Advice on disc protrusion

[Sonj]

Hi thanks, shoulder is much better after doing stretches of the rotator 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.

[alophysio]

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!

[monkey]

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 MRI 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.

[Sonj]

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 rotator cuff stretches as they seem to do the trick. Lol, I abs refuse to have another nerve root problem going on!