The following is the opinion of the Mountain View Pain Center, and these are some of the options we offer our patients. It is important to start conservatively and measure the improvements before heading into the surgery. This means working with the body to begin the healing process, before using drugs, or removing something through surgery. Of course, there are several different ways this injury can affect someone, and surgery maybe the only option, but the philosophy of the Mountain View Pain Center is to explore natural ways to heal the body, using surgery as a last option.
Typical Causes of Herniated Discs
The most common cause of a herniated disc injury is poor biomechanics (moving improperly, which we are all guilty of doing). Discs are most commonly torn by lifting a weight while twisting; getting something heavy out of the backseat of your car is an example. As we all know in the game of baseball, especially at the plate, the body goes through some twisting and contouring with a driving force.
Typical Symptoms and Non-Surgical Treatments for Herniated Discs
The first step is to determine what symptoms we have and address them accordingly. The most common types of pain from a herniated disc injuries are low back pain and/or radiating pain into an extremity. We are using low back pain as our example, but radiating pain into the leg is often experienced with this type of injury. In many cases you can just have leg pain and no back pain. The reason the pain is referred to as “radiating” is because the disc material will bulge out causing inflammation and put pressure on a nerve, and the pain will follow that specific nerve’s pattern. For example, a herniation of the L3 disc will put pressure on the L4 nerve, causing pain to radiate down the posterior (back) of a leg.
To determine if a herniated disc is causing you pain, your doctor will perform an examination and orthopedic tests. If your doctor determines that a disc is the problem, the next step is to take a simple X-ray to rule out any underlying problem with the bones or joints. The next step is an MRI; from here you will be able to see the level and severity of the herniation. It is also important to know that the size of the herniation does not necessarily correspond to the severity of pain. In fact, some people can have a large herniation with no symptoms at all, and some can have a very small lesion and experience immense pain. From the results, the doctor will be able to determine if your herniated disc can be treated with natural therapy or if surgery is required.
The initial phase of such an injury is often described as a patient saying, “I heard a pop and then all of a sudden I was in incredible pain.” The pop they heard is the tearing of the annular fibers of the disc. In the acute stage, or a few days after the injury, a patient can be in a lot of pain, and experience some inflammation and swelling. The patient comes in saying, “Doctor, just get me out of pain, please!” To immediately address the pain, the first step is to reduce swelling by cooling the area with ice, being careful not to put the ice directly on the skin. (Yes, you can get a burn from ice!) You can alternate ice on and off twenty minutes at a time. DO NOT use heat; it will increase swelling and you will regret it. At the Mountain View Pain Center, in this situation we like to use a therapy called Hi Volt, which is an electronic modality. The purpose of this modality is to decrease pain and move that edema (swelling) out of the affected area.
Once the initial pain is relieved, we can begin treatment of the injury. A treatment we often choose to begin with at the Mountain View Pain Center is a method called flexion distraction treatment, coupled with other therapies to reduce swelling. The flexion distraction treatment works by widening the disc space and causing the herniation to essentially get “sucked back into the disc”. This treatment can be done by utilizing chiropractic techniques to relieve pressure on the herniated disc.
Another technique we use is called traction therapy, otherwise known as long axis distraction. Here the doctor will use a DTS machine (decompression therapy) set to specific settings unique to each patient. The machine will gradually begin to pull and will slowly separate the two vertebrae pushing on the disc. The purpose here again is to relieve the pressure on the disc. Many patients have found that treatment with a DTS machine is a safe and cost-effective treatment, and have found relief without the need for surgery.
Once the patient is out of pain, the rehabilitation can begin. It is important to remember that just because the pain is no longer there; it does not mean the disc is back to normal. A full disc recovery can take up to 3 months. The purpose now switches to restoring the body back to its normal function. This is done by low back exercise and simple core exercises. A set of very popular exercises used for disc treatment are called Mackenzie exercise (extension exercises). Your physician will be able to instruct you on the proper way to perform these.
Another preventative step that can be taken is supplementation to strengthen the discs or joints, or supplements that help with inflammation. Check with your doctor or physician before taking any supplements to see what is right for you and make sure there are no risks to taking these vitamins.
Some supplements for simple joint care are:
- Glucosamine sulfate (500mg) with MSM (methylsulfonylmethane) (250mg): Glucosamine sulfate helps to stimulate specific components of your cartilage. MSM helps with pain and has been shown to be an anti-inflammatory
- Omega fatty acids: Many are known as fish oils, they have multiple benefits besides anti-inflammatory, and they also build cell membranes, and help improve neurologic and cardiovascular function. Omega fatty acids are not just good for your discs, they are essential to life.
- Quercetin/Bromelain: Also have anti-inflammation effects. These can be found naturally in vitamins, but not usually in the amounts useful to aid in inflammation.
These come in several brands, and we are not here to recommend specific brands of vitamins or supplements, just to inform the sports fans on injuries they see in themselves or many of their favorite athletes. If you decide you would like to know more about a specific vitamin or advice on the supplements we use, feel free to call, and we can point you in the right direction.
At Mountain View Pain Center we have seen and experienced that for the most effective pain recovery, conservative treatments should be utilized first before epidural injections and back surgery. However it is important for your doctor to acknowledge the importance of co-treating patients in their best interest for recovery. Our primary care is chiropractic and physical therapy, however if we determine a patient can benefit from another provider’s care we will refer them with no questions asked. The goal is to get the patient pain-free and restore them to healthy function in the manner that is most suitable to the patient.
Epidural Injections for Treating Pain
Joe Crede had the option to get an epidural injection, what is that? An epidural injection is the administration of medication that can cause both a loss of sensation (anesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disc and radiculopathy (radiating pain).
The injections themselves can be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed. Simply put, epidural injections do not produce long term results hence the patient has to keep getting them to reduce the symptoms they are having. Possible side effects of epidural shots can be increased pain, loss of sensation, infection, and nerve damage. Follow the link to learn more about the side effects of using epidural injections to treat pain.
Herniated Disc Surgery
When it became clear the injury would not heal on its own, or that natural methods would be unsuccessful in correcting the problem, the choices Joe Crede faced were epidural shots or surgery. Prior to 2007, Crede had been able to manage the pain through at least four epidural treatments. However, in 2007, Crede determined that the temporary relief provided by the epidurals was not enough. At that point he opted for the microdisectomy, and then unfortunately experienced a re-herniation of the same area. Thus, the microdisectomy had to be repeated again a year after the first surgery.
In some circumstances it may be determined that back surgery is the best option. However, surgery is not always needed, and unfortunately many surgeries are unnecessary and cause further complications. Studies have shown that more than half of lower disc surgeries do not successfully relieve symptoms. As mentioned above, at the Mountain View Pain Center we believe that surgery should always be a last-resort option. For Joe Crede, surgery finally came three years after the initial onset of the injury. Despite the relative lack of success Crede experienced with the first surgery for his herniated disc, both he and the Minnesota Twins are hoping that the second microdisectomy will allow him to move forward and have a healthy, productive season.