Disc Injury Treatment

Brad Muse  0:17 

Let’s talk about disc injuries, something we see every single day in our clinic. And there’s going to be a wide variety of these things so we want to talk a little bit about different types of disc injuries; how we assess them, how we treat them, some of the anatomy that Dr. Ulm is going to cover. Now, if you experience one of these things, you may injure a disc injury, maybe you’re picking something heavy up off the floor, or maybe even a toddler. It doesn’t have to be a crazy heavy thing, it could be just that right time of the day where you bend over and feel that little pop in the back. It could just present itself as just back pain. Sometimes you’ll even get some of the things that go down into the leg. But you don’t have to have these full leg symptoms for this to be a disc injury. So, we want to talk a little bit how these things are going to present, but let’s first talk about some of the anatomy.

 

Richard Ulm  1:02 

Yeah. So, the disc is the most common structure on the spine that gets injured. And so, we treat this, like Dr. Muse said, every single day where we’re seeing a cervical spine herniation or disc injuries, thoracic spine, and, of course, low back. But we want to kind of talk about the anatomy a little bit because it will explain why prolonged sitting will give you that glute pain, or that just aggravates the back; or when you stand up, you feel like you have to kind of stretch out before you could actually move; or why you might get shooting pain down the leg. And the discs are going to be sort of cartilaginous tissue that are designed to kind of absorb shocks. So, they’re engineered beautifully, and they are, essentially, like a water balloon with a lot of very stiff strong rubber bands wrapped around it. And what happens is if you imagine if you squish the water balloon down, it will push that fluid out against those rubber bands. And those rubber bands in the actual disc are called annular fibers. And those annular fibers are what get stressed and strained, and ultimately, fail to produce the various types of disc injuries that we have. So, when you bend forward to sort of pick something up, imagine that fluid instead of being pushed into all parts of the annular fibers, it gets forced all the way backwards. And then that’s what stretches those out over time. And then, eventually, they sort of overstretch, they strain, they distort, permanently distort. And then, that starts giving you the symptoms that Dr. Muse was talking about.

 

Brad Muse  2:32 

Yeah. And, like I mentioned just a moment ago, there’s going to be a variety of ways that the physical properties of the disc actually change, and the least severe, and there’s something called a disc protrusion. So, that’s where the rubber bands, those annular fibers Dr. Ulm just talked about, still have their integrity but now some of the nuclear material that jelly in the donut is beginning to kind of stress and push towards it. So, a protrusion is going to be a little bit of a outpouching of those rubber bands. The next one is going to be something called an extrusion or this falls under our herniation category where now some that jelly in the donut has actually made its way through those rubber bands and now it’s sitting in the canal where the nerve roots sit. So that’s where when we begin to have pressure, whether it’s mechanical or chemical pressure on that nerve, you might start to get some of those leg symptoms. One other category of disc injuries is going to be extrusion where now that part of that nucleus that has come out actually breaks off and it’s just kind of floating freely in that space.

 

Richard Ulm  3:39

You don’t want that

 

Brad Muse  3:39

No, you don’t want that. The good thing with that is over time the body does what it does, and will actually kind of resorb that back up into the bloodstream.

 

Richard Ulm  3:46 

Yeah. So, we see all three of those. There are subcategories of each of those, but we see all three of those all the time. Now, you might have, in the beginning, when he talked about the protrusion or a bulge, that’s where those rubber bands are kind of stretched out. You might notice that your back’s just a little bit tighter in the morning, or a little bit stiff, or maybe a little bit achy. Or if you drive to go see some family members, a couple of hour drive, you get out of the car and it’s just really, really stiff or you get fidgety. You don’t have to have pain in the legs or even under the glute, but you might. And then, as the process continues, you might now start having a little bit of glute tightness or aching maybe even down into the hamstring, that’s your classic sciatica. And if it keeps going and then that bulge either physically pushes up against the nerve root, or the nuclear material that he was talking about, the stuff that extruded out of the disk, if that sits on the nerve root, that’s going to give you a tremendous amount of unrelenting pain. So, we have the tools to be able to assess any of these. Just in addition to, obviously, what you were saying, we have to take you through a very, very detailed orthopedic, neurological, and mechanical evaluation that Dr. Muse is going to talk about.

 

Brad Muse  4:59 

Yes. So, if you’ve watched any of our other videos on our YouTube, which hopefully you have, you’ve probably heard myself and Dr. Ulm talk about something called the McKinsey method. So, we use this McKinsey method to assess each patient on an individual basis. No two disc injuries are alike. So every time a new patient walks in with something like this, we have to go through the same steps to figure out specifically for that person what we need to do. And that’s going to include a lot of repeated motions in each and every direction to see which ones are going to be provocative to that patient, but then which one, hopefully, one is going to be one that helps reduce the symptoms. So, if you’re having those leg symptoms, we want to pick a movement that will hopefully pull those up out of the leg and into the back. And then, of course, we’ll use other things like the soft tissue stuff, the adjustment to make that whole process go better. But the McKenzie method is going to be a major part of, not only the assessment, but also the treatment.

 

Richard Ulm  5:55 

Yeah. And we have lots of videos on that, you can link to or we can put links in here to videos on what is McKenzie, centralization, which is what he just talked about where the symptoms come out of the leg, the evaluation. A lot of information on that. But, broadly speaking, we’re going to use McKenzie as our primary evaluation because it’s a very, very, very thorough and robust way to evaluate the mechanical integrity of the spine. But we’re also going to do classic orthopedic tests. And, of course, if somebody comes in, we have to do a detailed neurological exam, which, honestly, sometimes it’s not done at traditional medical providers, I don’t know why. But these are all very, very important so that we can establish a really, really good clinical picture so that we know, not only what’s the source of the pain, but also what are some of the functional causes that might have gotten you here in the first place.

 

Brad Muse  6:42 

Yeah. And that starting point with that assessment is going to allow us to quarterback that situation, because sometimes with these disc injuries, if it’s bad enough, or maybe that extrusion is bad enough where we have chemical or inflammatory things going on around that nerve root, then maybe we will need something like medication. Maybe, at some point, we may need some imaging. But, first and foremost, we need to do a really good exam to figure out if this is going to be something that we can treat conservatively.

 

Richard Ulm  7:10 

Yeah. And even though we’re very willing to order an exam, sort of MRI, or maybe send you to some of the VIP docs that we work with to get an injection or maybe even surgery, the vast majority of the time between using McKenzie and doing a lot of the rehab that we would be doing, implementing like a lot of core stuff, joint manipulation, or mobilization if you’re not into the manipulation thing, soft tissue work, and really trying to get you functioning better. The vast majority of disc injuries, almost no matter how bad they are, or how much pain you’re in, are very, very fixable. And the last thing we want to say is one of the primary tenants of what we try to do here, especially in the case of the disc injuries, we want to make sure that you have exercises that you can be doing at home to reduce your own pain and have control over your symptoms. So, if you have just general back tightness every time that you get up in the morning and it’s been going on for five years and you’re just sick of it or you can’t sit down, for prolonged periods of time or shooting pain down your leg, then these are definitely things that we see on a consistent basis.

 

Brad Muse  8:16 

Yep. So, if you want more information on this stuff, check out our playlist on the McKenzie method on the YouTube channel. There’s plenty of other videos besides that, but that’s a great place for you to start for this kind of injury. If you have any other questions, be sure to call our office, reach us on Instagram…

 

Richard Ulm  8:34

YouTube, all the things.

 

Brad Muse  8:36

Walk in, come say hi, whatever you want to do. But we’re here to help you guys and we’re trying to put out more and more information like this to help you.

Richard Ulm  8:42

Yeah. Hopefully, the video helped.

Brad Muse  8:44

Thanks.

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