Herniated disc exercising
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Disks in the spine are doughnut-shaped cushions between the vertebrae of the spinal column. These disks have a tough, fibrous tissue on the outside and a watery, gelatinous material inside.
The purpose of these disks is to cushion each vertebrae during movement. A herniated disk occurs when the gelatinous center is forced outside the fibrous outer ring. It may press on nearby nerves and cause severe pain.
Some of the most common causes of a disk injury are:
• Trauma such as a fall or accident
• Repeated straining of the back
• A sudden strain on the back - from lifting or twisting violently
• Degeneration due to aging
• Spontaneous herniation without any specific injury
Symptoms of a herniated disk may begin suddenly or gradually. Sudden aching in the back or neck ,or being unable to straighten up without extreme pain are signs of herniated disk problems. Numbness, tingling, or weakness in one or both limbs, may also occur.
The following diagnostic tests are often necessary to diagnose a herniated disk:
• CT scan
• magnetic resonance imaging (MRI)
Treatment is straightforward. Conservative treatment may relieve most cases of herniated disk pain. This treatment recommended by a physician may include:
•Rest. In many cases, allowing the disc to rest (often while wearing a brace for stabilization) may relief pain
•Prescription muscle relaxants
•Hot or cold packs, depending on your doctor's recommendation
•Traction - stretching may help relieve pressure on nerve roots
•Steroid injections into the space near the herniated disk to control pain and inflammation.
A physical therapy program employing exercises to strengthen back muscles and the rest of the core muscles is helpful. Sometimes disk problems require surgery.
The severe pain from a herniated disk should get better within a few weeks, but some pain may remain for a few months. Backaches may be common in those with a history of disk problems, therefore continual back strengthening and stretching exercises are recommended on a consistent basis. Good biomechanics are also essential to protect the spine when lifting exercising.
Some Back Care Tips:
•Use correct posture when walking, sitting, standing, lying down, or working
•Use proper lifting techniques - don't bend over from the waist.
•Stand up straight with shoulders back, abdomen in, and the small of the back flat.
•When standing for long periods, move around frequently and shift weight from one foot to another
•Sit with the feet flat on the floor or elevated.
•Stretch often when sitting for long periods of time
•Use chairs with good back support
•Sleep on a firm mattress
•Don't sleep on the stomach
•Stop and rest often while on long road trips
Avoid returning too quickly to activity or exercise.
Herniated disks can often be prevented by maintaining normal weight. Strong, flexible muscles can stabilize the spine and protect it from injury. It is important to keep the core strong.
Catherine Clifford, a freelance writer in Chevy Chase, writes about exercise...
So what about exercise? Ask anyone with a chronically bad back what she has tried in the way of treatment and she's likely to respond, "What haven't I tried?" Massage, medication, manipulation or stretching may provide relief, but for most sufferers, the relief--if any--is fleeting.
Surprisingly, a number of recent studies suggest that what most back-pain sufferers should try is a back-muscle workout that will probably leave them in increased pain--at first, that is, but feeling much better in the long term. "It's not hard to help someone with her back pain one time, but the challenge is to keep her from having to come back," says Vijay Vad, M.D., a sports-medicine specialist at the Hospital for Special Surgery, an affiliate of Weill Medical College of Cornell University in New York City. "That's where exercise is crucial. The first couple of weeks you're going to be more sore, but the long-term solution for back pain lies, basically, in exercise."
For instance, a study led by Vad that's still under way has found that although patients with disc problems who followed a carefully designed exercise program were in more pain for the first three weeks, after that they started feeling better than a control group who used daily medication and a nightly back brace. More significantly, one year later, 70 percent of the exercise group reported that their pain was reduced by more than half, as opposed to only 33 percent of controls.
Of course, exercise has been recommended for back problems before. However, usually patients were cautioned to stop if it hurt. "But studies have shown that when someone has an incidence of back pain, back muscles atrophy very quickly, and surprisingly, even if the pain goes away on its own, which it usually does, the muscles stay weakened," says Vert Mooney, M.D., a clinical professor of orthopedic surgery at the University of California, San Diego, and president of Measurement Driven Rehabilitation Systems Inc. "So almost anything you can do to make those muscles work is a good thing. If exercising causes sharp pain, exactly the kind of pain you're trying to treat, then you're doing something wrong. But you should feel discomfort or achiness, the way you do whenever you start moving something that hasn't been moved in a long time."
How does exercise help alleviate back pain? "No one really knows," says James Rainville, M.D., chief of physical medicine and rehabilitation at New England Baptist Hospital and an assistant clinical professor at Harvard Medical School in Boston. "But our data on approximately 2,000 patients per year who undergo rehabilitation suggest that most who exercise, even if it is painful, experience a substantial improvement in the amount and intensity of exercise they can perform. And that is associated with a decrease in back pain.
"Their backs become more tolerant to the stresses of exercise, and are more resistant to producing pain messages after movement and strenuous activities," he adds. "But we don't know where this improved tolerance or desensitization occurs--whether at the back tissues, the spinal cord, brain stem or cerebral cortex."
Part of the explanation is psychological: Pain perception is made much worse by worry, fear or the expectation of pain, Rainville notes. "People are afraid that if they move, stretch or exercise their backs, they'll harm them further," he says. "But there's no indication in the medical literature or our vast experience that exercise is unsafe or unreasonably risky for people with back pain."
Some of the exercise machines used by back centers (and some gyms) are able to home in precisely on strengthening crucial muscles like the lumbar extensors, transversalis or paraspinals (back muscles that, with other exercises, tend to let stronger muscles nearby do all the work, Mooney explains). Based on patients' individual progress, doctors and trainers then can make informed recommendations on how hard a particular patient should push herself to maximize payoffs while minimizing pain.
Mooney estimates that perhaps only 10 percent of back doctors in the United States are on board with this exercise-centered approach (chiropractors and physical therapists are, similarly, found on both sides of the fence). Still, a number of facilities around the country operate practically as medical gyms, where back sufferers can learn how to exercise the right way. At the Spine & Sport Centers directed by Mooney in California and Tennessee, for example, many patients are set up with a six- to eight-week, twice-a-week program with on-site equipment. Trainers make sure that workouts are done correctly and track progress.
One of the leaders of the exercise-centered movement is The Spine Center at New England Baptist Hospital in Boston. It specializes in evaluating people with complicated spinal disorders--two-thirds or more of its 400 new patients a month are referrals from other doctors, typically cases in which, after years of various treatments, the patient is still in pain and hoping to avoid spinal surgery--or another spinal surgery. For 5 percent of patients, the center does recommend surgery, but for more than half of extreme cases it instead prescribes a very aggressive program of personally tailored exercise, continually tracking those patients for back strength, pain, flexibility and the ability to perform everyday tasks and activities.
Staying active in general is key to keeping back troubles at bay, according to Rainville. "The theory used to be that disc degeneration--the major source of recurrent back pain in younger people--was caused by physical activity, and the standard advice therefore was first, to rest, and second, to avoid physical activity, or at least any activity involving the back," he says.
Disc injuries can be precipitated by severe accidents or injuries, or occur spontaneously, often during trivial activities like reaching, bending or even sneezing. "The real source of most disc problems appears to be genetically predetermined for age-related degeneration. Following a long-term exercise program is ideal, but even without that, people who return as soon as they physically can, without torturing themselves, to their usual activities--which could be yoga, weight training, running, skiing, golf, basketball, gardening, carrying laundry baskets, picking up their kids, you name it--recover quicker, have better range of motion, less overall pain, fewer flare-ups of pain, fewer spine surgeries and, of course, a richer, happier life."
A little exercise helps a little; a lot helps a lot--to a point. "Two or three workouts a week is optimal for most people," Rainville says. "At the same time, we're not aware of any evidence that more frequent exercise causes damage to the spine--though some report more irritation to the back when exercising more than three times per week."
Having that kind of control over your own body and treatment is one of the most appealing aspects of the exercise-based approach. "Too much of back medicine puts health-care providers in control: They say, 'You need to come to me so I can help you out with a prescription, or by manipulating or massaging you, or by using this instrument or performing this surgery,'" Rainville says. "People just want something that makes sense to them and puts them in control, and for a lot of them, exercise is it."
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