Let's say that you're one of the lucky people who have a significant disc injury. Congratulations! Let's take a look at your prize choices!
Showcase #1: You're now the recipient of crippling spinal pain that radiates into your arms or legs, at least 1 but probably multiple spinal surgeries, a lifetime supply of pain meds, and a fear of movement and exercise because it might happen again! Quick, easy, and NO guarantee that it'll fix your problem...You're so lucky!
Showcase #2: You'll have a slightly longer, harder road to recovery, but one that will provide lasting results, requires no surgery or drugs, and will give you the confidence to keep your body moving!
Ok, so maybe choosing a treatment option for disc injuries isn't THIS cut and dry, but research is showing that the choice of most clinicians is leaning heavily towards conservative care! Let's take a look at and compare just some of the common treatment options out there for disc injuries. If you haven't read our last post about how disc get injured in the first place, do that NOW by following this link!
#1 Inversion Tables
Passively hanging upside down for a few minutes and completely eliminating your pain sounds not just fun, but downright easy, right? The idea of inversion therapy is based on the principle of spinal decompression/traction. The spinal vertebrae are being pulled apart from other another and held that way for a few minutes to allow the nutrients and fluid lost due to compression to flow back into the disc. Spinal decompression tables apply the traction very specifically, at a specific level of the spine with a precise amount of tension applied. A typical 200-pound male lumbar disc patient may start with only about 50-60 pounds of decompression. An inversion table is less precise, MUCH less precise. Flipping upside down applies traction to the entire spine, not just the segments that are injured, as well as a SIGNIFICANT amount of traction on the hip, knee, and ankle joints as well! You have no idea how much tension is being applied and it could be too much too fast, which can lead to back spasms or worsening injury. It can also cause problems in people with other health issues like heart conditions, high blood pressure, and glaucoma. That being said, traction can provide immense and sometimes immediate relief for discogenic pain. But decompression therapy is a PASSIVE therapy that can be a small part of the rehabilitation process. After decompression is complete, ACTIVE rehab needs to be done to maintain the progress made, otherwise, the weight of our bodies and gravity will just compress us right back down.
The final word on inversion tables: Go ahead and use them, but only if you consult with a medical professional first so they can make sure you are using it properly and have no serious contraindications to using one. Also, NEVER use one when you are alone! Always have someone around to help you in case the worst-case scenario happens.
#2 Spinal Surgery
No one ever wants surgery and should be the last resort treatment, but it is inevitable sometimes. Having a clinician that can identify the signs that it's time for a surgical consult is the most important part of the process. Too many people are too eager to ship off a disc patient to surgery because they are hard cases to deal with and the recovery is a process. The most common surgical procedure for a disc injury and degenerative disc disease is a discectomy and spinal fusion, meaning a surgeon will remove the injured disc and fuse the adjacent vertebrae using screws or a bone graft. In a 2018 article published in The Asian Spine Journal, the overall failure rate of lumbar spine fusion surgery was estimated to be between 10% and 46%. A second article written by Dr. Jeffrey Spivak, MD, an orthopedic surgeon and the Director of the Hospital for Joint Diseases Spine Center, states "Fusion rates of 60 to 95% have been reported depending on the fusion technique used and the surgeon's experience and skill, but clinical success in term of satisfactory improvement in preoperative pain occurs in only 50-80% of patients." Wait a sec, how is that possible?! That x ray and MRI said it was a disc problem... the disc is gone. And they said the painful movement between 2 vertebrae was the problem... but they're fused now and can't move. Why would there still be pain? It's because disc injuries are an easy scapegoat for diagnoses when there is really a deeper underlying problem like poor movement and stability patterns that need focused rehab to fix! Dr. Spivak even goes on to explain, "It is thought that this is due at least in part because of diagnostic challenges, so that even if there is a successful fusion, if the patient’s pain was not caused by motion at that disc space, the patient will still have pain after surgery. When a patient continues to have pain despite fusion surgery, this is generally referred to as failed back surgery syndrome."
A partial discectomy is another option, where the surgeon may remove only a portion of the disc and vertebrae. Instead of fusing segments forever, now there is a LACK of stability by removing bone and disc tissue needed for problem spinal stability. Even if a fusion is not initially performed, once a disc surgery is performed, the risk of having multiple surgeries, including an eventual spinal fusion for the same problem exponentially increases! A 2019 study published in The Spine Journal shows that "people who had a lumbar discectomy procedure were 2.97 times more likely to undergo a lumbar fusion than those who with a lumbar diagnosis but had not undergone a lumbar discectomy in the past."
There are better diagnostics always being developed in order to more accurately identify who is and isn't a good candidate for surgery, and there are newer techniques being done to more successfully provide relief with less long term side effects like artificial disc replacement surgeries.
The final word on spinal surgeries: It should be your last resort! Don't be scared by a scan into making a rash and quick decision about surgery. Make sure you are consulting with a clinician (or multiple clinicians) who is willing to evaluate your pain from a FUNCTIONAL standpoint, not just by looking at an MRI or x ray image. Surgeries are unavoidable in some severe cases, but a trial of conservative care is usually the best and most effective course in the majority of cases.
#3 Physiotherapy/Chiropractic/Sports Medicine
I am lumping all of these things together, because in my opinion a good PT, DC or other provider in the sports medicine field are doing A LOT of the same exact things for the same reasons, even if they may have different "brand" names on their techniques.
A lot of disc degeneration and disc injuries is a result of too much movement/not enough stability in the areas that they occur, and not enough movement in the surrounding areas. While degeneration is a NORMAL part of the aging process, poor stability and mobility patterns will lead to an increased rate of degeneration in areas vulnerable to it. There's a reason the vast majority of disc degeneration and injury occur in the same areas in the human population. Transitional areas of the spine (cervicothoracic junction, thoracolumbar junction) are areas vulnerable to HYPOmobility because of the changing of the shape and orientation of the facet joints. The cervical spine loves flexion and extension, the thoracic spine loves lateral bending, and the lumbar spine loves flexion and extension, but what about the areas in between? These transitional areas don't really LOVE any particular motion, they just kinda wanna be friends with each of them. This makes them prone to being stiffer and hypomobile, especially if you're not taking measures to stay moving and be active, or stay in bad postures for a long time. The pelvis and sacroiliac joints can also be put into this hypomobile category if not properly addressed. The segments above and below will make up for this lack of motion in the transitional areas, and viola!, the degeneration of those ares begin! Disc degeneration and injury is noted most commonly in the L4/L5 and L5/S1 levels in the lumbar spine, and the C5/C6 and C6/C7 levels in the cervical spine.
Like any other injury in the body, the key to relieving and recovering from disc injuries is getting through an initial inflammatory phase (the painful part), and then restructuring or rehabbing the tissue back to it's ideal state. The McKenzie Method of Diagnosis and Therapy (MDT) has been mastering this process for years by specifically loading the discs and joints in a way to slowly and progressively stress the tissues and provide lasting relief and prevent reinjury. Most sports medicine providers perform some variation of this method or something similar using it's principles.
Clinicians trained to mobilize the HYPOmobile areas while also stabilizing the HYPERmobile areas are the ones that will get the best and most lasting results when treating disc injuries! The goal is to share motion throughout the entire spine and body, while stabilizing the segments and joints that are prone to moving too much. This is accomplished by training the body with an ideal movement/stabilization strategy.
While all of these things can't guarantee to prevent disc injuries or stop disc degeneration, it can greatly reduce your risk for injury as well as provide quick and lasting relief for an injury that has already occurred. A 2020 study published in The International Journal of Molecular Sciences showed that "Up to 80% of patients with a prolapsed intervertebral disc respond to conservative therapy in an average of 4 to 6 weeks."
The final word on physiotherapy/sports medicine: This should be the first line of defense! Figuring out WHY the injury occurred is just as important as actually healing the injury, and these clinicians are great at BOTH! This is the key to preventing reinjury and avoiding unnecessary surgery and drugs. These clinicians are also great at recognizing when it IS time to consult with a surgeon if the injury is too severe.
The choice is yours! All of these common treatments are options for disc pain, and there are MANY more options out there. The key is finding which is best FOR YOU! Find a clinician you like and trust, one that will give it to you straight and use science and logic behind their decision when they give you advice on what treatment is best for you!
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