Common Questions and Concerns Regarding the Treatment of Lumbar and Cervical Disc Problems

In order to provide you with the necessary information you need regarding the treatment from disc problems, we have created this handout to answer the most common questions.  Well-informed patients often have better outcomes.

Table of Contents:

  1. What is the nature of disc and spinal nerve problems?
  2. Why me?
  3. What caused this problem?
  4. Should I be alarmed?
  5. What can I expect?
  6. If I have arm or leg numbness, tingling or weakness what does that mean?
  7. What are the effects of chiropractic manipulation?
  8. Should I be worried if my MRI or CT scan indicates I have a relatively large herniation?
  9. What would happen if I decided to have surgery instead of conservative non-operative care?
  10. What must I do to help the process of healing?
  11. What specific exercises are safe and effective for my spine?
  12. Should I be taking drugs or nutritional supplements?
  13. In Closing

1.  What is the nature of disc and spinal nerve problems?

There are 26 spinal bones, known as vertebrae, each separated by cushions, known as discs.  The discs help to absorb force and to “guide” the movement between the vertebrae.  A healthy disc allows the nerves to exit freely from the spine .The disc itself is made of cartilage, like the material that lines all of the joints. The disc has a tough outer ring (called the annulus) and a softer gelatinous inner core (called the nucleus pulposes). The disc material can become irritated (inflamed), torn (herniated) or a piece of torn disc material can actually separate itself from the disc (sequestered).  The source of your pain can come from the irritated disc material itself, but more often comes from indirect pressure on the nearby nerve. Nerves are extremely sensitive.  A little pressure on the nerve will produce pain, while greater amounts of irritation can produce numbness, tingling and weakness.  It is the normal function of nerves to allow your muscles to properly contract, giving you a sense of strength.  Nerves allow your skin to experience full sensation, which when decreased, results in numbness or tingling.

2. Why me?

Disc problems are fairly common.  The good news is they generally resolve with proper care and the passage of time.  They most commonly occur in 20 to 40 year olds and affect twice as many men as women.  Remember, however, these are just statistics and there are always exceptions.  We regularly see disc problems in patients that tend to sit for a living or who use their back more rigorously, particularly with bending, twisting and lifting while at work or play.  While genetic factors may play a role, we feel lifestyle plays a more important role. Just because your mom or dad had disc surgery, you shouldn’t expect to follow their path.

3. What caused this problem?

Only about one third of the patients complaining of symptoms related to irritated discs report an acute onset attributable to a particular event, such as heavy lifting. Much more commonly a small movement, such as picking up a sock, can be the precipitating event.  More patients have a gradual onset of neck or low back pain, followed by arm or leg pain (sciatica).  These patients generally have experienced many episodes of similar pain within the previous 2 to 5 years.

Specific stressors related to the onset of back pain related to an irritated disc include:

  • Twisting and repetitive bending
  • Prolonged sitting
  • Obesity
  • Cigarette smoking
  • Undue stress
  • Lack of strength and flexibility

4. Should I be alarmed?

Generally speaking, disc problems heal very well with proper care and time.  Studies show 98% of people recover without surgery. The worse case scenario with a disc problem is that it would require surgery. If surgery is required, you can still have a good outcome provided you do the necessary rehabilitation and make lifestyle changes.

Rarely, (less than 1/10th of one percent), the spinal cord can be compressed by a large centrally extruded herniated disc. This condition is known as cauda equina syndrome.  If you experience loss of bowel, bladder control, or sexual function, along with pain and numbness and severe weakness in both legs, you should go to the emergency room of the nearest hospital.  This problem often requires immediate surgery.

5. What can I expect?

The good news is less than 2% of people with disc problems causing nerve irritation and leg pain require surgery to fix their problem.  Even if you are experiencing nerve irritation (numbness, tingling, sharp or burning pain in the legs and/or a sense of weakness) you can have a very favorable outcome in 4 to 6 weeks with conservative care.

You can expect improvement within 4 to 6 weeks of care for a simple problem, whereas a very severe problem may require therapy for several months, even extending 6 to 12 months depending upon the severity.  Care is more frequent during the first few weeks and then becomes much less frequent in the following few months.  Once symptoms have resolved and you are able to do more of your normal activities without pain flaring up, your care is considered complete.  After that point, simple daily exercises are critical to decrease the chance of the problem recurring. We will do our very best to make sure you understand the importance and proper technique for particular exercises.

6. If I have arm or leg numbness, tingling, skin sensitivity, pain or weakness due to nerve pressure, what does this mean?

During the early and painful stages of disc irritation, the nerves become super-sensitized.  This may mean that your skin becomes very sensitive, or you might feel sharp or burning pain in the buttock, groin or leg area, leaving you with a preference not to have any pressure on the area.  The muscles may have more of a tendency to cramp or spasm.  These are normal consequences of nerve irritation.  Successful treatment will reduce these problems completely.

If you have neurological challenges (i.e. numbness, tingling, pain or weakness in your arms or legs), this suggests your case may be more complicated and may require additional care.  Following are suggested timelines for full recovery for particular conditions.  The most important thing to realize, however, is that ongoing care only occurs if you show measurable improvement both in how you feel and how your body functions.

  • 6 to 12 weeks – for mild sensory loss with or without mild muscle weakness.
  • 3 to 6 months – for moderate muscle weakness and loss of reflex.
  • Up to 12 months – for severe motor loss (i.e. leg or arm weakness).

7. What are the effects of chiropractic treatment?

There are more studies positively supporting the effective management and relief of back pain through manipulation (the primary tool used by chiropractors) as compared to any other approaches, including surgery, physical therapy, and medication.

Some patients may feel nervous about their initial treatment with a chiropractic physician, particularly if they are not familiar with what happens during a session in a chiropractic office.  We will explain our procedures and provide care that is comfortable and effective. The majority of our patients feel very comfortable with and enjoy their treatment, and have excellent outcomes.

Despite our success, all therapies or medical procedures produce some mild and temporary side effects.  Following is a list of these side effects or types of temporary discomfort that may occur after manipulation:

  • Local discomfort at the site of treatment            53%
  • Fatigue                                                                                11%
  • Radiating discomfort into the leg or arm             10%

8. Should I be worried if my MRI or CT scan indicates I have a relatively large herniation?

While this may not make sense at first glance, a patient with a larger disc herniation does not necessarily have a worse prognosis than a patient with a small herniation. Studies with people, who have shown large sized herniations on their MRI, show better cure rates.  The point we want to make here is we cannot assume just because a disc herniation is large, that the person will have a better or worse prognosis that a patient with a smaller herniation.

9. What would happen if I decided to have surgery instead of conservative non-operative care?

Studies show there is no difference between the outcomes of patients who either had surgery or tried non-surgical treatment (chiropractic care) at 4 and 10 years following the time of the surgery or treatment.  This suggests patients will often feel the same after 4 or 10 years regardless if they had surgery or not.

Other studies show if you can handle the discomfort for 30 days, it is far more beneficial to try and complete the suggested trial of conservative chiropractic care because of the chance of resolution of the problem. We realize there are a small percentage of patients that will absolutely require surgery.  We have very good working relationships with both the orthopedic and neuro surgical community and will make every effort to ensure you get the best care.

10. What must I do to help the process of healing?

The following are excellent suggestions to help you recover:

  • First of all, trust your body’s ability to heal.Be as active as you possibly can, letting pain be your guide.  Movement is your friend.
  • Bed rest is only necessary if it is the only place you can get any relief.  Even with this situation, you will need to try to get up and do your exercises regularly, despite discomfort.
  • For low back problems, sleeping on your back with a pillow under your knees or on your side with a pillow between your knees generally result in the least discomfort.
  • For neck problems, a pillow under your neck that allows it to extend backwards is much better than a pillow that props up your head in bed.
  • Drink plenty of water and get reasonable rest, including adequate sleep.
  • Eat enough fiber (fruits and vegetables) to reduce constipation, which can increase back pain. If this continues to be problem, consult your physician for further suggestions.
  • Don’t sit for more than 30 minutes at a time. Get up and move around.  When seated, be sure to sit way back in your chair, while supporting your back by the seat back.  A small pillow between your low back and chair can minimize disc irritation.
  • Do your exercises every day.
  • Avoid heavy lifting for 4 to 6 weeks following your injury.
  • If your pain becomes so intense that you can’t sleep or function, we may recommend you see your MD for medication.

11. What specific exercises are safe and effective for my back or neck?

  • These exercises should be done on a regular basis during the early phase of your treatment:
  • While lying on your back, put your legs up on a chair or couch so your back and thighs are at 90 degrees. Simply relax, breathe and hold this posture for 5 to 10 minutes, once in the morning and then at the end of your day.  This helps stretch the connective tissue of the back and neutralize the pressure on the disc.
  • If you have a relatively strong upper body, stand in between two stable chairs (placed apart about the width of your body) placed back to back to each other.  Place your hands on the top of the back rest.  With arms kept straight, slowly bend your knees and let the weight of your legs and low back “sag” down as you feel a sense of traction on your low back. Hold this for 5 seconds and repeat several times, perhaps 3 to 4 times each day.
  • Lastly, lie head down for a minute or two on an incline board that has the top of the board securely elevated 2 feet off the floor.  Putting your arms over your head can increase the traction.  Inversion tables have become very affordable, so if you find lying on a slanted board helpful, you may consider purchasing one.
  • Lumbar “Decompression” Therapy: There has been a resurgence in using traction as a treatment of disc problems.  You may have seen infomercials for the “DRX-9000”.  Another similar unit is the “Lordex” unit.  For some people, this can be very helpful.  I have sent patients to my colleagues and the results have generally been good.  If your current care isn’t helping or you are considering surgery, try it.  You should notice improvement after 10 to 12 visits.  If you aren’t, it may not be for you.  I would be wary if the clinic wants to sign you up for extended visits since you can’t predict how you will respond.  Also be aware that this does not take place of an active homecare program.  You will still have to exercise.
  • For your neck, try these exercises:
  • While lying on your back without a pillow, gently direct your visual gaze downwards towards your navel. Be careful not to lift your head off the table or bed.  Hold for one second then relax your gaze. Repeat 10 times slowly.
  • When the first exercise is well tolerated, add the following motion. After fully completing the gaze towards your belly button, while making sure your chin stays tucked towards the table or bed, slightly lift the forehead towards the ceiling, making sure to lift only 2 to 3 inches.  Hold this posture for 1 to 2 seconds only.  Drop the head making sure the chin is held is a tucked posture the entire time.  Repeat this 3 to 10 times depending on how well you can do this exercise. This should be done 2 to 4 times a day.
  • Cervical Traction units.  These are devices that hang over your door and apply gentle traction to the joints in your neck.

12. Should I be take drugs or nutritional supplements?

Medications can be used for short term pain relief, but are not a solution to your back issues.

These are medications your MD may recommend:

Corticosteroids

If you have severe leg pain, we may recommend that your medical doctor consider a short course of corticosteroids.  This is a very powerful anti-inflammatory medicine and can reduce the swelling of the disc so you can begin to do your exercises more effectively. Steroid injections (often called E.S.I.’s) have been used to reduce swelling around the nerves and in some cases can be very helpful.  Unfortunately, recent studies show they do not have any long-term benefit.

NSAIDS (non steroidal anti inflammatories) along with analgesics (pain killers)

These may be recommended by your medical doctor to help in the initial phases to reduce the pain and swelling. Do not take large doses for over a week due the damaging effects they can have on your GI organs (stomach, liver, and kidney).  They should be taken on a short term basis.

Muscle relaxants

On a short term basis, muscle relaxants can decrease your symptoms enough so you can sleep/function.  They don’t show any benefit when taken long term.

Narcotics

These prescription drugs may be reserved for patients with severe pain and great care is taken to reduce the chance of addiction, constipation and sedation – all which are common side effects.

Healthier Options

Proteolytic Enzymes

During the acute phase of pain, (generally the first week or two) proteolytic enzymes may be helpful in reducing inflammation of the disc tissue.  Unlike the medications described above, you can purchase these enzymes in our office or at a health food store without a prescription.  Studies on proteolytic enzymes show them to reduce the healing time for disc herniations and show no reported secondary side effects.

Calcium/Magnesium Supplements

These lessen the muscle spasms and tension.

Vitamin B Supplements

These help with nerve irritation.

Sleep Aids

If your sleep is disrupted, consider sleep aids such as valerian root (300 to 500 milligrams of valerian 1 hour before bed).

Glucosamine Sulphate/ chondroitin

This product contains the constituent for the material that makes up the disc material. It is best to combine glucosamine with another supplement known as chondroitin or MSM.

However, if you are a diabetic or allergic to shellfish, chondroitin sulphate is safe for you to take. Some studies have shown the glucosamine to minimally raise glucose blood levels and because it is commonly derived from shells, those patients allergic to shellfish may choose to do a trial of chondroitin sulphate alone.

The therapeutic dose of glucosamine is 1500 milligrams per day and should be continued for 3 months. At the end of three months, when your condition stabilizes and your pain is well under control, you can reduce the dosage to 1000 milligrams per day.

13.  In Closing:

If you have a particular question that is not answered in this handout, please be sure to ask your chiropractic physician.  Knowledge is power and assists in the healing process.

Thank you for taking the time to read this information and allowing us to help you recover from this challenging condition.  We have great confidence we can provide you with care that will allow you an excellent chance of recovery.

A special thanks to Dr. Kelli and Dana Weary of Spokane for this article.