A Cochrane review by Gibson & Waddell (2007) found that a discectomy could alleviate disc-related sciatic pain in specific patients quite quickly. Another common surgical intervention known as spinal fusion (whereby the bony material is joined together thus closing up the disc and joint space) can produce good results in around 80% of cases (Cluett, 2007). However there can be lingering pain and problems after a spinal fusion due to a change in the normal biomechanics of the spine.

One of the most exciting developments is the introduction of a “disc replacement”. This approach has only been performed in the last few years (Cluett, 2007), and is still considered to be experimental, with research being completed mainly in Europe (An & Juarez, 2007). The normal disc is replaced by a metal and plastic device that behaves as a normal disc would. The advantage of this approach is that unlike spinal fusion, normal biomechanics of the spine are preserved and fewer complications develop (Cluett, 2007).

Disc replacements are particularly effective for relieving pain associated with degenerative disc problems (an ageing disc) at L4/5 or L5/S1 when six months of conservative intervention has failed to improve symptoms (Holt & Majd, 2007). Research also suggests those with post-discectomy syndrome (continued back pain after surgery for a herniated disc) may benefit from a disc replacement (An & Juarez, 2007). As this is a new intervention, it is difficult to evaluate whether there are any longer term complications arising from a disc replacement (Cluett, 2007).The current selection criteria includes single level disc disease, strong bone composition and the absence of problems such as scoliosis and spondylolisthesis(Holt& Majd). Potential complications include damage and dislocation of the implant and infection. As with any artificial device, the disc may be prone to damage over time from wear and tear (An & Juarez).

If you have any other specific tops you want covered, drop a comment!

Consult your GP, specialist or physiotherapist for any personal advice. Already done so? Why not get another opinion? Many disc problems can be successfully treated.

Author: Natalie Szmerling B.Physio
Suite 4/75 Bay St Brighton, Victoria 3186 Australia
03 95306353
info@baysidetherapies.com.au
www.baysidetherapies.com.au
Read Natalie’s other articles here

This information is informative only and shouldn’t be used to diagnose or treat any ailment, disease [or anything else].

References:

An, H Juarez, K. Artificial Disc Replacement. Available from URL http://www.spineuniverse.com/displayarticle.php/article1671.html [Accessed 2007 August 17]

Cluett, J. Lumbar Disc Replacement. Available from URL http://orthopedics.about.com/cs/backpain/a/discreplacement.htm [Accessed 2007 August 17]

Gibson, A Waddell, G. Surgical Interventions For Lumbar Disc Prolapse: Updated Cochrane Review. Spine 2007; 32 (16): 1735-1747

Holt, R Majd, M. Disc Replacement Surgery. Available from URL www.spine-surgery.com [Accessed 2007 August 17]

PHYSIOTHERAPY
Physiotherapy uses a variety of techniques to assist recovery of a herniated disc. These interventions include massage, gentle mobilization, ultrasound and heat. Physiotherapists are experts at prescribing exercises and will teach those that will be beneficial. Many of these will be based on Pilates exercises.

CHIROPRACTIC
Chiropractors are well known for their ability to perform joint manipulations through the body. However, forceful manipulations are discouraged when a disc injury is suspected. Also, a chiropractor cannot “pop” a disc back in. Chiropractic treatment for disc injuries often involves traction of the lower back and pelvis. This is usually accomplished by a traction machine or a special bed. Chiropractors trained in Clinical Pilates may also teach special exercises to stabilize and support the back.

OSTEOPATHY
Osteopathy uses similar techniques to physiotherapists and chiropractors. For a disc injury, this would include mobilization, massage manipulation and exercise therapy. Osteopaths focus particularly on the inter-relationship between different body parts. For example, a disc injury may have been partly caused by a weakness in the hip and pelvis, and this will be thoroughly investigated by an osteopathic practitioner. Osteopaths also help to encourage blood flow and drainage of chemical irritants which can relieve pain.

MYOTHERAPY
Myotherapists are experts in the field of muscle and soft tissue (ligament, tendon, fascia) therapy. They focus their assessment on the palpation of different muscles to determine if there is a contribution from the myo (muscle) fascia (the thin sleeve of tissue that wraps around the muscle). Muscle spasm and tightness is very common in disc injuries, and can often refer pain into the leg. Myotherapists also utilize interventions such as ultrasound, TENS machines and cupping.

WHAT TREATMENT IS BEST?
As we are all unique individuals, what works for one person may not necessarily work with another. Of the treatments described, physiotherapy is widely recognized and accepted by western medicine. Chiropractic and Osteopathy are offshoots of western medicine dating back to the late 19th century but they are not overly supported by western medicine. Along with chiropractic and osteopathy, myotherapy is also considered a complementary health approach.

HOW DO I CHOOSE A THERAPIST?
Always choose a therapist that is registered with a professional body (such as the Australian Physiotherapy Association). It is important to find a therapist who really cares about you and your injury. Be wary of practitioners who refute the value of other interventions. All philosophies and sciences have something unique and valuable, and in a comprehensive treatment plan, this will be acknowledged by a competent therapist.

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Brighton Bay Physiotherapy
Suite 4/75 Bay St Brighton, Victoria, Australia.
03 9530 6353
http://www.baysidetherapies.com.au

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.

Tags: l4, l5, herniated-disc, herniated, disc, l4-l5, bulging-disc, bulging, buldging, buldge, bulge, slipped-disc, slipped, l4l5, l4-5