10 things you should try before you have back surgery on your herniated disc
This is the first of many expert tips and information on the treatments for a herniated disc from those in the know. There are many more on the way, so make sure you sign up for the email alerts and get them delivered fresh when they arrive.
If you or someone you care for is due for back surgery on a herniated disc, then this may be the most important letter you ever read.
Here’s why…
Going straight in for back surgery on a herniated disc without taking some crucial steps to prepare can increase the already inherent risks of such surgery on general health.
Physiotherapy
Physiotherapists are experts at assessing and treating disorders of the spine. Getting professional help early can dramatically reduce your recovery time and get you back to work and sport more quickly. You will receive advice on exercises and movements to avoid, as well as those that encourage healing. Many physiotherapists are experienced at teaching pilates and can design a program to strengthen your back and prevent further injury in the future.
Pilates
While it may be the latest fashion in sports and exercise, there is real benefit to be found from Pilates. Pilates exercises are based on improving posture and strengthening the “core” muscles. Whenever there is an injury or pain in the lower back, the core muscles reflexively “switch off”; Pilates can help to “switch on” your core again after injury. A strong core will provide crucial support and reinforcement to the lower back. Make sure you participate in a Clinical Pilates class that is run by an experienced physiotherapist.
Heat pack
Physiotherapists will frequently recommend the use of heat packs as a self management strategy. Heat packs are a wonderful and simple pain relief device that have been used successfully for thousands of years. The application of heat will assist in reducing or blocking pain sensations to your brain and will also encourage tight muscles to relax. This will leave you with more movement and less pain.
Anti inflammatory medication
The natural response of the human body to any injury is the release of inflammatory cells. These irritate pain receptors in the injured area and create discomfort. Anti-inflammatory medication effectively blocks the pain receptors and decreases the pain sensation. They are especially useful if you are experiencing pain during the night. If you are asthmatic, suffer from stomach ulcers or are pregnant, check with your doctor before using anti-inflammatory medication.
Back brace
A brace can help to provide extra support to your back while it is recovering. It essentially provides the same kind of support your core muscles would provide when they are strong and functioning correctly. Many people report and immediate improvement on using a back brace.
Walking
Walking is a wonderful, low impact activity that can help to maintain fitness throughout your life. It is also excellent for your lower back. The movement of your legs encourages gentle movement of the pelvis and spine, thus reducing stiffness. Being in a standing position can also reduce the loads and forces on the disc, thereby encouraging healing and decreasing pain.
Get a few opinions
Have you really tried everything? Surgery of any sort always involves calculated risks that you must be fully aware of. Spinal surgery in particular can be risky, and a positive outcome is not always achieved. Be sure to try a number of conservative treatments (physiotherapy, osteopathy, chiropractic, acupuncture) before you decide to walk down the path of surgery. For the majority, surgery can provide some relief but the degree of improvement varies from person to person. There are also cases of chronic pain that develop and persist after spinal surgery.
McKenzie Exercises
Robyn McKenzie is a physiotherapist from New Zealand who developed a system of assessing and treating spinal problems, including disc injuries. Her exercises and advice are based on positions and movements that encourage appropriate “re-positioning” of the disc fragments. Once the disc is sitting in its correct position, it will not be painfully impinging on nerves and tissues around the spine.. Many physiotherapists are skilled in McKenzie therapy.
Hydrotherapy
Combining exercise in a warm environment where there is no gravity can be absolutely superb in relieving pain and improving your mobility. Hydrotherapy is an excellent place to begin rehabilitation exercises.
Avoid activities that irritate herniated discs
Whenever we “herniate” or “bulge” a disc, it is usually displaced either backwards or backwards and to the side. The following activities and positions can really irritate a disc problem:
Sitting
Bending towards your toes
Bending forwards and twisting at the same time
Lifting
Driving long distances
Yard work
Gardening
The following can help to relieve pain and pressure on an injured disc
Laying on your tummy
Standing up
Walking
McKenzie exercises
Pilates exercises with an “extension” bias (ask your pilates instructor or physiotherapist for more information).
In my experience as a physiotherapist, I have seen the majority of disc injury patients make an excellent recovery using the above conservative approaches. This article does not substitute professional advice and treatment. For those residing in Bayside Melbourne Australia (Bentleigh, Hampton, Caulfield, Brighton, Elwood) and surrounding Melbourne suburbs, you can visit us here at www.baysidetherapies.com.au.
Others can find an APA accredited physiotherapist here www.apa.advsol.com.au.
Author: Natalie Szmerling - Physiotherapist & Pilates Instructor @ Brighton Bay Physiotherapy www.baysidetherapies.com.au
Address: Suite 4/75 Bay St Brighton, Victoria, Australia
Phone: 03 9530 6353
Disclaimer: This information is informative only and shouldn’t be used to diagnose or treat any disease, condition, ailment or anything else. Always consult your doctor or physiotherapist for personal advice and treatment.
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August 15th, 2007 at 3:03 pm
Hi Natalie,
Great article… I wished more professionals would reach out to ‘potential’ patients through forums like these… this is where the real issues should come out and be discussed… Matt, have you thought of a forum?
Also, I wanted to ask about the heat packs you mentioned…. I was recommended to stay away from heat pads when I was in real pain, as heat aggravates anything that is already inflamed? For instance when you see injured sports stars they always use ice packs.. not heat packs?
Thoughts?
Cheers
Chris
August 15th, 2007 at 3:22 pm
Hi,
You mentioned a back brace… is there an particular type you recommend… any websites?
Cheers
Mark
August 15th, 2007 at 10:38 pm
Hi Chris,
Glad you liked my article. It can be confusing whether heat or ice is best. Typically with any muscle strain or ligament sprain, you would apply ice for the first 48 hours and then switch to heat. In the case of disc injuries, the heat packs really help to lessen the associated muscle spasms which can generate extra pain and discomfort.
Cheers Natalie
Hi Mark,
Have a chat to your treating therapist about suitable back braces. The braces I give to clients I usually order through a company called OPC who are based in Melbourne.
Cheers Natalie
August 15th, 2007 at 10:46 pm
Hey,
Thanks for the reply Natalie..
I’m assuming OPC’s website is: http://www.opchealth.com.au/
If anyone else has any recommendations post them up!
Cheers
Matt
August 15th, 2007 at 10:50 pm
Hi Matt,
That’s the site. I’m not sure if they supply directly to patients though.
Cheers
Natalie
September 30th, 2007 at 5:42 pm
I will just say that, having had two herniated discs, and opting for surgery on one but not the other, there are cases for surgery.
(1) as long as it’s not fusion, surgery usually treats the ‘bad spot’ without causing neighboring vertebrae adjustments or outright problems, with adjjoining discs. This is because in recovery, you are concentrating on your core, not depending on any material in your back to give stability, so you end up strengthening your whole back and learning how to support the weakest link without help from other back muscles.
(2) my choice to have surgery was not based on pain, even though it was the worst pain in my life, INCLUDING childbirth. I lost a lot of nerve function in my leg - couldn’t feel parts of my leg, couldn’t walk straight sometimes, and couldn’t do simple things like hold a toe in place while someone pushed it down. I wanted to pursue PT, and did, but my dr said that when it comes to nerves, there is no guarantee that once it’s unpinched, there is no guarantee it will come back. It’s only theoretical that the longer the nerves are damaged, the more likely the damage is permanent. Conversely, it’s possible that if you opt for surgery immediately, the fix won’t work. Surgery will simply shorten the time that a disc is causing/continuing the damage. We set a ‘due date’ and I aggressively pursued PT, with really minimal results. I also consulted many doctors to be sure this wasn’t just a slice-happy surgeon. All confirmed this mystery around nerve damage and recover.
My surgery was succesful. A year later I reherniated the same disk plus one more, almost same pain evels, but no nerve damage or loss of muscle function. I’ve chosen to treat with PT, gentle cardio to get my weight back down, and never regretted it. I do deal with some level of pain every day and sometimes nothing but meds helps. However, I don’t regret the surgery I did have - it did exactly what it needed to and most feeling and function in my leg are now restored. I just have to watch how I stand, and lay.
I was interested to discover that the majority of patients opt for surgery AGAIN if they’ve had it. My dr started his speech with the assumption that I would want surgery and started talking about risks/rewards. I was well aware that even though my surgery went well, and I had a lot of relief and also support from family and work, it was a trauma on my body and I had a short bout of depression, problems maintaining the upward success trend, and weirdest of all, I’ve been a morning person all my life, I now can stay up very late, and tend to sleep until noon on the weekend, behavior I’ve always envied in others, but now that it’s different, I long for my old quiet and productive morning time. So does my husband who is a night person too.
(3) Fusion surgery is the one I hear about that never goes right. I have never heard one story where they fix one disk and the problem just travels to the next one, and so on. I would never opt for that even if I was in pretty serious pain.
(4) What bothers me is that spine doctors/orthopaedists tend to skimp on the meds, UNLESS you get a doctor who has also had herniated discs and/or surgery. They know you are not bluffing. The ones who haven’t start questioning you about your med use, and talking about more holistic pain mgmt. This is all great, but sometimes nothing knocks out the sciatic pain like an Rx, and fast. I like to get on with my life if I can.. It’s sad what the addicts and insurance companies have done to the ipharma ndustry to make it hard for those of us who are truly in pain, but managing it in regular phases using recommended doses, not going straight for the narcotic.
I’m new to this board but not to the issue - looking forward to hearing more of you talk about your experiences on this topic.
September 30th, 2007 at 5:43 pm
afterthought: ultrasound heat has proven to be absolutely the most helpful PT remedy. Too bad they are so expensive and/or you have to keep fighting with your insurance company to cover such treatment….sounds to them like a spa when actually it’s a productivity booster!
September 30th, 2007 at 5:45 pm
What about steroids - oral or injected in outpatient mode? The pills work for me but I’ve only had one injection which didn’t do much. Plus, needles give me the heebie-geebies.
March 18th, 2008 at 9:52 pm
Hi everyone - Suffered just like Texan for five weeks. Found a neurosurgeon to operate on Super Bowl Sunday-I could not take the pain for one more minute. I am glad I had the surgery but am totally depressed from the recovery. Stayed home for 3 weeks, went back to school as a high school teacher too early. I have constant moderate pain in lower back, top of left thight on the outside and occasional pain (mostly when lying down) on left front side of my shin. On sunday I threw myself into a swimming pool with a gravity belt and walked, jumped and stretched. I expected to come out of the water pain free but was again disappointed. Thanks for listening, any ideas.