!!! Ice is analgesic, in that it reduces pain, plus it reduces the inflamation that is causing the pain.
My post surgery treatment included a contraption called EB Ice. it is a little cooler that pumps icewater into a grid pad that is strapped to your back. I wore it for nearly a week straight after surgery on doctors orders. Now, when I have issues, I use it overnight, and am usually much improved by morning. In fact, I'll be using it tonight.

Good luck, it is a tough thing to go through, but it does get better.
2007-12-13 4:00 PM
in reply to: #1078353


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Subject: RE: Herniated Disc in lower back
I have posted some important information regarding disc herniations here, one is linked below. I think all the docs, PTs, chiros, will agree that the information is valid and worth taking into consideration. There is at least one more that I would recommend looking up.

http://www.beginnertriathlete.com/discussion/forums/thread-view.asp...

Unfortunately, when I see recommendations regarding different treatment protocols it tends to be from a misinformed position. I say that completely without malice and with no intention to be argumentative. However, when people are looking for solutions it is important to either give correct information or simply withhold the comment altogether. There are many people reading these message boards who might benefit from the very option which you dismiss.

First of all, the very notion that you will take a recommendation from a guy at your LBS concerning such an injury makes me incredulous. Regardless of whether or not your trust your chiro, ortho, or PT, I would think that the only reliable information you should consider would come from someone who manages these problems for a living. Do you ask your doctor for mutual fund advice? Think about it.

Secondly, Mike's advice ("However, from what I've read on the topic, and I've read a lot, chiropractic manipulation won't fix it either. The gooey stuff inside your disc has been pushed out. The only way to fix it is to push it back in, or remove it surgically. Given the anatomy of the back, there is no physical way a chiro can manipulate your spine from the outside to push the goo back in") indicates that either he hasn't read very much or that he's making a really poor analysis.

The interior of the disc cannot be "pushed back in," by a chiropractor or by anyone else. Chiropractic manipulation for herniated discs does not attempt to "put anything back in," but rather attempts to maneuver the disc into a position that reduces pain. This type of manipulation (flexion/distraction manipulation is probably the most commonly used procedure) works under a principle similar to the McKenzie protocol, of which I'm certain that Mike is aware. This would probably be some helpful information to read.

http://www.coxtechnic.com/homepage.asp

The bottom line here is that disc injuries can be managed - often without surgery (surgery is indicated in a very small percentage of cases) and in varying degrees of success by EVERY profession. It's important for people to give multiple interventions a try, sometimes in a multi-faceted approach, but always utilizing the most conservative options first.

Not everyone has an answer every time. But it's important that all options continue to be explored.

Steve
2007-12-13 5:09 PM
in reply to: #1100625

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Subject: RE: Herniated Disc in lower back
Thanks for your input steve. I would note that all of the studies and abstracts in the link provided for the COX technique are for chronic & elderly back pain. There is one study that mentions "Chronic/severe and Chronic/acute" pain...I'm not sure what chronic/acute pain is referring to.

The study comparing PT to COX technique was done on patients with chronic (> 3 mos) pain.

I'm not supporting or refuting the effectiveness of the technique, but it's important to know what patient population the studies were done on and what the treatment is being compared to (placebo, control, pt, etc).

This is really a non-informative post, isn't it.

I'm off to do some of my own "flexion-distraction-impaction" technique at the climbing wall! FWIW, this is the first time in 3years I've been able to climb without being disabled by back pain the following day. I"m getting stronger, and smarter as I get older.
2007-12-17 6:57 PM
in reply to: #1100804


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Subject: RE: Herniated Disc in lower back
The link I provided was simply a reference to a procedure that might hold value for someone looking for a different approach. I certainly didn't mean to hold it out as a gold-standard for treatment efficacy. There are many conservative approaches used by chiropractors and PTs that may be of benefit, some with better research behind them than others.

My outlook on the management of disc injuries is that there are a variety of approaches which range from quite conservative to considerably invasive. It is important to give at least several a good try prior to moving on to procedures which may well be irreversible. I find that many patients, if they're going to be successful conservatively, will tend to find their own methods. Some love McKenzie, some love chiropractic manipulative care (COX flexion/distraction or others), some are immediately improved via epidural injections. I have had patients with terrific post-surgical success and others where it has been a disaster.

My final thought on the matter, directed to the lay individual suffering from HNP (herniated disc) is to remember that very few disc injuries are alike. I often have patients comparing their disc injury to a family member's, or friend's, and asking why the same treatment is not being used for them. Many subtle differences occur with disc injuries including the size of the herniation, position of the herniation or disc fragment, complicating factors such as weight, fitness, and medical history, prior surgeries, and many, many others.

Get a good diagnosis and consider all the options for your specific case. Find someone with whom you can work and communicate and, above all, follow their recommendations. If you're going to give something a shot, give it your best shot.

Steve


2007-12-17 8:42 PM
in reply to: #1100804

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Subject: RE: Herniated Disc in lower back
AdventureBear - 2007-12-13 4:09 PM

This is really a non-informative post, isn't it.



FYI, I was referring to my post, not your previous one.
2007-12-18 10:32 AM
in reply to: #1078353

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Master
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Subject: RE: Herniated Disc in lower back
My biggest question to the health care proffesionals is why do we seem to wait so long for an MRI to be indicated? Seems to me that after 60 to 90 days of conservative treatments with no improvement it would be time to see what is going on. Instead, it seems that perhaps the insurance companies drag it out to avoid the cost of the MRI. I was just over 2 YEARS of problems before an MRI was finally done.
2007-12-18 7:05 PM
in reply to: #1107718

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Subject: RE: Herniated Disc in lower back
idahodan - 2007-12-18 9:32 AM

My biggest question to the health care proffesionals is why do we seem to wait so long for an MRI to be indicated? Seems to me that after 60 to 90 days of conservative treatments with no improvement it would be time to see what is going on. Instead, it seems that perhaps the insurance companies drag it out to avoid the cost of the MRI. I was just over 2 YEARS of problems before an MRI was finally done.


An MRI shows the surgeon where to cut. Ready to give up and have surgery? Get an MRI.
2007-12-18 7:07 PM
in reply to: #1095445

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Subject: RE: Herniated Disc in lower back
idahodan - 2007-12-11 12:20 PM

Makes me question the route of conservetive treatment a bit. I went through the pain for 2 years! It took that long before someone finally thought an MRI was warranted. What if that herniation had been seen 6 months, or a year after the injury. Would the long term damage be worse? Better? Who knows.



Evidence supports identical 5 year outcomes with and without surgery. From the article cited below:

Since 1934, many studies have demonstrated
the success of surgical treatment of sciatica. In
Weber’s landmark study comparing surgery with
conservative care in a randomized clinical trial,
which excluded patients with “intolerable” pain,
the outcome of surgery was superior at 1-year follow-
up, whereas after 4 years the results of surgery
and conservative treatment no longer differed.
22-24

Here is a recent article from the New England Journal of Medicine. Each individual case is differnt, but this answers your question of "Why the conservative therapy".
Sorry, too big to post, plus BT would probably ban me for copyright violation. Here is the conclusion:

Conclusions
The 1-year outcomes were similar for patients assigned to early surgery and those
assigned to conservative treatment with eventual surgery if needed, but the rates of
pain relief and of perceived recovery were faster for those assigned to early surgery.
(Current Controlled Trials number, ISRCTN26872154.)

Citation:
n engl j med 356;22 www.nejm.org may 31, 2007

Edited by AdventureBear 2007-12-18 7:13 PM
2007-12-18 11:44 PM
in reply to: #1078353

Elite
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Denver, Colorado
Subject: RE: Herniated Disc in lower back

I purchased the product seen at the link. Yes, this an "infomercial" product, but I didn't get sold by the infomercial. When I saw this product I immediately recognized it as a reverse hyperextension machine. I had read about reverse hypers from my readings on strength training so I had some prior knowledge. I didn't just get sucked in by the infomercial hype and I was actually quite skeptical.

http://www.mycorevolution.com/

Steve, is this similar to the flexion/distraction treatment you mentioned? If so, I think people would be better off doing these and strengthening the muscles in the process than simply having a passive chiropractic treatment. Reverse hypers can also be done on a Swiss ball using just the weight of your legs. In fact, doing them unweighted is the best way to start. 



2007-12-19 9:02 AM
in reply to: #1078353

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Subject: RE: Herniated Disc in lower back
My story is similar to yours, except it started all the way back in 6th grade! I noticed I couldn't stretch my legs as much as usual, then that turned into a throbbing pain when any pressure was put on the bottom of my legs. That turned into not being able to stretch my legs out flat if I was laying on my back along with having to walk with bent knees, you couldn't imagine all the kids that young asking you what your problem is and why you're walking like that. It sucked.

I begged my parents to let me see a doctor, they finally took me to one. The first suggested to see a chiropractor, didn't help at all. Went to a second, he had me get an MRI, after multiple pointless xrays and such. The MRI is what pointed out the issue. One of my disks in my lower back was being shredded to pieces :-[ So, all in all, I had surgery. So, my point, if it persists, try to get an MRI done.
2007-12-20 11:18 PM
in reply to: #1109061

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Subject: RE: Herniated Disc in lower back
MikeTheBear - 2007-12-18 10:44 PM

I purchased the product seen at the link. Yes, this an "infomercial" product, but I didn't get sold by the infomercial. When I saw this product I immediately recognized it as a reverse hyperextension machine. I had read about reverse hypers from my readings on strength training so I had some prior knowledge. I didn't just get sucked in by the infomercial hype and I was actually quite skeptical.

http://www.mycorevolution.com/

Steve, is this similar to the flexion/distraction treatment you mentioned? If so, I think people would be better off doing these and strengthening the muscles in the process than simply having a passive chiropractic treatment. Reverse hypers can also be done on a Swiss ball using just the weight of your legs. In fact, doing them unweighted is the best way to start.



I see every person in the video hyperextending their back in order to get the machine to work. This may be a legitimate exercise strictly for strength training purposes, but for acute back pain, to do these unsupervised as shown in the video I think would be very dangerous.

It's probably a decent exercise for lumbar extensors, but what I see on the link you provided is pure marketing. IMHO. FWIW. LOL.
2007-12-21 12:43 AM
in reply to: #1078353

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TinkerBeth
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Subject: RE: Herniated Disc in lower back

I have known many people that have benefited from non - surgical treatments of lower back pain, specifically herniated discs.

I am attaching a link to a clinic in my area that specializes in this kind of treatment.  Perhaps your dr or chiropractor could refer you.  If nothing else it is food for thought.

Good luck and best wishes!

http://www.lovemyback.com/prc.aspx?cat=olpostrest&movid=79

2007-12-27 3:26 PM
in reply to: #1109061


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Subject: RE: Herniated Disc in lower back
Hi Mike:

Sorry for the delay in responding. I have never seen the product you referenced, but in looking at the video it appears to be a reverse hyperextension exercise machine. Right off the bat I would say that this would not be something I'd recommend - particularly for a hot lower back, let alone acute lumbar disc herniation. Extension exercises put considerable strain on the lumbar facets and also force the disc posteriorly, not something you'd want with a lateralized fragment. Products such as these make me cringe because I worry that a lay person with LBP will make a problem substantially worse without realizing it.

Second, this is completely different than flexion/distraction manipulation. I don't want to offer too technical a post but F/D manip utilizes segmental traction combined with flexion/lateral flexion/circumduction in order to decompress discs or facet joints. What is nice about it is that there's no cavitation (the "crack" often associated with manipulative care) and the patient positioning is often more comfortable when he/she is acute. Lastly, it is not an actively-based exercise and therefore should be combined with specific stabilization exercises.

In regard to the question about the MRI, I think the question was ably answered. As I stated in one of my posts (maybe on a different thread), MRI is used to confirm a disc herniation, not to diagnose it. As a result, having a picture of the problem doesn't usually change the treatment strategy - unless, of course, surgery is being considered.

Best New Year's wishes to you all.

Steve
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