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  1. #1
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    Advice on disc protrusion

    Hi there. I'm not actually a physio, but am working towards getting into Uni to study physio. Came across this site and thought I'd ask for some advice about a problem I am having with my back.

    9 months ago I was out hill-walking and experienced tightness in my left buttock, and back of knee (lateral side), as I walked downhill I experienced a nerve type pain in the inguinal area also. This pain came on and off over the next month but I just thought I'd strained a muscle or something and kind of ignored it. Then I drove to the Lakes (5hr) did some rock climbing (carrying lots of gear!) and drove back home. 3 days later was VERY sore in left leg, stabbing in bum and radiating pain down back of thigh to knee.

    Went to GP who thought I'd poss torn a ligament and he put my down for some NHS physio. While waiting, I booked in for some private physio. She thought I'd fatigued deep muscle in back which was irritating sciatic nerve and causing radiating pain. Had massage and Ultasound which greatly helped but the pain returned a few days later. On second visit, nothing she did helped. She said that my nerves were extremely sensitized at that point and there wasn't much more she could do and recommended I go see an Osteopath. I wasn't too keen on this, so waited for my NHS appointment.

    When this came, they diagnosed a slight bulge in disc (L5 I think) and gave me back extension exercises to do (cobra pose- 10 reps every hour) This helped and I was in much less pain. The therapist said I could continue with my hillwalking. I went down to Wales to do some walking and 3 days there I became very painful again so came home. I hadn't been doing my extensions as much as I should have either, naughty!!! By the time I got home, I was in excruciating pain, evil stabbing from buttock right down to toes. Therapist said to continue with the extension exercises. Only problem was these exercises now caused MORE pain. Even moving back ever so slightly sent the stabbing pain down my leg. This went on for a few weeks with the therapist insisting this was the right exercise for me, and me trying my best to do it, but suffering much pain. Got fed up, as it seemed to be making things worse, and I booked an appointment with a Chiropracter.

    By this point as well as stabbing pains down my leg, I was getting a stabbing in the sole of my foot and an intense gripping pain in my lower calf. The chiro diagnosed bulge in the disc, inflammation of the Wikipedia reference-linkfacet joint and tightness in my SI joint, he thought that the SI prob had probably caused the disc problem. After just one manipulation the stabbing pain down my leg disappeared. I was left with just the calf pain, foot pain and a burning in my thigh. The calf pain would be very bad at times, like something was twisting inside. On a scale of 1-10 it was around 7ish. Now, I have been seeing the Chiro for around 5 months now and the calf pain has gone and the pain is now focused mainly deep in my bum.

    He thinks that Piriformis is very tight, and also TLF is tight but doesn't seem to be doing much to be trying to release them. I have started to do stretches at home and over the past week have got much relief. I am still sore and tight in my bottom when I walk, tho it does ease after a short time. And during the night, I wake in pain every few hours. I'm sore first thing in the morning but it eases as the day goes on, only to get sore again at night. Pain is now at a level of between 2 when good and up to 5ish when bad. I still cannot hillwalk or climb without it flaring up, and when it does flare, the calf pain comes back again. I have recently been for an Wikipedia reference-linkMRI and am waiting for an appointment with the Ortho consultant. My GP had a nosey at the results on his pc and says that I have a large disc protrusion but there is no evidence of it compressing the nerve root. Now it seems to me, that my muscles are possibly spasming to protect my nerve root from being compressed. Am I correct in assuming this???

    What my query is, is that I am wondering what will happen to the protruding disc? Will it eventually go back into place or will it continue to degenerate. If it is the case where the disc is beyond healing, then does this mean that I will continue to suffer until it degenerates completely??? 9 months seems an awful long time to be having this problem for, esp when the 'experts' keep telling me I will be better in 6wks, then a couple of months, then perhaps half a year. Sometimes it seems that the pain is only better because I am avoiding doing things. I never sit down, I eat lying down, I study lying down. The only time I sit is to drive my car. And to drive any distance longer than 20mins in the car I have to take 30mg of dehydracodeine to cope. I cannot hill walk or climb without a flare up of the pain. And I have not slept properly for the past half year and this is affecting my studying now. Any advice??? Do you think the Ortho will want to operate if there is no evidence of nerve compression? And I think the main thing I'd like to know, is will this blasted disc ever heal or will I just have to put up with it and manage the pain until it has degenerated completely. I will put these questions to the Ortho and to the chiro when I see him next, but just after some more opinions really, though I do know you can't really give me much advice over an internet forum! Oh, should also add, that I go for an hour long walk in the morning, followed by 2more 20min walks during the day and eve. When I am lying down to study, I get up and stretch and move around every half hour also. And I try to stretch out my piriformis, TLF, gluteals, hamstring and calf 3x a day. Hamstring on affected leg is VERY tight.

    Phew, sorry for long winded post!

    Thanks in advance for any tips on what will become of my disc

    Similar Threads:
    Last edited by physiobob; 28-02-2007 at 07:22 PM.

  2. #26
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    Re: Advice on disc protrusion

    Taping
    When I had an active neurology practice I focused on nutritional and alternative treatments to disc protrusions and disc dessication.

    1. One of the main things to do is to stay well hydrated and to use methods that may specifically improve disc hydration
    2. I would check out the use of hydrolyzed collagen - I am including some sections of a book I am writing on the benefits of hydrolyzed collagen. The idea is to use a nutritional supplement that provides the raw materials for connective tissue repair.

    Why hydrolyzed collagen affects the electrical properties of the body
    • The collagen in everyone’s body declines with age and collagen loss is accelerated in disease. This means the conductive pathways in acupuncture meridians will also become impaired. In addition toxins that accumulate also disrupt the structure and function of collagen. Collagen molecules in the connective tissues such as skin, ligaments, tendons, discs and bones are constantly being broken down and regenerated. This process is called remodeling. However the regeneration of collagen requires an adequate supply of the basic dietary amino acid building block of collagen. Both poor dietary habits and excessive physical stress can result in a situation where collagen breakdown exceeds collagen synthesis, which will result in structural instability as well as degradation in the bioelectric circuits. In addition, trauma and inflammatory processes damage collagen and cause dehydration in the connective tissues and correspondingly can impair transmission of signals in the acupuncture meridians.
    • If you want to improve the hydration of the connective tissues and their function as bioelectric circuits it is important to provide dietary materials that will support the structure and function of the connective tissues. Therefore the best source of nutrition would be a food product that provides the raw material for collagen synthesis.


    Hydrolyzed Collagen may help osteoarthritis pain and disc pain
    • Hydrolyzed collagen improves joint function, and leg strength in individuals with osteoarthritis.
    • Some studies also show that hydrolyzed collagen improves pain in arthritic joints Adam, 1991; Moskowitz, 2000).
    • Hydrolyzed collagen contains the same amino acid composition as joint cartilage and disc material. Hydrolyzed collagen when given orally to mice will lead to the accumulation of collagen material in cartilage (Oesser et al., 1999). Hydrolyzed collagen has been demonstrated to stimulate cartilage cells to produce cartilage (Oesser et al., 2003).
    • Daily use of a dietary supplement of hydrolyzed collagen may help increase strength and decrease pain in the knees and other major joints in individuals with arthritis who experience pain when they are doing repetitive activities (Zukley et al., 2004).
    • Hydrolyzed collagen like gelatin contains significant amounts of the amino acids Proline and Glycine. The body uses these and other amino acids to rebuild damaged collagen. These two amino acids are found in high amounts in joints and cartilage and are required by the body to replace collagen when it is broken down by wear and tear (Carpenter et al., 2004).
    • James M. Rippe, MD published a book in 2001 titled The Joint Health Prescription. In this book he reported the results of a study that he and his associates performed at the Rippe Lifestyle Institute in Shrewsbury, Massachusetts. This double-blind controlled study involved 175 patients with osteoarthritis between the ages of 40 and 85 who used either a gelatin supplement or a placebo over a 14-week period. The participants in the study consumed either 10 grams of gelatin (Knox Nutra-Joint) or a placebo before breakfast in a glass of water or juice. After 14 weeks the participants who used the gelatin supplement had improved joint mobility, improved knee strength and decreased symptoms of pain and stiffness compared to those individuals who received the placebo (McCarthy et al., 2000).

    • While there are no absolute recommendations on the therapeutic intake of collagen hydrolysate, however studies in arthritic patients suggest a 10 g daily dose may be beneficial. The treatment period should not be less than three months. However, as symptoms tend to return after discontinuation of treatment, long-term administration may be prudent. Collagen hydrolysate has no side effects beyond digestive issues (loose bowels at high doses in a few individuals); therefore long-term regular use is safe and may serve as preventive measure.

    3. Also check out the use of IceWave patches for pain control. Information on pain control using these nontransdermal patches can be found at www.lifewave.com.


  3. #27
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    Re: Advice on disc protrusion

    Hi all,
    Very interesting reading, and good histories. The problem with scanning over the years is that as scan resolutions become better, more 'problems' are discovered. Recent evidence indicates that between 67% & 75% of people aged between 30 - 80 years of age will have degenerative changes evident on scanning. These changes include disc bulges and spinal cord / nerve root compressions. What is even more interesting is that mild to moderate degenerative changes can be completely symptom free, also including spinal stenosis, nerve compressions.
    Therefore a person may have had a disc disruption / compression for years without knowing, hurt their back in another way, have a scan, and find out information that is completely useless to the current new problem. This explains why many treatments, including surgery. Therapists are trying to fix something that is not broken.

    Forgive the simplicity of this next suggestion, but I believe that the majority of your symptoms can be explained by a tethering of your piriformis muscle to your sciatic nerve. Stretches can sometimes improve this condition, but can also worsen the irritation. Your sciatica is explained by tethering, as are the exercise induced symptoms, as well as the problem caused by sitting.Lumbar muscle spasms are due to the erector spinae muscles spasming or tightening to act as a splint, which then decreases your mobility further, and increases compression forces.

    I believe that you need a very deep piriformis friction massage, then gluteal / sciatic exercises over two days. If the treatment is not firm enough, it will fail. Your previous history of severe pain in the gluteals should not preclude this deep type of treatment, but it will hurt!
    I carry out such treatments all the time, and they are safe, and usually unmask the nature of symptoms, and often provide information as to whether tethering or the disc is the major contributing factor to the pain.
    As other writers have suggested, you are now in the chronic pain category, therefore compensatory changes will have occurred with the failed treatments and time eg further tethering, muscle imbalances.

    As you cannot readily access your physio, you could try the following:
    1. To find the correct area, place your little finger on the top portion of the gluteal cleft, and your thumb of the same hand onto your greater trochanter
    (bump on your upper thigh bone).
    2. A third of the way between your little finger and thumb is likely to be a tender point.
    3. Find the sharp edge of a cupboard or table top, and back your buttock onto the sore area very firly, to the point of deep pain.
    4. Do the same thing 25 mm (1 inch) above and below the first point, on a curve. The areas are probably sore.
    5. Do a stretch either in standing or laying down, where you pull the affected side knee towards the opposite shoulder, hold the stretch without bouncing, for 15 seconds. Repeat 10 times, 3 to 4 times daily.
    6. Do a hamstring stretch for the affected side with the same directions as for the gluteals.Do not bounce any stretches - have a sustained hold to the point of discomfort, not pain.
    7. Morning and night lay on your back, knees bent,with your heel a comfortable distance from your buttocks, knees and ankles pressed together, and rock your knees gently side to side for 5 minutes, not into pain.

    Do the above exercises for at least 2 days, even if the buttocks are sore. The pressure against the table top edge can be sufficient to cause bruising, if done correctly. If you do not do the exercises, the treatment is a waste of time, as is a gentle treatment.
    Do not increase your daily activity levels within the first two days, no matter how much better you feel.

    Note, if any of the exercises cause increased true neural signs such as loss of strength, or numbness beyond what you already experience, decrease the intensity of the hamstring stretches.This is unlikely if you take the exercises gently. The friction massage for the priformis cannot worsen any spinal stenosis, and is therefore safe.

    Hope the above helps. It is certainly worth a try, especially as surgery is being viewed as an option.Do not sit for greater than 20 minutes for the first two days, without doing glteal stretches (one for 15 seconds), or better still walk a little (couple of minutes change of position).
    Goodluck
    MrPhysio+


  4. #28
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    Re: Advice on disc protrusion

    Sorry for not replying sooner, I've been out rock climbing nearly every day for the past week, yeeha!!!!

    It's 3 weeks since the steroid injection and after the initial horrible reactions in the 1st week I am completely pain free, the difference is astounding!!!

    I'm still doing all my stretches and going walking though. The only thing I'm left with is that I'm still waking in the morning a bit tender in my bum and behind me knee and down the lateral side of my thigh. I remember the 1st private physio I went to see massaging into my bum at the painful point as yes it was VERY sore when she did it but effective (if only for a couple of days). I mentioned to the Chiropracter about doing the thing where you use a tennis ball to reach the Piriformis but he reckoned there was too much irritation and inflammation present and this would just irritate it further. I ignored what he said, curious to see if it would help or not but he was right and the deep pressure caused spasms of agony and much nerve pain. But a while back, after being on the Amytriptyline for a couple of months and the pain had subsided enough for me to be able to start doing more stretches without causing too much pain I was able to do several Piriformis stretches which were very soothing to do and he did say that it was then ok to use the tennis ball. I think he thought that Piriformis was going into spasm because of the irritation to the nerve and not the other way around.

    Certainly, all the pain was most def coming from the nerve compression as the steroid injection was injected into the right place and has removed all the painful symptoms. Interestingly though, when I do any back extension exercises they still cause my leg to go numb. Probably the disc bulge has not fully retracted and my bending backwards causes it to get squished out more? But all the flexion type exercises are fine. Tho I can seem to do the exercise know as The Cat in yoga fine tho with just not as much flexibility as before. The 2 stretches which still cause problems are lying prone and doing a Cobra type stretch and lying prone and keeping chest and head on floor but lifting leg up. Both of these make my leg go numb and if held in position for too long leg goes a bit sore. But I'm still doing them, but only to the point where they don't cause symptoms.


  5. #29
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    Re: Advice on disc protrusion

    PS - the tender point you mention between the gluteal cleft and the trochanter is still a tad tender, certainly even when I press into there with my fingers I can feel a tender spot. How long should I sit on the sharp corner bit of a desk etc?? Cos you are right, it is bloody painful to do that!!! (Excuse my language!)


  6. #30
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    Re: Advice on disc protrusion

    Hi,

    it is good that you are feeling better.

    However, please listen to your body...it is telling you that extension is no good! Numbness is not a 'normal' sign for anything. It would seem to me that you are compressing the nerve root.

    Any good Mackenzie therapist worth their salt will tell you that extension is not the only way to treat discs. In fact, there are 7 derangements described by Mackenzie so please don't get caught up on only one of them!

    I would still think that the nerve is sensitising the piriformis...but only my opinion! L/S extension, unless you are severely overactivating your hip muscles, doesn't cause leg numbness from an overactive piriformis.

    Staying within the symptom range as you are is the smart thing to do! Don't keep reassessing it! Do it once a week only. I had a patient who kept testing his L/S - he was doing it every hour or so - he didn't get better until he stopped testing his L/S!!

    Good luck!


  7. #31
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    Re: Advice on disc protrusion

    Hi, yeah that's what we were thinking, that it was the nerve irritation annoying Piriformis rather than Piriformis annoying the nerve. Both the Chiro and the Physio said that nerve damage/irritation can take up to 18months to heal properly so it may be that all I'm left with now is just a sort of small residual nerve pain and occasional numbness. And certainly my muscles have lost alot of strength over the past year, so it's gonna take some time to get back to proper strength and fitness. I've been missing out the back extensions now and the prone leg extensions but I did try them again today and it seems not so bad as last week so I guess it's just a case of taking it slowly and cautiously. And I'll do that, just trying it once a week gently to see how it improves as there are other stretches I can do for my back in the meantime.


  8. #32
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    Re: Advice on disc protrusion

    THanks for the updates.

    Don't forget to try to integrate your rehab exercises into your functional activities. In particular, hill walking and any other aggravating activities.

    Of course, don't be in a hurry to do this...just don't lose sight of the big picture - which is to get back to as normal a life as possible.

    Thanks again!


  9. #33
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    Re: Advice on disc protrusion

    Have you also tried the neural tension techniques as described by Butler? Have you got any sessions of these from any therapist? These techniques may resolve you residual neural tension.


  10. #34
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    Re: Advice on disc protrusion

    Do you have a link to any of these neural tension techniques?

    Both the Ortho and Chiro reckon the disc is no longer compressing the nerve and that the nerves down my leg will take around a year to heal properly.

    Would you believe it though, I seem to be developing a bit of shoulder impingement, aaaaaaaaaaaaarg!!!!!!!! Just can't win, lol! I think it's due to lying on my front for so long and shoulder being scrunched up, then jumping back to climbing several times a week too quickly. It went stab the other day and I lost ROM for a few hours. ROM back now but it's pretty achy. Chiro said Supraspinatis was very tight. So, that's more exercises for me to do now!! Damn, being a climber is hard work sometimes )


  11. #35
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    Re: Advice on disc protrusion

    Hi,

    I wouldn't be calling it "neural tension" to a doctor simply because it implies deformation to the nerve (i think).

    Neurodynamics (the preferred term of Michael Shacklock) or neural mobility or neural mechanosensitivity are more likely to get a better response from a doctor, especially a neurologist.

    The key authors that i know about are:
    Bob Elvey
    David Butler
    Toby Hall
    Michael Shacklock (www.clinicalneurodynamics.com.au i think - google it - in fact google all of them! They are physiotherapists)

    You can look their work up of www.pubmed.com (it directs you automatically to another site) where you can just type their name into a search strategy and their articles should come up.

    Alternatively, you can buy books by Butler and Shacklock (don't know about elvey).

    Lastly, how did they suddenly decide that the nerve is no longer compressed? What are your reflexes like? Don't worry about the shoulder - dysfunctions are not limted to just one area - fascia connects the whole thing up in a nice little web!

    Good luck!


  12. #36
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    Re: Advice on disc protrusion

    Let me describes the principles of mobilization of the nerves, as described by Butler.

    The intensity of the maneuver should be related to the irritability of the tissue, patient response and change in symptom. The greater is the irritability, the more gentle is the response.

    If the restriction is primarily tension, the stretch force is applied into the tissue resistance, held for 15 to 20 seconds, released and then repeated several times.

    Neurological symptoms of tingling or increased numbness should not last when the stretch is released.

    The application of the techniques requires positioning the individual at the point of tension (symptoms just begin), then either passively or having the patient actively move one joint in pattern in such a ways to stretch, then release the tension. Moving different joints in patterns, while maintaining the elongated position on the other joints, changes forces on the nerves.

    After several treatments and tissue response is known, the patient is taught self stretching.

    Have a look over the techniques for mobilizing the lower quadrant and sciatic nerve.

    Straight Leg raising with Ankle Dorsiflexion:

    Patient position and procedure.
    Supine with lower extremity in straight leg raising position (SLR), add ankle dorsiflexion. Several variations may be done; ankle dorsiflexion, ankle plantar flexion with inversion, hip adduction, hip medial rotation and passive neck flexion. The maneuver may also be performed long sitting (slump sitting position) and side lying. These various positions of lower extremity and neck are used to differentiate tight and strained hamstrings from possible sites of restrictions or nerve mobility in the lumbosacral plexus and sciatic nerve.

    Once the position that places tension on the involved neurological tissue is found, maintain the stretch position, and then move one of the joint a few degree in and out of stretch position, such ankle plantar flexion and dorsiflexion, or knee flexion and extension.

    Ankle dorsiflexion and eversion places more tension on tibial tract.

    Ankle dorsiflexion and inversion places tension on the sural nerve.

    Ankle plantar flexion with inversion places tension on the common peroneal tract.

    Adduction of one hip while doing the SLR places further tension on the nervous system because sciatic nerve is lateral to the ischial tuberosity; medial rotation of hip while doing SLR also increases tension on sciatic nerve.

    Passive neck flexion while doing SLR pulls spinal cord cranially and places the entire nervous system on stretch.

    Slump Sitting Stretch:

    Patient position and procedure.
    Slump sitting with neck, thorax, and low back flexed. Extend the Knee and dorsiflexion the ankle just to the point of tissue resistance and symptoms reproduction. Increase and release the stretch force by moving one joint in the chain a few degrees, such knee flexion and extension, or ankle dorsiflexion and plantar flexion.

    Prone Knee Stretch:

    Patient Position and procedure.
    Prone the spine neutral (not extended) and the hips extended to 0 degree. Flex the knee to the point of resistance and symptom reproduction. Pain in the lower back or the neural signs are considered positive for upper lumber nerve roots and femoral nerve tension. Thigh pain could be rectus femoris tightness. It is important to not hyperextend the spine to avoid confusion with facet or compression pain. Flex and extend knee a few degrees to apply and release the tension.

    Alternate position and procedure.
    Side lying with the involved hip upper most. Stabilize the pelvis and extend the hip with knee flexed until symptoms are reproduced. Maintain the knee flexion, release, and apply tension across the hip by moving it a few degrees at a time.

    Prevention:

    These maneuvers especially the SLR with repetitive ankle dorsiflexion and plantar flexion, and the respective upper quadrant maneuvers may be used to prevent restrictive adhesions from developing if done early on in treatment after an acute injury or surgery.

    Precautions and contraindications to Nerve tension Testing and Treatment:

    Butler Cautions that there is incomplete scientific understanding of pathology and mechanisms occurring when mobilizing the nervous system. The clinician should always use caution.

    Precautions:

    Know what other tissues are affected by the position and maneuvers.
    Recognize of irritability of the tissue involved and do not aggravate the symptoms.
    Identify whether or not the condition is worsening and the rate of worsening. A rapid worsening condition requires greater care than a slowly progressing condition.
    Use care if there is active disease or pathology affecting the nervous system.
    Watch signs of vascular compromise. The vascular system is in close proximity with nervous system and at no time should show signs of compromise when mobilizing the nervous system.

    Contraindications:

    Acute or unstable neurological signs

    Cauda equina symptoms related to spine including changes in bowel and bladder function and perineal sensation.

    Spinal cord injury and symptoms.


  13. #37
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    Re: Advice on disc protrusion

    Another neural stretch position for stretching the sciatic nerve is when hook lying, place one foot over the opposite knee and passively flexing the opposite hip (either by someone doing it for you or by grabbing onto the thigh and pulling it towards your chest). A stretch should be felt over the posterior thigh.

    I teach this to many of my patients with sciatica and they feel very good relief after a few sessions.


  14. #38
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    Re: Advice on disc protrusion

    Hi thanks, shoulder is much better after doing stretches of the Wikipedia reference-linkrotator cuff, a sublime (but painful) massage from the chiro and massaging it myself also. Shoulder impingement is one of the most common climbers injury but it wasn't really proper impingement but def felt like the start of something, thankfully nipped in the bud!!

    When the chiro examines my back each session he has me do certain movements as he palpates up my spine. In simple terms he likens the joints to hinges on a door and when all is well they move smoothly. He said that with a protrusion or inflammation etc it feels more akin to a door with rusty hinges, not smooth and all jerky like I guess. So he's been saying it feels much much better and movement is good. The Ortho said that as well as reducing the inflammation the steroid jab would reduce the swelling so I guess that is why he is saying it is no longer compressed. It's def not healed as I can still feel it not quite right but it's a great improvement and the way things are going, even though symptoms are not 100% resolved I don't think I'll get another jab, even if they recommend one cos the side effects from it have been a bit horrible.

    Thanks for the post on the neural tensioning stuff. The stretches sound similar to what I'm doing already, ie lying supine and doing SLR both plantar and dorsi flexed and holding for 20-30 secs. In dorsi flexion I can almost lift my leg as high as my good leg now with no pain, but still get a little neurological symptoms in plantar flexion and I seem to hit a barrier, where it feels tight in the lumbrosacral area, but not painful. Also the knee stretche lying prone doesn't produce any pain whatsoever and never would have.

    Aisha, that stretch you recommended is one that I have doing for a while now and is def very very soothing, esp to my bum. Another one which is good that is soothing is lying supine, flexing good knee but with foot on floor, then placing bad foot on the outside of good thigh and pulling knee on bad leg up to the opposite shoulder.

    Last edited by Sonj; 27-04-2007 at 06:01 PM. Reason: spelling mistake

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    Re: Advice on disc protrusion

    Hi Sonj,

    Thanks for the update

    Just a few things.

    1. It is good to hear you are doing well. You probably had a strained shoulder which will usually cause you to use the shoulder differently and then it leads to things like impingement etc. So dealing with it quickly was good.

    2. Your joints should move smoothly. However, there are a number of factors that make up smooth movement.
    - You can have "form closure" problems - where the joints, ligaments etc don't work properly - swelling can affect this.
    - You can have "Force Closure" problems where the muscles don't support the joints properly - like in muscle strains and tears.
    - You can have "motor control" problems where the brain doesn't coordinate the muscles properly in sequence leading to incorrect support for the joints - this is a very common problem.
    - Lastly, you can have your "Emotions" that can control what is going on, especially in persistent pain (Chronic pain). This is often the pyschosocial aspect of chronic pain - read G Waddell - the back pain revolution for more information.

    3. It has been months now since your problem started so central sensitisation has probably occurred - what this means is that pain can be perceived without nociception - that is pain is sensed by the brain without there actually something causing the pain physically. This is a bit hard for people to understand (even physios!!). Try Google for "central sensitization" - i found this one at the start of the list... <click here>

    4. Keep going with the neurodynamic self treatment. The "stretch" shouldn't be strong as the blood supply to the nerve is easily compromised under slight strain. They (the experts in this field) are recommending more "neural flossing" type techniques where the motion is continuous rather than sustained stretching. It would be like doing your current exercise10 times instead of holding it for 60secs

    Good luck!


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    Re: Advice on disc protrusion

    Hi Sonj,
    I have recently joined this forum and only skimmed through the thread. I am not sure whether the original question on natural resolution of a disc prolapse has been dealt with. I have always advised patients that natural resolution does occur and surgery is simply a means to alleviate present symptom levels. Patients often feel they should have surgery to stop them having problems in the future but having spinal surgery now actually makes you more likely to require surgery in the future. Of course there are cases where surgery has to be performed but if symptoms are resolving then leave to a natural recovery.
    I have Wikipedia reference-linkMRI scans of patients with large disc prolapses who have had repeat scans a year later and the disc prolapse has shrunk to a small bulge. The way I usually explain this is in laymans terms: when the disc first prolapses it is full of fluid, like a grape, with time it loses its water content and becomes more like a raisin (due to proteoglycan deterioration and dehydration).
    So yes disc prolapses do resolve but disc degeneration will remain.
    The problem is there is poor correlation between size of disc prolapse and symptoms and virtually no correlation between disc degeneration and symptoms.
    The good news is that a huge proportion of the elderly population are walking around with severely degenerate discs which are not causing them any problems. This is why the epidural is useful, very often the symptoms are due to chemical rather than mechanical factors.
    The best evidence for self care is try and gradually return to normal activity, try not to worry. Fear of re injury is a big barrier to recovery.
    Good luck with your shoulder, I can't help you with this, except being a spinal specialist I would probably put it down to a C5 nerve root problem.


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    Re: Advice on disc protrusion

    Thanks for that. Aye, fear of re injury was strong at first (you keep expecting the pain) but once I got back into climbing I don't tend to think about it anymore. The pain is now all but gone with just the occasional flicker and occasional numb foot and a bit sore first thing in the morning which resolves as soon as I'm up and moving. The one thing that's still bothering me though is that I still can't sit down for very long or I get a pain in my bum (piriformis?) but this again resolves as soon as I get up and move about. I'm still doing all my stretches daily and there def helping. I still havn't had a big long day on the hill yet with going down steep ground but hoping to shortly to see how my back copes with it. Couple of weeks ago I did go down some pretty steep ground carrying a pretty heavy sack and there was no problems but I was only going down for around 5mins as opposed to the hour or so that I was used to before.

    Re the shoulder thing, been no more twinges but it does ache a little sometimes when I'm climbing so I'm just continuing with the Wikipedia reference-linkrotator cuff stretches as they seem to do the trick. Lol, I abs refuse to have another nerve root problem going on!


  18. #42
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    Re: Advice on disc protrusion

    Sonj, a bit more time and you will get there. Remember, it is actually the static loading positions that cause the symptoms, movement is good. Discomfort and stiffness in the AM and after sitting or sustained flexion are usually the last to clear. The classic phrase is hurt does not mean harm. If you over do things you may make yourself a bit saw but that does not mean you have restrained your disc. It is normal to have some flair ups on the road to recovery, these are usually short lived. Why not try a 20 minute walk with your sack tonight and see how you feel? As my mother always used to say: "procrastination is the thief of time".


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    Re: Advice on disc protrusion

    Hi, Re the static loading positions, not sure about that one because it was always 2-3 days after walking down steep ground with or without a sack that I'd be in agony, due to the disc being continuously compressed on each step downhill. I have carried a heavy sack for over 20 mins now (prob about half an hour to 40mins) just not down any steep ground for that length of time. I'm carless at the moment so can't get to the hills but as soon as I get some more wheels I'll be seeing how I get on. Oh re the static thing again. I reckoned that bending to pick up my heavy sack and swinging it up and round onto my bag was probably not good, so I've been finding a high point each time for the sack and kind of backing into it to put it on or else getting a friend to put it on my back for me.

    That's good to know that the little pain I'm feeling are usually the bits last to go, guess it shows I'm on the right track. The chiro did also say that forward flexion would be the last thing to come back but he did reckon also that I might never be able to touch my toes again. (lol, this has made me a bit stubborn and determined to prove him wrong) Ok, so I know being able to touch your toes isn't an important thing in life, lol, but I was always very flexible before this injury and having good flexibility, esp in the hip, is good for climbing. I think it's with my hamstrings being so tight at the moment that makes me less flexible, they are loosening and I'm getting more stretch in them, but gawd it's taking forever!


  20. #44
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    Re: Advice on disc protrusion

    UPDATE

    Well it's nearly 3.30am and I am unable to sleep as I am in alot of pain, worse than ever before. I don't know what has happened. Last Monday I had some acupuncture and was a little sore the day after but for days after that the little flickers of discomfort I was getting were pretty much gone and the pain in my buttock that I had in the mornings was all gone. Then one evening I had a bit of a stabbing pain in my back which lasted only briefly and I didn't think much of it. At noon today I had an appointment with the Chiropracter for a massage and manipulation. Left feeling good and got a lift home from my friend as I am still without a car. 10minutes from home and my back and leg started to hurt. When I got home I had to limp to the house and lay down to stretch out. Within an hour I was in agony and I couldn't stand up. Forced myself up as I needed to go upstairs to use the toilet but I couldn't walk upstairs and had to crawl up. Then my daughter had to pull up my trousers as I was unable to. Managed to get downstairs again and lay back down. I phoned my GP and he was able to fax a prescription to the local chemist in the village where I live and he kindly came to my house with some Tramadol. Lying on my front the pain is bearable but as soon as I move into any other position the pain is bad. Later I had to use the bathroom again, and again I had to crawl upstairs and needed help. Luckily my ex boyfriend had come to take my daughter for the evening and was able to help me. I got stuck at the bottom of the stairs and could not move for the pain. Everytime I tried to take a step the pain would stab in my back and down my leg, just as before but much much worse. The pain was so bad I was crying in agony and hyperventilating. He had to carry me through to the living room and I had to grit my teeth and force myself through the pain to be able to lie back down. He has gathered things for me so that I can lie here for the next 24 hours and not have to go back upstairs for anything as I cannot walk. Even crawling now is very painful. The tramadol is helping a little as long as I stay lying on my front and every so often I am crawling to the kitchen to get ice to put on my back which is soothing it somewhat.

    I phoned the chiropracter and told him what had happened and he thinks that the manipulations have perhaps caused things to get a bit inflammed (or very inflammed IMO as I cannot walk!) He is hoping things will settle back down again but if not, he is going to come to my house tommorrow to see if he can help me. I just don't understand how this can have happened as I was feeling so good since the steroid injection. He doesn't think that the injection has worn off, as he thinks the pain would have come back more slowly and not hit so suddenly the way that it did. I don't think this is just a small flare up that will die down as the pain is worse than it has ever been before, hopefully I am wrong.

    I'm tired of all this as I was doing so well. My flexibility was improving also and I was starting to be able to sit down and was even able to stretch out my hamstrings from a sitting and standing position.

    Surely if I was still healing but just having a flare up the pain wouldn't be so sore. It has been 14 hours since the pain came back and it hasn't lessened any. Ocassionaly I can manage to roll over slowly onto my back and flex my bad leg at the hip and knee and pull it towards my chest and this gives a very slight relief, opening up my spine more?

    One thing I wondered about that the Wikipedia reference-linkMRI showed up, was that the endplate of the L5 vertebrae was dented? How could a prolapsed disc cause denting to the vertebrae? I know endplate material is softer, but is it so soft that disc material could dent it? Is a dented vertebrae the same thing as a compression fracture or is it a different thing? These were all questions that I forgot to ask the Ortho when I saw him.


  21. #45
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    Re: Advice on disc protrusion

    Hi sonj,
    Sorry to hear you are bad again. Loads of issues here.
    Main question: why did you have further treatment from the Chiropractor if you were feeling so good? I do believe that he has helped you more than anyone else up to now, but you get to a point when natural recovery is best. There is a risk in manipulating a disc protrusion.
    As I said previously, the majority of people with disc problems have flair ups of symptoms. Standard advise would be to give yourself a couple of weeks (don't panic the initial severe pain should start to settle), if you are not starting to improve after 2 weeks try and get another epidural as this did help you last time.
    Disc protrusion into the end plate is relatively common and may have happened to you previously. This usually happens when the end plate is weaker than the annulus. It is often an incidental finding and can be seen when there is a previous history of Scheuermanns disease and are described as Schmorl's nodes. However, Scheuermanns usually does not effect lower lumbar spine. Schmorls nodes are often asymptomatic and I would not worry about this finding on you Wikipedia reference-linkMRI.
    Give yourself a few days for the intense pain to subside and then try and get up and mobile again. Please don't let this flair up cause you to get all that fear back, you are likely to recover and if you are not recovering then you still have the option of the epidural.


  22. #46
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    Re: Advice on disc protrusion

    Thankyou, on day 3 now and I am still lying here unable to walk ( I have liquid morphine for the pain and it is helping only a little. I try to get up onto my knees are crawl around every so often and also pull my legs up as before to try and get some mobility. I tried to stand up again a while ago and managed to take 4 steps but had to go back down again as the pain is excruciating. The chiro came to my house and gave my back a very gentle massage and used some vibrating machine thing on my back which he said should ease any muscle spasm and it was very soothing. My friend also gave me some acupuncture yesterday and when the needle went into my sacrum the pain went away completely straight away, but it came back again as soon as the needle came out. I was still seeing the chiro once a month just for maintanance sort of thing and when I left the other day he was happy for me to go away for 6 weeks.

    I have a friend who is coming down every day to get me food and empty a chamber pot which I am having to use, all rather humiliating but there you go.

    My GP advised me that if the pain did not settle again I would have to get back in touch with the hospital. My main worry is that I go for another injection and eventually I need to have another one again. I have been told I can only have 6 injections. I am scared that even after having 6, I may just be delaying the enivitable of needing surgery. I thought flare ups were meant to be less painful than the original injury, but this is far far worse.

    Re the schmorl node thing. The chiro reckoned that when I originally injured my spine it is possible that I fell onto my bottom (which I did do a few weeks before the pain started) and this compressed my spine so badly that the disc ruptured. As well as protruding laterally onto the nerve root, he said it would have protruded upwards, fracturing the L5 vertebrae. Obv this has healed ages ago and he said this is what the denting is that has shown on the Wikipedia reference-linkMRI. Of no significance now obv if it was a fracture as it would have healed a long time ago, but I was curious nonetheless.

    My daughter will be coming home on Monday and I am still incapable of caring for her and unsure of what it is going to happen now. A few weeks ago I said I wouldn't get another steroid jab as I hated the side effects but by god I would happily put up with the side effects to stop this pain


  23. #47
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    Re: Advice on disc protrusion

    Sorry to hear you are still in so much pain and it must be difficult to try and remain positive. Sonj, you had a good response to your first epidural why are you thinking so negatively about the prospects and that you "may" need as many as 6 and then have sugery. People do recover from disc prolapses it just takes time. Everything should be geared towards helping you through this bad spell. Obviously if your pain does not settle over the next few weeks or with another epidural then surgery is an option.
    Let us know how you are at the end of the week and I really hope you can report some improvement.


  24. #48
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    Re: Advice on disc protrusion

    Hi, I guess the negativity is just worry about having a course of injections only to end up needing surgery anyway and I wonder if I'm not just best to have the surgery and get it over with. I know I won't know if they will heal this permanantly until I try but I'm just getting so sick of it all now and the thought of going thro another while of being ok after a jab only for it to reoccur again is unbearable. But yes, I should be thinking more positively. Just finding it quite hard just now cos of the pain, lack of mobility and lack of sleep.

    It's been nearly a week now and there has been a little improvement. I had to stop taking the morphine as it was doing very little for the pain and just making me feel very sick (I threw up) and horrid. Out of hours GP came to my house and gave me Fentanyl patches and these have made a big difference to the pain level. I am using them with the CoDydramol for breakthrough pain and also using some Ibuprofen gel when the Codeine wears off but it's not time to take more. The gel is affecting my gut and I feel sick and raging heartburn and am using herbal Slippery Elm powder to rememdy that as I find things like Rinitidine and Lanzaprosaline(or whatever it's called!) abs useless. Feel like a walking pharmacy, lol!

    So, I can now stand and shuffle/limp across the living room and I'm doing this every so often, usually before it's time to take the painkillers or it leaves me in agony for about half an hour. But atleast I'm starting to be able to walk for a tiny bit longer. Still pulling up my legs and going for crawls too! My knees were going very red and sore from the crawling so my friend and I have fashioned knee pads from sponges and pairs of tights, lol! The ortho has squeezed me in to see me on Thursday and an ambulancey thing is being arranged through my GP to get me to the hospital. I have been trying to contact the pain clinic re another injection but nobody is ever answering the damn phone and they havn't got back in touch when I left a message but it has been a Bank Holiday so hopefully they will get back in touch today.

    My icky shoulder feels like it's burning up too cos of lying on my front and having to crawl. I feel a right mess just now, lol! Oh well, atleast I can still laugh at myself, you just gotta sometimes. My daughter is home now and my friend is helping me to get her meals and stuff. Her father is being a BLEEP!!! and totally unreliable! Thank goodness for good friends!


  25. #49
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    Re: Advice on disc protrusion

    UPDATE

    I have been to see the Orthopaedic consultant and he was saying to me, that in cases like mine where the inflammation keeps on reoccuring and getting worse each time, then it is more than likely that this will keep on happening and just getting worse. He believes there is little point in having another injection and reckons that having surgery is the only option left to me.

    I am now able to get up and walk some and have been managing to get outside for the past 3 days. My leg feels very odd, like I have to focus all my attention on being able to move my leg. It took me 20 minutes to walk what would normally take just a few minutes. But boy, it's great to be mobile again!!! I had some more acupuncture on Thursday and it has def helped and it has even taken away the pain I was getting in my shoulder. The pain is now under control with the Fentanyl patches, codeine and Ibuprofen gel and various other stuff for all the side effects!!

    The surgeon said he unfortunately couldn't operate in the next few weeks as he is on leave but I'm assuming that as soon as he gets back he will want to operate ASAP. He will be doing a keyhole discectomy and I will only be in hospital overnight. He said as long as there were no complications (which he doesn't forsee) it should take 4-6 weeks for me to recover and be able to drive again and there is a 90% success rate. I asked when he could see me climbing again and he said that as soon as the 6weeks were up, I should go for it as soon as I felt fit and well enough. Seems all positive.

    I also enquired about the denting to the vertebrae and it would seem that my GP has been misinforming me yet again!! He said there was no denting whatsoever and that the 'acute endplate changes' referred to the fact that the inflammation from the disc was making my vertebrae inflammed also. So this clears up the confusion I was feeling over that because I was rather baffled as to how and when I could have fractured my vertebrae. Mentioned above that I had fallen onto my backside a few weeks before my troubles started but it wasn't a bad fall and there was no pain/bruising/swelling at the time. So that's that bit cleared up anyway!

    Thankyou for listening and for all the advice over the past few months. Hopefully once I've had the surgery I can move on from all this and get my life back on track


  26. #50
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    Re: Advice on disc protrusion

    Must have Kinesiology Taping DVD
    Good luck sonj. I hope all goes well with the surgery. The majority of patients who end up having to have surgery are pleased with the results if they have been wanting relief from sciatic pain. Let us know how you are after the surgery and what exercises and advise you found most useful. Look on the bright side, you will make a cracking spinal physio specialist with this experience.



 
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