Resolving Disc Injuries with Manual Therapy
Resolving a disc injury is a combination of removing any type of mechanical restriction that is causing stress on the disc and avoiding all physical stresses that are perpetuating the disc problem.
Initially, disc injuries can be incredibly painful, it may seem that surgery will be the inevitable outcome. Fortunately the majority of disc injury patients do not require surgery, in fact less than 5% of patients do.
This is a good thing to keep in mind as you are going through therapy. The length of time therapy takes to resolve a disc injury depends on several factors; the severity of the disc problem, the length of time you have had the problem, your age, and your physical condition to begin with.
For acute disc injuries, ice should be initially applied for the first 72 hours to reduce pain, inflammation, swelling, and muscle spasms. For the lumbar spine one of the most effective ways to ice the area is either ice massage or wet ice. Wet ice refers to putting crushed ice in a bag which is then covered by a wet towel. This will lower the temperature of the affected area very quickly to reduce pain and inflammation.
After 72 hours, heat can be applied to the affected area to increase blood flow and reduce muscle spasms; even the deeper structures such as facet joints can benefit from heat therapy.
In the acute stage of injury resting for a maximum of two days can be helpful. If you have ever had a disc injury, as I have had, just lying on the floor for a few days may be all you can do. On the other hand, the sooner the patient can return to normal activities the faster the recovery will be. Disc injuries are not a condition that you can wait for symptoms to resolve before returning to your activities.
Performing Activities of Daily Living
When you have a disc injury all your daily activities should be performed in a way that will not aggravate your condition. Essentially you must do everything you can to avoid performing tasks in a way that causes you pain or irritates the disc injury. This may require you to reduce your range-of-motion when performing a task, move more through your hips than your back and brace your core before moving or lifting any object.
Another essential action you have to perform is listening to your body. If your body tells you the way you are performing this action really hurts, listen to it. Basically, if you try to work through the pain you are experiencing you will only do more damage to your body turning an acute problem into a chronic one.
Activities that are especially damaging to the discs in your back are actions that involve any repetitive motions performed in a flexed spinal position. This is particularly true if you are lifting heavy loads in this position. Even lifting minimal loads can lead to considerable disc damage if the task is performed repetitively in a flexed position.
Removing any type of mechanical restriction that causes stress on the disc will be of great benefit. The specific physical restrictions that need to be addressed with manual procedures (ART, Graston, Massage, Manipulation) in a disc injury will vary depending on the individual.
Determining which areas need to be addressed will depend on biomechanical analysis and palpation of the affected areas. A key point to remember is that there is no one group of structures that is the key to addressing all disc issues. Any injured muscle, joint capsule, ligament, tendon, or connective tissue restriction can cause changes in motor patterns (neuromuscular imbalances) that directly affect spinal stability.
Imbalances increase stress on the discs of your back which perpetuate or cause further injury. Fortunately, those spinal imbalances can be addressed with manual procedures. When these procedures are combined with dynamic exercises to re-establish normal motor control good results are often seen.
If you are having trouble with a disc injury have Dr. Abelson, or one of his associates, review you case to see if manual therapy can help you.
Prescribing the right type of exercises for a disc problem is essential. The first thing when it comes to exercising with a disc injury is to avoid exercises that cause more injury. It may sound strange but most disc patients, (and back pain patients) are prescribed exercises that perpetuate their conditions.
If we consider the mechanism of how disc injuries occur we can obtain considerable insight into what exercises to perform and which to avoid. Considering that cumulative motions with your spine in a flexed position commonly lead to disc tears, exercises such as bent-knee sit-ups should definitely be avoided.
One of our main objectives in prescribing exercises to disc patients should be to increase neuromuscular control and muscular endurance. Just focusing on increasing strength and flexibility often leads to poor results.
On a general note, the spinal exercises (other than a Cat Camel stretch) should not be performed first thing in the morning. You need to give your body time to warm up; the discs and surrounding soft-tissue structures of your spine are very stiff. This is partially due to an increase of viscosity in the disc. When you lie down at night your discs rehydrate all the fluid that was pushed out with the compressive force of gravity – you standing.
This increased viscosity in your discs can create increased internal friction which can have a very damaging affect on disc problems. That is why we recommend Cat Camel stretches first thing in the morning. This exercise pumps fluid out of the disc, reducing the chance of injury first thing in the morning.