Disc Bulges, Protrusions, Herniations and Extrusions

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Disc Bulges, Protrusions, Herniations and Extrusions 2017-05-08T16:45:03+00:00

18_hern_disc_lab

There are 4 stages to disc injury.  Disc injuries are commonly misdiagnosed or under diagnosed by doctors, physical therapists and chiropractors.  The result of this misdiagnosis is long term worsening of the condition.

Stage 1 – Disc swelling/bulging – Can also be referred to as degeneration.  Disc swelling and degeneration can result from wear and tear, aging or trauma.  This condition often goes undiagnosed because it will usually resolve itself if the person removes the irritant.  It is common for doctors to take x-rays (which do not show disc swelling) and proclaim “nothing is wrong”.  It is also common for physical therapists to tell patients they have a “weak core” and need to do abdominal exercises.  This ignorance to the true nature of the problem exposes the patient to a lifetime of chronic and recurring lower back pain.  If treated properly chronic pain can be avoided.

 

disc swelling can put pressure on your nerves

disc swelling can put pressure on your nerves

Stage 2 – Disc Protrusion – Can also be called a prolapsed.  A disc protrusion results from repetitive movements such as repeated bending and twisting or can result from a specific moment in time trauma.  This injury will usually cause nerve pain that will radiate in a very specific pattern into your thigh and possibly all the way to your foot.  X-rays are not useful in helping to diagnose the severity of the protrusion but MRI’s are.  In this modern era doctors are reluctant to send patients for MRI’s and usually refer them to physical therapy where they are often mistreated.  If treated properly the protrusion can be reduced and the associated pain eliminated but if left unchecked or treated improperly the patient can and will progress to stage 3.

Stage 3 – Disc Herniation – A disc herniation is the area between a disc protrusion and extrusion.  It is a severely debilitating lower back injury that causes nerve pain in very specific pain patterns.  These patterns are predictable and reproducible if tested properly.  X-rays are useless in the diagnosis of a disc herniation.  MRI can be useful in diagnosing the severity of the disc herniation and helping the doctor and patient decide on a proper course of treatment whether that be conservative or surgical.

Stage 4 – Disc Extrusion – This is a severe condition that usually results from years of the person suffering from repeated bouts of lower back pain.  A typical patient will present with an antalgic lean, pain radiating down their leg and a history of progressive lower back pain.  A disc extrusion is often likened to squeezing the jelly out of a jelly doughnut.  This condition is not reversible and is usually severely debilitating and limits the patient’s ability to function normally.

 

The disc material can be squeezed into the spinal canal and cause severe pain

The disc material can be squeezed into the spinal canal and cause severe pain

How do you treat Lower back disc injuries?

Lower back disc injuries need to be diagnosed accurately first and treated properly second.  How many people have visited their doctor with lower back pain only to be told to take Tylenol or Ibuprofen and put ice on it?  Most of these patients were not even touched or examined by the doctor.  If they are “really lucky” the doctor referred them for physical therapy.  In many instances the patient would have been better off without this referral.  We have come to know these therapists as “Physical Terrorists”.  The well intentioned but misinformed therapists either torture the patient with painful exercises or give them “grandma” exercises to do that are useless.  It is critically important that an accurate diagnosis is achieved that way a practical and realistic treatment program can be instituted.

 

How do you accurately Diagnose Lower Back Disc Injuries?

The most important way to diagnose lower back disc conditions is to LISTEN to the patient’s history and description of their symptoms.  Secondly a thorough orthopedic assessment should be performed.  These orthopedic tests are commonly taught worldwide in medical schools, chiropractic schools and physical therapy colleges.  These tests allow the doctor to differentiate where the pain is coming from by stressing various tissues and nerves.

Seated Leg Raise

Seated Leg Raise

Seated Leg Raise

 

 

 

 

 

Supine Straight Leg Raise

same as seated leg raise but lying down

same as seated leg raise but lying down

 

 

 

 

 

Slumps

stretches the nerves

stretches the nerves

 

 

 

 

 

Femoral Nerve Stretch test

stretches the femoral nerve

stretches the femoral nerve

 

 

 

 

 

 

Kemp’s Test

can cause local pain or nerve pain

can cause local pain or nerve pain

 

 

 

 

 

 

Piriformis Test

stretches the glute medius and piriformis

stretches the glute medius and piriformis

 

 

 

 

 

 

Range of Motion Testing

flexion, extension, lateral bending, rotation

flexion, extension, lateral bending, rotation

 

 

 

 

 

 

How do you effectively treat Lower Back Disc Injuries?

Once a proper diagnosis is achieved an effective treatment plan is put in place that meets specific criteria.  It must be reasonable and practical, not worsen the patient’s condition and must result in resolution of the patient’s symptoms.  The first thing that is necessary is to remove the irritant.  If you are suffering from lower back pain and you are continuously doing something or some activity that is either causing it or aggravating it will never get better!

Step 1: Remove the irritant(s)

The next most important thing to do as the doctor is to establish WHY the patient is suffering from the disc pain.  One patient may have disc swelling because of muscle weakness or imbalance while another patient may be suffering from disc pain due to misalignment of their spine or pelvis while another may have disc pain due to a traumatic injury.  These 3 patient examples would all be treated separately and distinctly.

Step 2: Find the cause and remedy it.

Treatments for lower back pain due to disc injuries range from conservative to surgery.  Surgery should only be used in severe cases that do not respond to conservative measures.  Conservative treatments for disc injuries include chiropractic adjustments, modalities such as ultrasound, traction, strengthening exercises and home exercises such as stretching and foam roller.  When all of these treatments are combined we find the effects to be magnified and are able to help many patients with lower back disc injuries recover quickly.  Unfortunately many clinics ONLY provide one of the interventions causing the person to recover slowly or even worsen and progress to a higher stage disc injury.

Chiropractic Adjustments/Spinal Manipulation

gentle chiropractic adjustments align the spine

gentle chiropractic adjustments align the spine

 

 

 

 

 

 

Therapeutic Modalities – Ultrasound, Electrical Stimulation, and massage are all examples of therapeutic modalities.

electric-modality-848x518

 

 

 

 

 

Traction/Decompression – Inversion tables, lying lumbar traction units and expensive decompression centers are all examples of traction.

20-40 degrees of inversion is all that is necessary

20-40 degrees of inversion is all that is necessary

 

 

 

 

 

 

Rehabilitative/Strengthening Exercises – Exercises that promote strength and movement of the spine and core muscles are known to help with lower back pain.  In my opinion it is ridiculous for most patients to have “supervised” physical therapy.  In our clinic we teach the patient what to do, email them a YouTube instructional video and have them perform the exercises at home or their gym.  Paying a physical therapist to watch you perform exercises is an absolutely monumental waste of your hard earned time and money.

lumbar extension exercises can be very helpful

lumbar extension exercises can be very helpful

 

 

 

 

 

 

Home exercises, stretching, foam roller routines

low back stretch low back foam roller

At San Diego Sports Injury and Running Institute we have found that spending the extra time to arrive at an accurate diagnosis is paramount.  We then spend the needed time treating the patient correctly and providing the necessary treatments.  Patients are also instructed on how to properly care for their condition at home.