Disc Problems

By Dr. Richard L. Cole, DC, DACNB, DAAPM, FICC

DIAGNOSIS:

One of the more serious problems that we encounter involves disruption of the intervertebral discs, the dense ligamentous material found between the bones in your spine. This could take several forms including disc rupture, disc herniation, disc degeneration, or disc bulge. The different terms make for a great deal of confusion among patients because some doctors use the terms interchangeably. However, each term has a different meaning and the treatment and outlook for each condition can vary significantly. To get a handle on your problem we need to name it correctly and that is not always an easy task. ConservCare doctors are highly trained at making the right diagnosis of your disc problem and determining if it will respond to conservative management. In order to make a proper diagnosis a thorough history and examination has been performed. We normally use x-rays to look at the bone on the edge of the disc and at the disc space for clues. Sometimes we will need to obtain an MRI or CAT scan of the disc to properly identify the problem. Nerve tests are also helpful in determining if nerve tissue has been damaged. Whatever tests are run you may rest assured that they were necessary for the proper identification of your problem. The pain of a disc problem comes from three things: swelling in the disc, compression on the nerve, and chemical irritation of the nerve. You can have one of these or any combination of the three. Sometimes the surrounding muscles and joints become involved also adding to the patient’s discomfort. Patients with disc problems usually have leg, hip, or pelvic pain. Often, there is back pain, but not necessarily. In severe cases, the leg will lose some feeling or strength. All symptoms must be watched closely during your course of treatment. Answer completely the questions that your doctor asks you about the symptoms that you are experiencing. If your problem is a surgical case, we will refer you for neurosurgical examination. Some of the top neurosurgeons in the country work in Memphis and we have established a working relationship with them.

TREATMENT:

The first thing that must be done is to get the swelling under control. The doctor may be using a protocol of manipulative procedures and physical therapy designed to limit the swelling as quickly as possible. As the swelling diminishes so will the pain. Secondly, decompression maneuvers may be performed for the disc to improve the mechanical function of the low back and disc tissues. There are several ways to do this and our doctors will work with the treatment they think is best for you. The regimen may be modified if you are not responding properly. Physical therapy may change throughout the course of treatment to assist in the recovery process. The last phase of care will involve strengthening the area to prevent reoccurrence and further damage to the disc.  With each injury disc problems become more complicated. Therefore, we want to prevent re-injury if possible. In order to accomplish the objectives, you may be given some homework. It is essential that you follow your doctor’s orders to the letter. Some patients do not do what the doctors ask and some do more than they want. They will be specific with their recommendations. Please, follow them closely. If you do no meet your expected improvement your program should be modified. Home care is very important. The doctors may ask you to walk on your heels and toes at home in the morning and evening for the first few days. It is just a test to determine the strength in your legs. If you feel that you are getting weak in your legs, let your doctor know. Also any alteration in your bladder and bowel function should be reported. These are important clues to help us in diagnosing your condition. Home ice treatments may be prescribed early in the course of treatment. Please place the ice on the spot that the therapist has shown you and use it 20 minutes for each application, unless directed otherwise. The best source for ice treatments is a baggy filled with ice and with some water. Try to get all the air out of the bag. You might also want to double the bag to insure it does not leak. Next, watch your posture. You may be restricted to the number of hours that you can sit and stand. Follow these instructions closely. Early compliance will get you back on your feet soon. When you do sit, find a firm chair and sit very erect. Do not sit on a soft chair, couch, or recliner. It will just make your back worse. When you lie down and rest, you may find it more comfortable to lie on your side with the pain side up. Another good position to lye is on your back with your knees up. This removes pressure from the nerve. Whatever posture you can find that helps the pain, probably will not hurt you unless it breaks one of the previous guidelines.

Most disc problems are going to respond to conservative treatment. Recent studies have shown that conservative management and a little time is the best approach to disc disease. Work closely with your doctor and you too may get this behind without radical intervention.