Question
I have a history of back problems starting 4 years ago when i ruptured my L4-5 disc...then 2 years ago I bent over and got a buldge in L3-4. About a month ago I was lifting something really heavy (with correct body mechanics) and felt something "slide" in my lower back. I was fine until the next day when the spasms were so bad I could barely move. I am still having problems with severe lower back pain with intermittent numbness/tingling of both of my feet. No weakness. My MRI does not show anything "new" - just the annular tear, and the buldge that I already knew about....I have been going to physical therapy....I now have a pending appt with a neurosurgeon - I am just wondering what you think is going on....and why I am still having such pain - thanks!

Answer
Hi Kate,
I believe the reason you are still having pain is that you have an annular tear. I don't think it is advisable to do active exercises since this will only keep the tear from healing. It takes 6-8 months to heal a tear since it has such a poor blood supply.

To make up for this, we do ultrasound treatments while the patient takes 3 grams/day of glucosamine sulfate with MSM to speed it's absorption. This should be followed by interferential therapy 9a type of electrical stim to control pain) and ice to minimize the inevitable increase of inflammation from the heat modality (ultrasound). Make sure you are not using heat on your low back, this will only result in pain!

Once the rear is healed in a decreased amount of time utilizing the protocols outlined above, you can address getting the disc decompressed non-invasively using flexion/distraction by a D.C.

Flexion-Distraction Therapy - What is it?


Flexion-Distraction, (F/D) is a gentle, chiropractic treatment procedure utilized for back and neck pain. Flexion-Distraction is a safe alternative to back surgery for those 95% of patients whose conditions do not demand surgical intervention. The doctor is in control of the treatment movements at all times.

Flexion-Distraction is utilized for many conditions such as:

Failed Back surgical Syndromes
Disc Herniation/Ruptured Disc / Bulging Disc / Herniated Disc
Sciatica / Leg pain
"Whiplash" injuries
Stenosis
Arm Pain
Neck Pain
Failed course of Steroid Injections
Chemical Radiculitis
Spondylolisthesis
Headache
Transitional segment
Many more conditions?
How does Flexion-Distraction Work?

For Disc related conditions:

Increases the intervertebral disc height to remove annular tension on the annular fibers and nerve by making more room and improving circulation.
Allows the nucleus pulposus, the center of the disc, to assume its central position within the annular fibers and relieves irritation of the spinal nerve.
Restores vertebral joints to their physiological relationships of motion.
Improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.
For Non-Disc related conditions:

Patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac restrictions and misalignment, certain types of spinal stenosis), Flexion/Distraction provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain:

The posterior disc space increases in height.
F/D decreases disc protrusion and reduces stenosis.
Flexion stretches the ligamentum flavum to reduce stenosis.
Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6mm more than extension.
Flexion increases metabolite transport into the disc.
Flexion opens the apophyseal joints and reduces posterior disc stress
The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100mm Hg. On extension the nucleus or annulus is seen to protrude posterior into the vertebral canal.
Intervertebral foraminal openings enlarge giving patency to the nerve.

Reference: Cox JM, Feller JA, Cox-Cid JA: Topics in clinical Chiropractic 1996; 3(3):45-59

A neurosurgeon would be a bit drastic, you only need them for ruptures, not bulges and herniations. These are easily fixed with spinal decompression or preferably, flexion/distraction.

Hope this helps,
Good Luck!
Dr. Timothy Durnin
drs.chiroweb.com