Low Back Disc Herniation and What to Know

Last year, each one of our Chiropractors wrote up 10 different Diagnosis Sheets for our patients. That has given us about 40 different different Diagnosis Sheets ranging in topics. Below is an informational blog from Dr. Larry Masarsky on Lumbar Disc Herniations.  Many patients deal with this condition and have no real answers to their pain. Feel free to contact us if you have any further questions on the topic.

Lumbar Disc Disorders

The lumbar spine is made up of five bone segments called vertebrae. In between each vertebrae are flexible intervertebral lumbar discs, which act as a shock absorbers for the spine. The inter-vertebral discs are composed of two components, a tough outer ring of fibrous tissue called the annulus fibrosis and a jelly-like center inside the annulus fibrosis called the nucleus pulposus. The structure is then held together by ligaments on the front and the back of the vertebrae. Additional support is provided by muscles of the trunk.

In most cases, lumbar disc disease is the result of of a normal aging process called disc degeneration which causes structural changes in the normal disc. As we age, the disc begins to lose fluid and become dried out causing the disc to compress. This may lead to the break down and degeneration of tough outer ring of the disc (annulus fibrosis) allowing the inner core (nucleus pulposus), to bulge out. This is considered a bulging disc. This puts pressure on the outer ring of the disc, which may cause low back pain. As further degeneration of the disc continues, or with continued stress on the lumbar spine, the inner jelly-like core may actually rupture out from the outer ring causing a ruptured, or herniated, disk. Once the inner nucleus herniates through the outer ring, pain in the lower back may actually improve. However, the fragmented disc material can inflame or put pressure on the spinal nerves leading to an increase in sciatic leg pain, weakness, numbness, or changes in sensation in one or both legs. Most disc herniations occur at the lower lumbar spine at L4-L5 and L5-S1 levels. Occasionally, severe trauma can cause a normal disc to herniate or may cause an already herniated disk to worsen.

Risk Factors of Lumbar Disc Disorders

●      Age and Gender - highest incidence in men between the ages of 30 and 50.

●      Obesity - being overweight puts added stress on lumbar discs.

●      Sedentary lifestyle - lack of exercise and poor core body strength.

●      Smoking - smoking decreases oxygen supply to the discs causing more rapid degeneration.

●      Improper lifting - using your back muscles instead of your legs to lift heavy objects. Twisting while lifting

●      Posture - hyperlordotic lumbar curvature, anterior pelvic tilt (lower cross syndrome).

●      Repetitive activities that strain your spine - jobs that require constant lifting, pulling, bending, or twisting.

●      Frequent driving - staying seated for long periods and the vibration from the car can put pressure on your discs.

                                                         

History and Symptoms of Lumbar Disc Disorders

Lumbar disc disorders may include one or a combination of the following symptoms: intermittent or constant lower back pain and/or pain in the buttock, leg and/or foot pain, numbness or a tingling sensation in the leg and/or foot, weakness in the leg and/or foot, decreased reflexes in the knee or ankle, and changes in bowel or bladder function. The symptoms will vary depending on if and where the disc has herniated, and what spinal nerve root is affected. Leg pain is usually greater than low back pain with disc herniations and nerve root involvement. However, if there are only annular tears without herniation, pain will generally be localized to the low back and buttock. The onset of pain can be sudden or gradual after an injury. Pain may follow heavy lifting, twisting, or straining activities or repetitive stress trauma. However, patients may not recall a prior injury or a precises time the condition began because it is often preceded by frequent episodes of less severe low back pain that usually resolved. Pain is usually characterized as a sharp, shooting, or electrical pain that may be aggravated with movement, changing positions, sneezing, coughing, or prolonged sitting and standing. The pain is usually relieved with rest and a recumbent position.

Treatment of Lumbar Disc Disorders

Conservative care should be your first course of treatment to manage lumbar disc disorders but treatment will depend on the clinical presentation, your age, overall health, and tolerance to therapies. With disc herniations, the first few days of care will focus on centralizing (reducing) leg pain, decreasing inflammation, and preventing further neurological loss by decompressing nerve root impingement and reducing the disc herniation. Osseous mobilization and manipulation, and soft tissue therapy may be administered as tolerated. Home care will consist of pain-relief repetitive positional exercises and/or lumbar stabilization exercises. We will also educate you on ways to protect your lower back, positions to avoid, and how to manage activity. In most cases, bed rest will not be recommend as the sooner you are up and moving, the better the prognosis. Once pain and inflammation has decreased, we will continue working on lumbar stabilization and progress into proprioceptive training. We will evaluate muscle imbalances using posture and movement patterns with the goal of restoring good biomechanics and core body strength. Your home care will emphasize the progression of stabilization protocols and corrective exercises. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a referral for a surgical consultation will be recommended.

3 Minute Pre-Run Warm Up

Many times our patients ask us about a warm up they can do before they run or cycle. We always make sure to explain to them the importance of a warm up versus static stretching while not warmed up.

We decided to figure out a way that is easy, effective and efficient to warm up prior to their training. One of the other key aspects was to be able to remember it and to be able to do it anywhere and while standing.

So we developed this brief warm up that is very effective in warming up the proper muscles and body parts required for running and cycling. As you will see in this video, the stance leg stabilizers of the hip and foot/ankle will be firing and you will also be getting optimal dynamic mobility of the opposite leg.

Watch this video and implement this in your routine and you will help prevent potential injures and perform better early in your run or bike.

Sleeping Habits: What may be causing your pain?

Do I need to change my mattress?

What is the right mattress?

How should I sleep at night?

What kind of pillow should I use?

Many times in our practice we get these questions and more on sleep positions and mattresses. We have some absolute thoughts on this, and sometimes some very vague answers to these questions.

I will do my best to give what we have found to be the best sleeping set up for you, however, don’t underestimate some potential side effects such as snoring if you start sleeping on your back instead of your stomach; or changing firmness of your mattress and your significant other not adapting to it well. 

Sleep Positions

Without a doubt, sleeping on your stomach causes the most issues for people and increases the risk of causing neck, low back and shoulder pain. This causes neck pain because you must turn your head to one side to breathe. This consistent rotation of the neck really puts undue stress on the neck when you do it for 6-8 hours every night. Low back pain is caused due to the sagging of the Lumbar spine in the prone position for hours. This sagging causes pressure on the Facet joints of the Lumbar spine. We see many patients who come in with a wry neck or achy back and find out it really was caused by stomach sleeping. I can’t stress to you enough the issues with sleeping on your stomach. 

Arms Overhead

Arms overhead is another concern whether you are on your stomach, side or back. Don’t do it! It can really cause a lot of shoulder pain from the impingement position of the shoulder. It can irritate the rotator cuff tendon and even the nerves. Ever woke up in the middle of the night with a dead arm? There ya go. 

I highly recommend sleeping on your side or your back. The side sleeping and back sleeping reduces the chances of causing pain syndromes related to sleeping. You can still get a sore shoulder by sleeping on your side, or a sore neck by sleeping on your back, but it reduces the chances.

The next step in preventing pain syndromes from sleeping will be perfecting your mattress and pillow situation as best as possible. I will follow up this article with one covering that topic. For now, work on your sleeping position. It will be difficult to switch from stomach sleeping, but I assure you in a few weeks it will start to feel normal. I was a stomach sleeper for the first 22 years of my life and changed “cold turkey” and never reverted back to sleeping on my stomach. You can do it too!

Here is a short video of an insider's look at the XPE Player's suite at the NFL Combine this year. We are the clinical directors for XPE Sports and this is our 7th year at the NFL Combine. We were there for 4 days and enjoyed the fun, stress and excitement of it all. 

 

Are you cought in the "Mouse Trap"?

 

Is your mouse hurting your neck?

Do you have right sided neck pain?

Ever wonder why you have neck pain only on the right side of your neck?

Do you work at a computer for a living?

If you use a mouse regularly for work or recreation, you may not know it but you are most likely over-using the muscles in the right side of your neck and shoulder. Specifically, the Upper Trapezius muscle, or otherwise known as the "Trap" muscle.

See, every time you use the mouse, you are subtly shrugging your shoulder. These muscles on this side are constantly activated and firing over and over again. This is the beginning of what we call the "Mouse Trap".

This non-stop use of these muscles causes over-use strain, trigger points and even inflammation in the area. The main muscle groups, especially the Upper Trapezius are affected most. The Upper Trapezius originates from the base of the skull and inserts into the shoulder area.

This can cause anything from headaches, neck pain, limited range of motion, shoulder pain and arm pain/tingling, etc.

We see this all the time in the office and with some appropriate changes, self care, treatment it can be a thing of the past.

Keep a look out for a follow-up posts on some easy solutions for this all too common condition. 

Your FIRST solutions is to alternate using the mouse with left hand. I know, sounds crazy, but give it a few weeks and it will feel normal. 

The "Why" to what we do in our practice 

What a Sports Chiropractor's role in a NFL Combine Prep entails

It’s that time again, January through February is NFL Combine’s training season for XPE Sports and Health-Fit Chiropractic and Sports Medicine. Tony Villani is the founder and sports trainer of XPE Sports and has a great group of 24 guys this year, including 5 potential first round picks! I have been fortunate enough to be the lead sports chiropractor and/or clinical director for the 8^th year in a row of my career, the last five of which spent with Tony Villani. It has been a learning process and has helped shape the way we provide sports chiropractic in our regular practice to the community. 

The NFL Combine is a 2 month process where college football players who have entered the NFL draft process train to perform optimally at the NFL Scouting Combine in Indianapolis at the end of February. This 5 day “job interview” consists of physical assessments such as the 40 yard dash, vertical jump, position drills and bench press, to name a few. In addition, they go through full medical evaluations, IQ tests, interviews and even body fat testing. Their performance at the scouting combine is instrumental in where they may potentially get drafted. We have seen some of XPE’s players jump multiple spots in the first round or even multiple rounds of the draft. These types of leaps are potentially worth millions of dollars to the player. 

Our role at Health-Fit is to coordinate the health care needs, and provide treatment for each of our 16-25 players each year. Each of our players have access to Chiropractic, Physical Therapy, Orthopedics, Acupuncture, Muscle Activation Technique, Massage, Sports Recovery and much more. 

We provide the initial full examination and from there help guide the course of treatment for the player. Some players will only need supportive care, while others may have significant injuries and need full medical attention. We have some players that are coming off surgery, some with serious injuries, and some just with nagging injuries that could potentially affect their speed and agility enough to drop their performance considerably, and consequently their potential draft position. Besides our Sports Chiropractic treatment of the players, we also facilitate and guide their treatment plan with the other medical entities. We also communicate regularly with the Tony Villani on what the player can and cannot do as for as speed and agility training. Luckily for us, Tony Villani is well versed in all phases of injury rehab and how to seamlessly integrate an injured player into his training programs. He has world class experience and has therefore successfully helped with many NFL players coming off devastating injuries. He has been instrumental in bridging the gap from post-surgical physical therapy to return to play at a high level for many athletes. With his knowledge, you’d think he has a medical degree.

Our last role in regards to the NFL Combine prep program for XPE Sports is to travel with the group to the NFL Scouting Combine in Indianapolis in late February. We stay there for all 5 days providing maintenance and performance care to make sure the players are firing on all cylinders. In some cases, we need to confer with the player, agent, and Tony to decide if the player is healthy enough to run the 40 yard dash and do agility drills or participate in activities such as the bench press. It is always a hard decision, but taking in all the factors is a must when determining the level of involvement an injured player can sustain at the NFL Combine. 

I hope you enjoyed this little insight as to what our two month process with the NFL Combine prep program is and how we apply our clinical skills to a highly pressure packed 8 weeks for all parties involved. Here’s to a fabulous 2015 XPE NFL Combine class!