Pain from a herniated or protruded disk may be local, spread to the buttocks or radiating down through the leg. Depending on the anatomical location of the protrusion, its proximity to the nerve, inflammatory response and the stability of a spinal segment causing pain of different quality. Pain is usually worse while sitting or bending down and improves with walking. There may be numbness, tingling and loss of strength. The body may react with antalgia. Antalgia is a protective scoliosis – bending of the spine away from compressed nerve in order to relieve the tension on the spinal nerve pinched by protruded disc material.
Here are some of the common causes for a herniated or protruded disc. Anatomical predisposition, motor developmental aberrations, poor spinal stability, abnormal hip alignment, improper lifting activity, poor posture, repetitive trauma as well as variety of other biomechanical factors.
Disk pain may mimic many other syndromes in the low back such as: sacroiliac joint pathology, facet irritation and muscular pain. Unless steroid injection or surgery is considered MRI (Magnetic resonance imagining) is not necessary in most cases.
Discal pain without radiation may be difficult to diagnose clinically, as its presentation is similar to other back pain syndromes. This type of pain must be differentiated from pain arising from sacroiliac joint or facet joints. Some of the treatment methods such as stretching or manipulation can have grave consequences if not diagnosed correctly. Pain from the pinched nerve by the disk is much more clinically evident.
Different disk syndromes may respond to different type of therapy or treatment. Therapy choice should be based on thorough clinical evaluation, history factors rather than MRI images. There are no miracles in treating disk pathologies. The success is based on experience and comprehensive approach rather then specific technique.
At NYDNR for treatment of herniated or protruded disc we use a combination of the most modern evidence based clinical approaches such as DNS (Dynamic Neuromuscular Stabilization), ISM (integrated system model), McKenzie method and clinical Pilates. We may combine these with acupuncture or a epidural injection if necessary.
Another novel approach, which is unique with us, is called reflex stimulation (vojta therapy), which in the past has only been used for treatment of neurological diseases. Reflex stimulation has clinically been proven to be most effective in the acute and sub acute stages of disc herniation.
if YOU HAVE a DISC HERNIATION
This page contains presentations on novel evidence based approaches for treatment of low back pain and herniated disc disorders. Please click here to review our unique non-invasive evidence based physical therapy approaches for treatment of back pain, herniated disc disorders and sciatica
Herniated Disc Treatment
If you are reading this, you are probably looking for quick remedy of herniated, bulging or protruding disk.
Let me warn you. Magic does not exist. Over the last 50 years many therapies, commercially available devices as well as surgical and other invasive interventions – all have failed.
Occasionally some success is reported when by accident an applied intervention happens to match the exact anatomical configuration of the pathology bringing relief to the sufferer. Mostly however patients are destined to wander in circles from specialist to specialist in the eternal quest for the healthy back. Until they come to realize the fact that there is no easy way out and it is necessary for them to put their full trust in the hands of specialists who base their treatment on the latest scientific evidence and uses comprehensive approach. Who do not sugarcoat the issue with promises of some “miraculous cures”, but approach the problem realistically providing the patients with what is best for them individually.
There is no evidence or consensus to this day as to what type of herniation should be treated with what method. Every attempt to match a specific therapy to a specific type of herniation has failed. The extensive variability of the degree, shape and position of intervertebral disc herniation make intervention targeting next to impossible. The obvious question is – why?
I am not going to go into the intricacies of the spinal anatomy for it will only shift your attention away from the actual problem. Just like over-reliance on the most popular imaging modality – MRI – that has done exactly that. The radiological evidence of disc displacement and compression of the nerve by the bulged material of the disc is only a radiological fact, a mere outcome of the disease. It is simply not the cause. Recently I see an increase in awareness of this by radiologists, who now are much more careful in their interpretation of MRI imagery. What they would have called a disc prolapse (herniation) a few years ago, for example, is now classified as a disc protrusion.
Another example of this controversy is the Failed Back Surgery syndrome. In this condition the patient continues to have the same pain after the discectomy (disc prolapse removal). The fact is that the surgery could have been avoided altogether and pain successfully eliminated by other conservative methods, even thought there was a herniated disc present on the MRI images, for it obviously was not the cause of the pain.
It is a known and scientifically proven fact that there are just as many patients with disc herniations that do not have pain than there are those that have pain. So what makes some patients with herniated discs to be in extreme pain while others with the same herniation have either very little or no pain at all?
The source of pain lies within the contents of the corresponding intervertebral unit. Pain occurs either due to direct mechanical pressure on the nerve root by the bulging disc tissue or triggered by the inflammatory process, to which the nerve responds when it is exposed to the foreign tissue of the disc material.
The cause of the disease however lies outside of the intervertebral unit. Herniation of the disc occurs due to variety of abnormal neuromuscular interactions in the whole body (not just a spine) that lead to repetitive overloading and resulting shearing forces that impact spinal discs. The causes of those abnormal forces are numerous. To name a few:
In most patients with herniated discs those factors coexist and interact.
There is a variety of other factors that may contribute to the chronic pain caused by the herniated disc, such as improper medical treatment in the very beginning of the disease, negative attitude and reckless behavior patterns, non-compliance with treatment protocols, depression, poor coping strategies, etc.
As it is so logical that treatment of the symptom and not the cause will fail, the treatment of the herniated disc must address the causes of the spinal overload which lead to pain and to the herniation.
Based on scientific studies and clinical experience, we know that some types of disc herniations dissolve with time. Symptoms from herniations, which do not dissolve, can be successfully eliminated if axial (vertical) compression on the spine is decreased.
The effect of decreasing axial compression of the spine would be the drastic reduction of pressure on intervertebral discs and spinal nerves, and normalization of biomechanics of the spinal joints and muscles of the affected segment. This allows for cessation of the inflammatory reaction around the nerve pinched by the herniated material of the disc.
Neuromechanics should be addressed as improper nerve/interface gliding can be inflammatory perpetuator. Gait( walking) mechanics should be addressed as gait and breathing are the two most important basic movement patterns.
Eventually, when spinal loads are properly redistributed by rehabilitative exercises, soft tissue physical therapy techniques, joint mobilizations / manipulations and variety of other conservative methods, the inflammation around the nerve is further decreased, the nerve root finds its way around herniated or protruded disc material and the pain disappears.
Treatment of herniated discs should be based on careful clinical evaluation of all causative factors and their interactions. As all of the above-mentioned factors come from variety of structures and control systems within the neuromuscular complex, it requires a clinician who is intimately familiar with how different structures and control systems interact within human body.
Since disc herniations always result from multilayered pathology, the treatment and rehabilitation of patients should be either done by a multi-factorial group of physicians and therapists who understand each other’s language and practice within the same facility, or by a clinician who is familiar with structural and functional diagnostics and has proficiency in a variety of treatment techniques.
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