A Disc Bulge or Disc Herniation DOESN'T Mean Surgery!
Dr. Williams, chiropractor in Amarillo TX, explains
I see it in my patients' faces almost every week when I tell them that I believe their back pain is due to an injured disc in their spine. Their faces sink, their eyes look down at the floor, and they take a deep breath and let it out slowly. For just a moment, it's pretty heavy and you can see the weight of the information hitting them at full force.
Before they have a chance to take that second breath, fortunately, I have the pleasure of being able to tell them that they are not stuck this way and typically they will not have to deal with any shots or surgery. Then I watch as relief drifts over them.
Here is a factoid. Did you know that disc injury is the most common reason for a patient under the age of 50 to have back pain? That is the reason I see this scenario play out so often. Another factoid; out of 56 million Americans suffering back pain, of which disc injury is the most common reason, only about 5% of them actually require surgery.
The truth is, most just do not need surgery at all. The only real reasons to have back surgery are progressive neurological deficit, unrelenting, life-changing pain, and/or cauda equina syndrome. Let me explain those briefly:
1. Progressive Neurological Deficit - this refers to your reflexes, like when the doctor taps you with the reflex hammer. If one reflex is gone compared to the other side of the body, that is an example of a neurological deficit. If you have noticeable weakness in muscles on one side of the body compared to the other side, that is a deficit. And finally, if you feel things differently on one aspect of a leg, foot, arm, or hand when compared to the same area on the other side of the body, that is a deficit as well.
2. Cauda Equina - The calling card of Cauda Equina is altered ability to control bowel or bladder function and/or saddle anesthesia. Saddle anesthesia means having numbness or tingling in any area up and underneath between the legs that would touch a saddle when sitting on it. This condition is an emergency and needs to be seen in the ER as soon as possible.
3. Unrelenting, Life-changing Pain - Patients that are suffering from pain do not appreciate hearing this but, pain is NOT a reason for having surgery. However, unrelenting, life-changing pain may need a second look. There are steps to be tried prior to that surgery though. Pain that cannot be relieved requires investigation. X-rays and MRIs are likely in order for that kind of pain initially. Assuming there is no obvious reason for the pain on the imaging, then, according to the American College of Physicians' recommendations, you start treating with spinal manipulation, exercise, heat, low-level laser, massage, acupuncture, and cognitive behavioral therapy. Assuming those things fail (they almost NEVER fail, by the way!!), then the patient would go through a trial of medication, followed by a trial of shots, then.....assuming EVERYTHING else failed, the patient would undergo surgery in an attempt to provide some level of relief. THIS IS A RARE OCCURRENCE.
Now that we have covered the three most common reasons for surgery and we have covered the fact that the most common reason for low back pain is a disc injury (disc bulge, disc herniation, disc desiccation, disc dehydration, annular fissure, etc.), let me talk about how surgery is typically avoided through non-invasive, non-pharmacological, conservative treatment.
The first thing to know about a disc injury is that they are usually self-resolving. If given the time, many of them simply go away on their own. So, why would you need a chiropractor or physical therapist or anyone else? Because we can speed the process up and if you have ever been in the grip of disc injury pain, you know why it is imperative to get out of it as quickly as possible. Pain from a disc injury is honestly about as bad as it gets. When a patient is unable to get themselves to the bathroom without assistance, then you understand the level of pain I am talking about. If a practitioner is able to shave a week or more off of that type of pain, most patients will agree that that is worth every penny spent.
As far as treatment for the disc injury goes, I can only speak for myself. I have Fellowship training in Orthopedics and Neuromusculoskeletal Medicine so for me, my treatment may look different than other practitioners' treatment looks. The first thing I'm going to do is determine how long the pain has been present. That will give me some idea about whether we need to have a talk about chronic pain and what is involved. Then I would check for progressive neurological deficits and cauda equina syndrome. Then it is on to questions about the pain. Does walking help or hurt? does it hurt to roll over in bed? What is your best position between sitting, standing, or lying down? What is your worst of those positions? Does it hurt to cough or sneeze? Does it hurt to stand up from a chair? What happens to the pain when you bend over to touch your toes? What happens to the pain when you bend backward? Where does the pain hurt exactly? Can you take one finger and point to the one spot?
All of these are helpful for me to narrow down exactly what is going on. If we can determine that it is a disc, we can then move on to finding movements, exercises, and strategies to help the patient recover quickly and self-manage at home between visits. When these patients are in the office with us, we use spinal manipulative therapy, because movement is healing all the way down to each segment in the spine. We use exercise, decompression, and low-level laser as well.
In addition, I am going to give my patients recommendations on how to move in the future to avoid these types of injuries in the future. We call the discussion a talk about biomechanics. How the body moves basically. I tell them how to use their back properly and help the back protect itself and what kind of movements are harmful. For example, many times patients think that stretching by bending forward at the waist is good for stretching the low back when in fact, this could be furthering the disc injury. Some patients need to understand when forward bending is OK and when it is harmful. Not everyone is the same so you need to be going to someone that can guide you correctly based on knowledge and experience. This is vital to recovering quickly and completely.
As I mentioned briefly, we commonly use non-surgical spinal decompression combined with low-level laser. These two modalities can really provide us a lot of leverage when dealing with a disc injury. Decompression places gentle traction on the discs helping to decrease pressure on the nerves in an attempt to reduce the herniation or bulge while re-hydrating the disc to an extent. The low-level laser, also known as cold laser, is used to reduce inflammation in the area and calm everything down to whatever extent possible. I have honestly never seen anything as effective for disc injuries as non-surgical decompression when combined with cold laser. It is literally a game-changer for back pain caused by disc herniations and other disc injuries.
So, if you get diagnosed with a bulging disc or herniated disc, don't lose hope. There is rarely any reason to undergo surgery, it can usually be resolved quickly and safely with the help of a specialized and knowledgeable chiropractor, and you should be back on your feet before you know it with the right help and the right attitude!
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.