What they are, and…
Our program to get them better without surgery
Have you been diagnosed with a lumbar disc herniation and are considering surgery? Are you experiencing pain that seems to originate in the back and travels down the leg, calf, or even all the way to the foot? If you’ve been led to believe or think that the only answer to this problem is the scalpel, please keep reading. There is another way.
Back pain is a significant and expensive problem with a majority of people experiencing it in their life and many people being limited in their function and activities by it. You’re not alone!
You can read about my personal experience with low back pain here.
Rarely does back pain necessitate surgery. In fact, surgeons often won’t operate on your spine unless you are in fairly good health because the outcomes are often disappointing for all involved. It strongly suggested that in many surgical cases, it might be the post-surgical rehab that is actually responsible for the positive outcome. In other words, the surgery isn’t necessary, but rather, a good dose of working on mobility, strength, and movement patterns was all that is needed.
I’m going to cover-
What a disc herniation is,
How we and others like us treat it,
Whether you need an MRI,
and What it costs.
What is a disc herniation?
First of all, discogenic pain and disc herniations are very common. If we only went off of the findings of imaging – we might conclude that most people eventually get one. And we do know from research that many people with what looks like a herniation on imaging, don’t have any back pain.
The process of a disc herniating really happens over time, but is often marked by a normal moment of bending over to tie your shoes, or pick something up and feeling like your back “goes out.” Shoveling is another common beginning to the painful experience of a disc herniation. The way most people shovel combines a simultaneously flexing and rotating spine – putting the disc at its greatest vulnerability.
Microtrauma to the outer fibrous rings (or onion-like) portion of the disc, called the annulus fibrosis, allows the inner (softer) nucleus pulposus to start to extrude towards the nerve root contained in the intervertebral foramen. As this condition progresses, if the nerve root becomes irritated by the discal material, you will begin to experience not only back pain, but also glute, thigh, leg, and/or foot pain.
The First Step
The first step is to determine what type of back pain you have. It’s not always immediately obvious. Is it acute, chronic, local, radiating, radicular? Is it muscular, joint, disc, or nerve related? Are you a person that tends towards stiffness or more flexible. How do you move? How is your strength? What are your activities that are driving the condition? Do you have any “Red Flags” that lead us to think that this may be a more serious pathology?
Here’s one little problem for the back pain sufferer
No profession has of yet really claimed back pain expertise. Well, perhaps it has been “claimed”. But no profession has of yet set up a responsible, accountable, more complete system.
You can go to your GP and receive pain meds or muscle relaxers, but that often doesn’t work well – plus we’re in an opioid abuse epidemic. So maybe they refer you to physical therapy. Maybe you get a high-quality PT; maybe you don’t. Maybe the exercises help your problem; maybe they don’t.
Perhaps you try a chiropractor; you probably know a person or two who swears by one – but like PT, you never really know what you’re going to get. Some problems respond great to joint manipulation; others don’t – and some chiro’s are a little woo woo.
And there’s massage. Might as well give it a try, it might help, and if not – at least it feels good.
But here’s the part where we can get frustrated together, and we can blame “the Man” or “the System”. With all the knowledge We have… why isn’t high quality, evidence-guided, patient-centered care, reimbursed well by insurance, the status quo? Who knows? We could probably think of hundreds of questions like this…
We do know that you have to do your own research, and be your own advocate and take personal responsibility.
If you’re here, you’re doing just that.
There is a solution…There is hope
There’s a considerable amount of evidence for conservative treatment methods that produce better outcomes a high percentage of the time.
It simply takes an up-to-date assessment with subsequent and relevant treatment techniques. As I said previously, no profession owns this condition, but there are individual Chiro’s, PTs, MDs, DOs, etc., that utilize the most up to date assessments and treatment methods – sitting side by side at continuing education courses and utilizing the same principles of assessment and treatment.
I’m going to organize this to help you understand the process and do some name dropping and linking so that you can validate this information for yourself if you need to.
There isn’t just one way to treat a disc herniation, and sometimes practitioners get lucky, but there is a more systematic, evidence-guided approach that leads to better outcomes much more of the time.
Let’s first start with Professor Stuart McGill, currently considered by most to be the world’s foremost expert on lumbar spine biomechanics and discogenic conditions.
From his work, we get a good grasp on the most common injury mechanisms to the intervertebral disc. We can understand what makes us vulnerable to injury in acute situations and what kinds of things injure the disc slowly over time. From there, we get a great idea on how to incorporate “spine sparing techniques”. In other words, if you hit your thumb with a hammer every day, you have to stop doing that if you ever want your thumb to heal.
We also learn a lot from McGill (and colleagues) work in regards to the need for spinal stability and how to progress it intelligently when someone has injured their spine as well as how to progress it even further to improve athletic performance. It’s a continuum of compression and stiffness.
I’ve read his textbooks (so you don’t have to) and been practicing based on his research and strategies for several years.
We use a systems-based “toolbox” called the Selective Functional Movement Assessment (SFMA) by Gray Cook and colleagues. This assessment looks at the interconnectedness of the body
…to root out areas that need more mobility,
…to find the areas that need to be strengthened and stabilized, and
…and identify movement patterns that simply need to be taught and learned, to again, “stop hitting your thumb with that hammer.”
We plug our joint and soft tissue manipulation tools into the mobility slot and our biomechanics knowledge and exercise science techniques into the stability and motor control slots.
Dr. Stalheim has also taken the McKenzie Lumbar Spine assessment and technique course, which is multi-disciplinary and highly regarded as having excellent outcomes with reducing the pain and dysfunction associated with disc herniations, sciatica, and subsequent pain radiating into the glutes, thighs, legs, and feet.
By now, this is getting fairly long. But if you’re suffering from chronic back pain acute or chronic disc pain, I’m certain you’ll continue reading if any of this is making sense to you.
There is a lot to treating back pain and disc injuries. You need the right treatment, in the right dosage, in the right progression, based on your condition and unique factors.
There are evidence-guided clinical prediction rules to classify who is likely to respond best to what kind of treatment. We can do much better than hunt around in the dark hoping that some practitioner somewhere has a silver bullet.
So here’s the breakdown:
-We have assessment and classification systems to figure out what to treat and how to treat it.
-We have techniques to improve your pain and symptoms including joint manipulation, soft tissue manipulation, McKenzie technique, flexion-distraction (decompression), and electric stim.
-We have the tools to identify and show you how to stop doing the things that are driving your pain and keeping you injured.
-We have the tools to strengthen and progress you to a stable state where you don’t need to constantly fear reinjury.
There are movements in various professions that are trying to establish conservative spinal expertise (there’s certainly a need for it) – until then; the back pain sufferer will have to do their due diligence to find an individual with the full toolset. As of writing this there are moves in the chiropractic profession to establish integrative, cooperative, evidence-guided spine programs, but there are additional moves by others within the profession to keep us shackled to chiropractic roots from 1895.
Where does an MRI fit into all this?
If I think I have a disc herniation, I need an MRI, right?
We can’t tell if the bulging disc seen on this picture is causing pain and symptoms any more than we could tell if a phone is ringing by looking at a picture of that phone.
Disc herniations are a common finding on MRIs of people with no back pain whatsoever. And plenty of people have terrible back pain and no particular abnormal findings on MRI. The majority of people can get better relatively quickly without the need for advanced imaging. When someone is receiving quality treatment and not seeing much in improvement within 4-6 weeks, that is generally the time to consider an MRI to rule in and rule out other conditions.
Please let us know upon scheduling if you have read through this page.
If you have insurance, and we are an in-network provider, we will work with your insurance. Typical out of costs per visit for those with insurance is between $10-$40 – depending on your individual plan benefits. For those without insurance, your initial appointment with exams and treatment costs $95, with subsequent treatments costing $65.
The severity and variable factors of this condition make it difficult to give a set number of treatments to resolve the condition. It is not uncommon to reduce symptoms by 50% in 2 weeks, with steady progress from there. Generally, we recommend 2 treatments per week for 4-6 weeks. Sometimes it takes less than that, sometimes it takes a little more. Each treatment takes 20-30 minutes.