Herniated Disc and Sciatica Facts

Introduction

Herniated discs are probably the most common diagnosis for severe back pain and sciatica (leg pain). Discs are large cushions that lie between the individual vertebrae of our spinal columns.

The disc is composed of layers of ligaments (annulus fibrosis) arranged in a criss-crossing matrix that hold in a gel-like substance (nucleus pulposus), giving the disc its "shock-absorbing" ability. Sometimes the gel swells (which is called a disc protrusion or bulge).




A more problematic situation occurs if the gel pushes through its ligamentous wall (which is a disc prolapse or extrusion). Both situations can led to pressure or irritation of the vulnerable spinal nerve roots. This can lead to sciatica - an abnormal sensation felt anywhere from the buttocks to the feet.

For more that 70 years, orthopedists have believed that most lower back pain and sciatica were caused by herniated discs. The "dynasty of the disc" led to the typical medical advice of bed rest and medication. Gordon Waddell, a renowned British orthopedic surgeon, wrote in the journal Spine, "There is remarkably little scientific or clinical evidence to support the value of bed rest for low back pain or even sciatica." Bed rest is now known to cause prolonged pain, muscle weakness, joint stiffness, and depression.

If bed rest failed, surgery was the usual next step. Unfortunately, due to poor patient selection, many unnecessary surgeries were performed. Waddell said, "surgical successes unfortunately only apply to approximately one percent of patients with low back pain." According to Alf Nachemson, M.D., editor of the journal Spine, bulging discs are found and taken as an excuse to do a lot of surgery and percutaneous discectomy. Discs are made to bulge; that is a normal finding."

Edward Carragee, M.D. the Dean of Neurosurgery at Stanford University reported that disc bulges are present even in 20 year olds, BUT by age 30 there are more episodes of back pain in individuals whose spines had no abnormalities when they were 20 than in those with the bulges! He has also written in the journal Spine that the long-term results of surgery vs. conservative care for pinched nerves is no different.

Back and even leg pain can arise from the muscles, joints, or ligamentous structures of the spine. Whatever the cause, evidence is growing showing that rehabilitation not surgery is the treatment of choice for most lower back disorders.

When should I see a doctor?

Anytime a person has pain radiating down their leg they should see a doctor to find out the reason why. This is not something urgent unless there is buckling of one or both legs, incapacitating pain, progressive pain or numbness, loss of bowel or bladder control, or numbness around the genitalia or anus.

Pain Control/First-Aid

Goal: reduce pain, swelling and inflammation

• physical therapy (e.g. ice, electrical muscle stimulation)

• manual therapy (e.g. massage, traction) and manipulation

• anti-inflammatory/pain medication if necessary

What can I do for myself?

An important study from a leading orthopedic center in San Francisco demonstrated that more than 90 percent of patients with disc herniations responded to non-surgical treatment. Most of these patients had already been referred by neurologists for immediate surgery. Their treatment included simple pain control methods in combination with rehabilitation. According to Nachemson, "All the structures in the back fare better with early, controlled motion....if something is injured and you start to slowly move it under controlled conditions, then the structure heals quicker and better."

It is important to spare your spine if you have a pinched nerve. Slumping or bending forward from the waist are key sources of irritation of the disc. Prolonged sitting is another problem. Try not to sit for more than 20 minutes at a time without getting up and limbering your back. Because the disc is mostly water it swells at night when you are recumbent. Thus, the morning time is a critical time to keep your spine from bending forward while you brush your teeth, dry your feet and change.

Besides taking over-the-counter pain relievers of anti-inflammatories iceing your back at home is a key treatment. This can be performed for 20 minute intervals a few times a day.

Ways to increase your activity.

Walking is a safe exercise for pinched nerves due to herniated discs. If bending forward increases your leg symptoms, but bending backwards ONLY hurts in your back you may want to perform press-up and standing back extension exercises a few times a day. 10-12 slow repetitions are generally recommended. It is best to see a qualified health care provider to determine what exercise is best for you.


Rehabilitation

Goal: stabilize back through better flexibility, strength, and endurance

• education about lifting, sitting, etc.

• exercises to increase back and cardiovascular fitness

• encouragement to achieve and maintain a healthy back

Sources from : Clinicalrehabspecialists.com

Low Back Pain During and After Pregnancy Facts

Introduction
Low back pain (LBP) is a common problem during pregnancy and even more so afterwards. The pain can vary from a mild discomfort to severe and disabling. Serious causes of back pain are rare and easy for your doctor or chiropractor to diagnose. Most back pain is mechanical in nature and greatly subsides in just a few weeks.

When should I see a doctor?
LBP often gets better on there own as nature takes its course. Many women do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Back pain can occasionally be associated with pain extending down into the leg. This condition sometimes known as “sciatica” and you should see a doctor to diagnose it.

Health care providers are useful for making sure you don’t have serious disease and offering reassurance. Also they can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life or the pregnancy. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities. Often the rehabilitation specialist will work hand in hand with your physician when appropriate.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

There are several preventive measures one can take to help reduce the likelihood of developing low back pain or as self-care for back pain.

• Staying active: By staying active often times you can reduce minor episodes of low back pain from becoming more serious. The old notion of staying in bed until the pain is gone is no longer the best advice. The sooner you get moving again, the quicker you’ll progress through the pain episode and move on with your life.

• Lifting: If you have to pick up something try to bend at the knees, keeping your low back curved forward, not slumped. This is called the “hip hinge” and forces you to use your buttock and thigh muscles to take pressure off your back.

Incorrect lifting position with slouch Correct lifting position with hip hinge



• Sleeping: Try supporting under your knees with a pillow when sleeping on your back or between the knees when lying on your side.

• Specific stabilizing exercises: Often a rehabilitation specialist can prescribe specific exercises for back pain to help strengthen and stabilize muscles. As no two patients are alike, your rehabilitation specialist can help find what exercises are appropriate for you.



Ways to increase your activity.
Sometimes it may seem quite daunting to deal with activities which increase your LBP. Often times its frustrating because the activities you were first able to perform without pain are now giving you discomfort. Find out how long you can perform a specific activity without “flaring-up” your condition or making you worse off than when you started. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point.

Having a little discomfort is normal, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. Monitor the sciatic leg pain and tell your health care provider if it is either not improving or getting worse. It’s normal to have good days and bad days. Don’t be afraid to ask others for assistance. Your body has changed and it’s natural for symptoms to occur, but they should pass with time.


Here are some other examples of ways to modify your activity:

Staying active and doing your normal activities is one of the most important things you can do for yourself. You may have to modify the way you perform certain activities to keep from aggravating your back. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Your rehabilitation specialist can help you with modifying activities which are giving you difficulty. Massage, manipulation and other modalities may help relieve the pain, but they are best used to getting you re-activated and moving on with your life. Sometimes ice or heat packs may give some relief. Some women find relief with braces or belts that support the increasing abdominal weight. Medication (even over-the-counter) is to be used only with approval by your physician. Ask your rehabilitation specialist about specific problems you may be experiencing.


Rehabilitation
When self-care and activity modification does not give you sufficient relief, see a rehabilitation specialist for help. These doctors and therapists are specially trained to bridge the gap between what you are capable of doing and what you want to do. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts, fears and concerns to your healthcare provider. Often specific procedures following the pregnancy such as “Caesarian births” or the use of an epidural may dictate a specific kind of exercise or therapy. Pain and “flare-ups” may happen from time to time. This is normal and you will learn “first-aid” approaches for this. However, the more important goal is to re-condition your abdominal and back muscles so you are more stable during your chosen activities.

By staying active, modifying activities, and getting information from your healthcare provider, one can greatly reduce the occurrence or duration of LBP episodes.

Sources from "clinicalrehabspecialists.com"

Low back pain

Low Back Pain Facts

Low back pain is a common ailment which most people (80-85%) suffer with it at some time in their lives. The causes of low back pain are poorly understood and can range from trauma, poor lifting and overuse/underuse of the muscles. 85% of the time the pain is mechanical coming from either the muscles, joints or ligaments. Fortunately, it is rare for the pain to be caused by a serious medical problem and such causes can be ruled out by a thorough history and examination from your healthcare provider.





When should I see a doctor?

Often low back pain episodes will get better on there own as nature takes its course. It’s important to stay as active as possible as the old adage of bed rest and trying to completely avoid pain is not the best advice. Most people do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Understand that low back pain is a very common problem and the chances that it is caused by serious disease are very rare. Health practitioners can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

Keep in mind that staying active with your normal activities is the best thing you can do to limit the effects of low back pain on your life. You may have to modify the way you perform certain activities to keep from aggravating the tender tissues. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Pain medication, hot/cold packs, massage, manipulation and other modalities may offer pain relief, but they are best used to getting you re-activated and moving on with your life. Keep in mind that the pain is your own and the manner in how you deal with it and return to normal activities is the greatest thing you can do for yourself. Try to stay working as only in cases of particularly severe pain do you need to be off work. You may need to find restricted duties or reduced hours, but staying active is important. Staying active helps prevent long-term problems. If it has been several weeks since you have been back to work, you really should be planning with your doctor or therapist and employer how and when you can return. Here are some ideas to keep your low back pain from becoming a more long-term problem:

•Keep moving.

•Do not stay in a position for too long.


•Move before you stiffen up.


•Move a little more each day.

•Don’t stop doing things-just change the way you go about doing them.


Ways to increase your activity.


First ask what is it that I want to do? Is it walking further, going up stairs, shopping, etc.? Find out how long you can perform this activity without “flaring-up” your condition or making you worse off than when you started. This is individual to you. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point. Having a little discomfort is alright, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. It’s normal to have good days and bad days. It takes some patience, but it works.


Ways to Modify Your Activities

Sitting

Find a chair that is comfortable to you and supports the small of your back, you may have to experiment with several. Get up and stretch often.


Rising from a chair
Avoid slumping as in the left hand picture. Instead stick your chest out as in the right hand picture to protect your back. Getting up and down like this utilizes what is called “the hip hinge” to spare your spine. This can be incorporated in other lifting and bending activities as well.



Desk work
Make sure the height of the chair fits the desk. Arrange the keyboard monitor and phone so you do not feel strained. Get up and stretch often.

Driving
Adjust your seat from time to time. Try some support in the small of the back. Take regular stops and get out of the car for a quick break. Walk around and stretch.

Lifting
Think before you lift on the best way to move the load. Don’t lift more than you need to. Keep the load close to your body. Lightly tighten your stomach muscles to brace your back. Turn with your feet when carrying the load, don’t twist the back. Finally, be sure to “hip hinge” to maintain an upright spine as the picture above shows.

Carrying and shopping
Ask yourself if you need to carry at all. Keep the load close to your body. Split the weight of the load between two hands. Push carts with both hands.

Daily activities/hobbies
Don’t do any one thing for too long. Keep changing activities.

Sports
Continuing to play your normal sports is fine, but you may need to modify your game or decrease your intensity.

Sleeping
Some people find relief sleeping of a firmer mattress; possibly try a sheet of chipboard under the mattress. Painkillers an hour before you go to bed may help.

Sex
Sex is fine, but you may need to try different positions.

If your pain is not settling down or getting worse, you may need further assessment from your health care provider. Make sure you ask questions or voice your concerns about your pain to your healthcare provider.


Rehabilitation

If there are specific activities which you are having difficulty with, a rehabilitation specialist can help. Once serious causes are ruled out and the pain is under control, the rehab specialist examines where the dysfunction lies. First identify specific goals or limitations you wish to overcome that are agreed upon by both the practitioner and you. The rehab specialist will perform a functional evaluation to determine what you are able to do and what areas may be causing some trouble. Bridging the gap between what you are able to do and what you want to do is the essence of rehabilitation. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts and concerns with your healthcare provider. Pain and “flare-ups” may happen from time to time. This is normal and should not be the focus in care. Rather, try to focus on the exercises that are bridging the gap to your goals and what activities you want to do.

It is important that you maintain contact with your healthcare provider. If the pain is not settling down or is getting worse, you may need further assessment. Follow up visits provide you the opportunity to obtain more information and address any fears or concerns you may have with your low back pain.

www.clinicalrehabspecialists.com