DDD / Lumbar - Try Physical Therapy?

[stars]

F / 33yrs old

Is there anyone who can provide any advice to me regarding physical therapy after a L5S1 disc bulge flare up? I hear that sometimes PT helps but sometimes it makes it worse. What is your experience?

My situation:
Disk Bulges in: L3,L4, L5/S1
L5/S1 bulge is severe w/ canal narrowing

I have had great healing experiences with my chiro during pregnancy and after. (I have a two year old). He has been treating me with my most recent disc bulge flare up. I keep messing it up because i am stubborn and start feeling better...then WHAM square one. I avoided the epidural shot and managed the pain. After 3 weeks, I finally broke down and got some pain killers to help me work. I was standing at my desk for about 3 weeks. I am now sitting.

I also saw 3 different spine doctors. They all told me the same thing as the chiro. My L5/S1 is shot. (But it is still there..there is space between the vertebrae).

I am in good physical contidion. (5'6 @ 115 lbs). In fact, i am a bit underweight. I have not worked out in a year and have been losing some muscle tone. I have bad posture but am working on it.

Anyway, I am getting decompression at the chiro. It helps.

Since the doctors and the chiro agree that i have a degenerate disc, I know that is the case. But what they do not agree on is PT. I want to try physical therapy. My chiro does not want me to try it. (He says I am in good physical shape and to do core exercises like plank, etc. ) I have a consultation next week at the Dr. They will recommend physical therapy for me. I'm not sure what to do.

I am requesting your experiences.

Has PT helped any of you?
hurt any of you?

I am really scared because I have never had a medical problem. Always been healthy. So, i am in a depression over this. I am trying to get out of my funk. I know it could be much much worse.

I just don't want to make it worse by going to PT when the only guy who has helped aleviate my pain told me not to.

What would you do based on your experiences?

[Billy Bob]

My situation is not nearly as bad as yours.

However I have had dozens of PT visits...

For me they made me more limber and that made me feel a bit better. I get pretty stiff because I don't want to do much. So over time my flexibility goes to shit.

However the PT never fixes the problem.

There are some really smart people on this board though. I am sure they can give you more sound advice than I can.

Good luck!

[stars]

Thanks for your response Billy Bob.

I do understand that nothing will "fix it". That is probably why i can't stop crying. haha.

Anyway, I am a good weight but I know that I am weak. Especially after having a baby. I worked out the first year, but not the second. You CAN be out of shape and be skinny. I think my chiro thinks i am "in shape" because i have a nice figure (am not overweight). I think my core could definitely use some strengthening.

I have always been a 0% or 110% kind of gal. This SLOW healing and "can't fix this" has been a hard bite for me to swallow.

Thanks again Billy Bob and I hope that you are not having too much trouble with your spine issues. I feel so sorry for anyone who has to deal with this.

[Maria]

In the US before anything is done surgically usually insurance will require a trial of PT before moving on to authorizing other types of more invasive treatment. Myself PT was never that helpful for my spine except with my SI joint stuff and even then it took one PT out of a number to treat my injury really well and it's difficult to find that "one" person. I think core exercises are definitely key but there are some things that one will find that aggravate or flare a bad disc up so you kind of have to work with what doesn't flare things up.

If you do go to PT don't let anyone push you if your spine starts hurting.. stop doing whatever makes things hurt because you can worsen the situation so be careful with that. I think you could probably work out your own exercise regime on your own though again if you see a doctor and are considering surgery then you will likely have to go thru a course of PT and it will have to fail before anything more invasive surgically would be recommended. PT might be helpful to you though again don't let anyone push you when your back hurts more because it's probably not going to make it better and might make it worse. A little pain when first beginning is normal if you're out of shape but nothing that really aggravates that disc which is far too easy to do.

An ESI might be very helpful and I would reconsider this. I had ESIs over a 10 year period of time and was able to avoid more surgery. They don't work for everyone but when they do work they're pretty awesome.

If you develop the following get seen ASAP(emergency): loss of bowel or bladder function (incontinence), numbness in the saddle area (perineum), numbness or loss of use of your extremity, extreme unrelenting pain that isn't alleviated with any method of treatment such as rest, etc.

Good luck with everything and keep us updated if you feel like it~ Maria

[stars]

Thanks Maria.
That is very helpful.

I have PT scheduled next for monday. A co-worker of mine referred me to his PT at the Spine&Neuro center who also happens to be the director of PT. He said he was the "best". I took a chance and emailed the director, and I am scheduled to work with him. My chiro specifically told me not to "twist" and avoid touching my toes in my pilates and yoga classes. So, I will be careful at PT. I am just really scared it will start to flare up again.

I am a graphic designer so I sit all day. My employer purchased me a really nice chair with memory foam and a cut out at the place where my sacrum hits. It is so much better than my other chair. I have a sit down/stand up desk on the way. I guess I am lucky because they didn't have to do that. (My production has been down since my flare up).

I will start PT on Monday against my chiropractor's suggestion. I will stop any exercise that aggravates it (although it might be too late). I suppose there is always ESI if I go down in flames from it.

Re: ESI
I WILL get one next time. I was regretful I did not do it this time. I have just been really scared since all this is being thrown at me so quickly. I have not had ample time to do research. I do feel grateful that Mark has started this site so we all have a place to go for help. I wanted to post immediately since all of you have way more experience than me. I really welcome opinions and information from those who have gone down this path.

Thanks again Maria. I will let you all know how it is going.

[Maria]

Stand at your desk? If so get a mat that absorbs shock like hair stylists have at their station and have a chair so you can sit if needed though can stand and move around a bit. I did that the last 5 years I worked as an "advice nurse/telephone triage" with a modified work station. Maybe wear shock absorbing and supportive shoes as well. I have not been able to ait for long periods even after 2 discectomies (L5S1 and L4) so the standing station helped greatly. I didn't start getting ESIs until after I retired on perm disability tho I wish I had.

Good luck with your PT consult and all

[Jim M2]

hi Stars

Needing to stand at your desk sounds like classic DDD. One of your pain generators is the disc? right? This was my situation at L5S1 before ADR and currently it is my situation with L45. Leg pain has been a lesser issue for me. For this reason I never found injections to be helpful. I found that some of the more effective core exercises aggravated my central back pain at the DDD level. I think the PT does help one manage pain a bit. I'm curious to see how your outcome from PT. Good luck.

[stars]

Hi Jim,
No one told me I have DDD. But I guess that is what it is since my L5S1 disc was black on the MRI? I am seeing another Dr. next week (non-surgical). I will ask her to give me some terms for my condition and stuff I need to know. This is all so overwhelming.

Yes, the disc is the pain. It is not ever numbing my legs or anything. When it gets bad my back and butt get kind of numb. It gets really really painful and swollen. I think my pain was a 7/10. I would rather give birth again than go through that! I think i should have tried the ESI but instead I just got laser treatments done at the chiro and they helped me out a TON. After 6 treatments my pain was almost gone! Then i started moving stuff in my garage, picked up my kid and wham! square one! I did this 3 times! I am a complete fool! I just didn't know that I had this type of condition because i was always seeing the chiro, not the dr. The chiro is the one who helps me tons! But also, I didn't know my disc was blown ya know? so I just though i was out of shape or just had a bulge... and that there was nothing wrong in my spine. Then i got the MRI and saw 3 Drs. wow. reality check.

Anyway...I am on week 6 of this flare up. Chiro told me to do some exercises and walking this weekend. He is not going to be happy when I tell him I am doing the PT. But I think i have to at least try it? right? We will see how it goes.

I am excited about the PT. I've been so down and depressed since I found out "something is wrong with me" that i "can't fix". So, I'm pretty tired of crying at my desk. ya know? time to deal with it and make some abs of steel! and try to protect my spine the best I can!

Is that silly? I mean, when i got adjusted today my chiro said feel that? it was when i was on my stomach and I was lifting my leg straight and up towards the ceiling...and it sort of shifted. Chiro said "that needs to be tightened up". (But he doesn't want me to go to the PT because i will have another flare up??) My gut tells me he actually cares and is empathetic and wants me to be better! But you never know what everyone's intentions are! I wish people had to wear "integrity" rings that changed color so I could know. ha!

I keep having to look up all these acronyms. So you had ADR, I will probably privately message you about this.

My L5S1 hurts! But i took less pain meds today and I am feeling a little better. My pain is 3/10. I'm on 5 mg hydrocodone (just to work).

PT scheduled for NOV 11. I will keep posting on this thread to let everyone know my progress.

I hope it will be positive.

[Jim M2]

Stars,
A couple of things. My memory is terrible but I think I remember Chirogeek telling us crack the back therapy was not for DDD. I had a chiropractor who I thought hastened the onset of high level pain. I'm glad your chiro is giving you some relief.

I had L5S1 ADR in 2003. It got rid of my disc pain for sure but I had other complications. Namely my facets were painful. I was never able to get to the bottom of what went wrong. There are many successful ADR implants. I was not one of them because of the facet problem.

Jim

[Maria]

You may want to get an injection of Toradol 60mg Intramuscularly when you have an acute flare up to see if that alleviates the muscle spasms associated with a disc flare up. If it does you will cut your pain down markedly and rest period as well. You can get this injection at Urgent Care, Pain Management, Ortho, or regular Primary Care doctor's office. It's often used for people that come in complaining of neck and back pain and spasms. One must have good kidney function for this medication. It's a non steroidal anti-inflammatory medication and while it comes in other forms like oral and a nasal spray called Sprix the injection is the absolute most effective and won't upset your Gastrointestinal system.

Your Chiro might not want you to go to PT because if someone else can help you feel better maybe you'll stop seeing the chiro? Also doctors of osteopathic medicine (D.O.) are often very good at treating back pain with manipulation and one does not have to get high velocity or crunching done which I'm sure your chiro isn't doing to you either with your injury.

A 3 out of 10 sounds like progress and hopefully the pain will continue to be alleviated. With a really bad L5S1 and your history of flare up I imagine it will kick up again though. Many tools in the arsenal to treat back pain are worthy of a try and hopefully one can get some good relief without surgery and/or know when the time is right for that move.

take care~ Maria

[Maria]

Just wondering how you're doing and hoping much better! Maria

[stars]

Jim - I'm sorry your pain became another kind of pain. It sucks so bad. I can't imagine having something like this for years, much less a decade.

Maria - You hit the nail on the head re: chiro. He does alleviate my pain, but I had no one making me do exercises correctly. My $$$ has been sucked out by the chiro. I am skinny but not in good shape AT ALL. In fact, i would say I'm borderline anorexic. I know my body. I know that I have not worked out in a year due to work and stress, etc. When i don't work out I lose muscle tone. To me, this is the whole reason this crept up so fast on me. I was weak, and I kept trying to do it all. Lift kid, move stuff, etc. So, I am glad i let it surface at 33. Now, I just have to get really strong and hope you all +Drs will guide me.

PT is helping me a TON. Thanks for all your advice. I was off this site for a few days. I really REALLY appreciate it. I didn't know who to talk to. I was feeling sooooo depressed.


Week 1:
Evaluation: Pain is in the center. Not going down my legs. (Stated my hips were weak as well as my core).
1- Presses (similar to Cobra in yoga). I started slow and moved up to 10/hour while i was at work. Pain went down from a 4/5 to a 2/3. Hooray! Pain also moved.
2- Traction
3- Stem / heat

Week 2:
1- Presses
2- checked out to see if my SI joint might be an issue (1 out of 5 hurt..so he said it prob wasn't that).
3 - Pushed around on my vertebra and sacrum.
4 - Pressed on sacrum while i did my presses. (He said my sacrum is tilted...so he's trying to nudge is back).
5 - He added pelvic floor exercises as well as core.
A. Pelvic Tilts B. Bridging C. NS w Ball Adduction D. NS with Theraband Abduction


I am to do those 4 exercises a few times a day. I already feel better. I was able to pick up my kid a few times this past weekend.

Currently, My pain is a 1/2.

[Maria]

So glad to read that your pain is that level! Seems like PT is helping you quite a bit.

Yeah people can be super slender and be way out of shape. Most doctors I've seen in the past were so pleased that I was very slender and made it sound like everything was great because of that one factor going in my favor. I do know when it comes to surgery it does help if someone is on the slender side vs. heavier or going towards obese. Especially if one is having surgery in the abdominal area and there is a lot of excess fat there.

I'm sure you have a quite a bit of reconditioning to do though at least you don't have to lose weight ... maybe gain a bit but not lose!

Glad you can pick your kid up correctly and keeping the pain in check so far. Hoping it continues this way for you! Thanks for the update! Maria

[Melissa]

My 49 year old brother had lower back surgery June 13 for a herniated disc. He was scheduled to have the surgery one day and go home the next. Then we were told the dura membrane was nicked. Otherwise, the doctors said the surgery was very routine and uneventful. He has been paralyzed since the day of his surgery. He has regained urine and bowel control; he has feeling in his quads. However, no feeling in his buttocks or from the ankles down. What is going on?

[mmglobal]

Melissa, I responded to your post on the thread you started.

Stars, that is awesome about your low pain levels.

I agree with Maria that chiropractic manipulation like 'cracking your back' can be very dangerous for spine patients. I don't understand how they can risk it as many of us have mechanical instability that could be aggravated with that kind of force.

Mark