Understanding a Bulging Disc
Hey guys, Dr. Lell here explaining another common condition in an easy to understand way. Last week, I blogged about disc herniations and today I want to explain something very closely related and in times, a precursor. I’m talking about the bulging disc. My patients recognize this as a “squishy disc”…you won’t find that term in any textbook.
Think of bulging discs as a ticking time bomb that may never go off and having one doesn’t always mean you’ll feel pain. It’s an often overlooked but very common cause of “nonspecific” low back pain. Unlike the herniated or blown disc, the bulging disc isn’t necessarily caused by any one event. It spans all ages (though it’s less common in older people) and activity levels.
What is it?
Take a look at the picture below. For a more detailed review of the anatomy, please read this. To review, the disc is a jelly-like center wrapped by a thick outer covering. As pressure in the disc increases (while sitting, straining, lifting, etc.) the jelly presses up and pushes against the outer covering (top left picture). If that outer covering is weak (from repetitive strain, smoking, or moving improperly just to name a few) it can give a little and start to protrude (top right). This alone can be painful and can cause pain in the low back that may radiate into the butt. It may cause the muscles in the low back, butt, and hamstrings to lock up as a protective mechanism and may put slight pressure on a nerve. The bottom pictures are representative of a disc herniation, which the bulge could turn into.
How do I know if I have this?
Symptoms may include the following…
- It may or may not be painful. It’s typically low back tightness with or without pain into the butt.
- The “pain” is worse in the morning or with getting in/out of a car or bed or up from a chair
- Chronically tight hamstrings
- Inability to touch your toes
- A leg that doesn’t seem to be as strong or “able” as the other
How is it treated?
This is largely a functional condition. The best treatment, especially if it isn’t painful, is education about how to move your body and exercises that can be done at home to strengthen the area and prevent further “squishiness” or a potential herniation. The way that you move, lift, and bend is what caused this and it can be the way that you fix it. The degree of treatment really relies on the degree of severity and the other associated risk factors. For example, someone that handles luggage for an airline may need more rehab exercises than someone who walks dogs. Someone with occasional back tightness will need less than someone with an occasionally numb foot. I typically start by reducing the pain and symptoms (if there are any) and then setting up a great home based program for people to maintain and work on preventing future episodes.
Understanding Herniated Discs
Hey guys, Dr. Lell here explaining another common condition in an easy-to-understand way along with a review of current treatment options – the herniated lumbar disc.
Ever hear about someone’s slipped disc? Or about how they threw their back out? Uncle Stan’s bulging disc? Fortunately, none of these things sound as bad as a full blown disc herniation. There are a lot of names out there to describe the different injuries to and pains caused by the discs between the bones in your spine. Today we’re going to talk about herniated discs. What it feels like to have them, what causes them to happen, and what you can do about them. As a Chiropractor, I can type volumes about this one subject. But I’ll keep it condensed and easy to digest. I’ve separated out a closely related condition that often precedes this into another blog, the bulging disc. I strongly recommend you read that as well to gain a more comprehensive understanding.
Who gets a herniated disc?
Usually people between the age of 25-45 but especially between 35-45 years. It used to be predominantly men but as more women enter jobs requiring heavy lifting, those statistics are starting to even off.
What does it feel like?
The symptoms can greatly depend on severity. They include…
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- Low back pain
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- Pain, tingling, burning, or numbness into the butt, groin, or leg
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- Weakness of the legs or feet
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- Changes in your bathroom habits
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- Sexual dysfunction
The pain is usually made worse with…
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- Bending
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- Sitting
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- Lifting
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- Getting in and out of a car, a chair, or bed
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- The pain is usually worse in the morning
What causes it?
The herniation is usually caused by a singular event like lifting something heavy or taking a fall. But this event is usually the last thing in an accumulation of factors. It’s the last straw that broke the piano mover’s back. People can be pre-disposed to these injuries making them more likely than someone else to get it. These predispositions can include a weakened annulus (more on this later), a degenerative spine, being overweight, and smoking cigarettes just to name a few. There are even weird ones like working a night job or being depressed. Some people are even finding a genetic link.
Disc Anatomy
To understand the ins and outs of what’s really going on, we need to cover some of the anatomy and how they interact with one another.
Take a look at this image from Rochester Medical Center. The disc is composed of two parts: the annulus and the nucleus. The nucleus is a thick jelly like material and it is surrounded by a thick outer covering (think of a tire or a wicker basket), the annulus. Around the disc are the nerve roots that help you walk, feel, and pee and the spinal cord is in the middle.
The jelly like nucleus moves and changes in reaction to what you’re doing with your body. It is supposed to cushion your lumbar vertebra throughout its range of motion and act like a shock absorber. If you bend forward, the nucleus gets pushed towards the back. If you bend backwards, it goes towards the front. Same idea with bending side to side. The flaw in our design is that the thick outer covering is weakest in the back (near the spinal cord) and off to the side (on top of the nerves).
Through abnormal wear and tear (and not helped by those dispositions), the thick annulus starts to break down – especially in those weak spots. Think about taking a rubber band and rubbing it across a sharp corner. Eventually, the band will start to fray and snap – it’s kind of the same thing.
So – the moment of injury. Traditionally, the injury occurs with bending over and/or lifting something. This builds up enough pressure in the disc to shoot the jelly like nucleus through the weakened outer covering (the annulus). Sometimes the nucleus hits up against a nerve or the spinal cord causing neurological involvement. This usually happens in the lumbar spine but can occur in the neck and mid-back too.
The broken annulus is painful. The nucleus is where it shouldn’t be (outside of the annulus) so the body treats it like an invader and sets up a local inflammatory response (this is also painful). The muscles in the low back and surrounding area sieze up and lock as a protective mechanism. And if the nerves are being pushed on, you may get radiation into the legs or some weakness.
I’ve got a herniated disc – what do I do about it?
Herniated discs are generally self limiting despite being painful. Waiting it out and hoping you don’t make it worse is an excruciating option but 75% of all herniated discs spontaneously resorb within six months and the larger they are, the faster they disappear. Now in some cases, emergent care is very necessary so it’s important to monitor the situation. Increasing muscle weakness, change in bowel or bladder, or tingling/pain in the upper inner thighs and pubic region call for a trip to the emergency room.
They can be debilitating so most people choose to get treatment. Treatment not only helps with the pain but also drastically cuts the healing time. The options are the traditional medical route, surgery, or conservative care like chiropractic medicine or physical therapy. The risks of each must be weighed against your specific situation and what you’re hoping to gain. Prescription painkillers and muscle relaxers will help with the pain but they won’t do anything for the underlying problems causing the pain and may even allow you to cause further damage by dampening your body’s warning system (that’s what pain is – just an alarm that something is going wrong). New surgical procedures today are an okay option because they’ve gotten less invasive but I’m inclined to try anything before going under the knife. A study was done comparing the effects of surgery vs chiropractic care. People who underwent either chiropractic care or surgery have the same pain levels months after treatment has ended. The surgery group got there faster but the group receiving chiropractic care maintained the gains for longer.
Once you’ve herniated a disc, you’re more likely to do it again. So post care rehab and education is very important.
I’ve got a herniated disk – what are you going to do about it?
My approach to this is three-fold. First, I tackle the pain and inflammation. Rehab begins day one so that I can show you exercises and stretches to relieve the pain and prevent further damage. After the pain is under control, we’ll work together on reducing the herniation and teaching the muscles to relax in order to restore normal motion. After that, I focus on teaching preventative measures to keep this from happening in the future.
In short, lumbar disc herniations can be a debilitating and painful injury to the low back. There are many options out there for treatment, but this condition responds very well to conservative care. This post has gotten pretty long so in future posts, I’ll talk about my favorite stretches and exercises to relieve pain caused by a lumbar disc herniation.
Getting the Most from Your Chiropractor
When you think of a chiropractor, you typically think two things: low back pain and adjustments. And although that’s not wrong – it is certainly understated. This all depends on each state where the scope of practice can change, but doctors here in Oregon can practice as primary care physicians and even incorporate proctology, gynecology, obstetrics, and minor surgery into their practice. Many chiropractors regularly order up the same blood-work, lab work, and imaging that you’d go to your MD for.
But regardless of what state you’re in – you should think of Chiropractors not just as the “back doctor” but as the best resource in your community for health and wellness.
How healthy you are depends on three things:
- How you move
- How you eat
- How you think
Chiropractors have two thirds of those covered as we are THE authority figures in healthcare regarding proper movement and nutrition.
How You Move
Yes chiropractors are the best when it comes to low back pain, neck pain, and headaches. But we’re also better than most at hips, shoulders, wrists, elbows, and even jaws. We look at the human body as an entire moving piece and can appreciate how your tight hip muscles can limit motion in your shoulder causing pain in the elbow.
How You Eat
Chiropractors spend the most time out of any other physician type learning about nutrition in school. We’re second only to nutritionists and dieticians. Many common and run-of-the-mill problems you may your medical PCP for can be addressed with neutraceuticals (higher than “normal” doses of quality micronutrients). Today, most of the health problems killing people in this country are lifestyle related and are directly influenced by a person’s diet. The obesity epidemic has become a pandemic and the associated diseases are terrible and hurting people at younger and younger ages. Taking a prescription to “manage” a condition caused by poor diet makes no sense if you aren’t addressing the root cause. In the future, as predicted in the far past, food and diet will be the best medicine.
If you’re going to a chiropractor for typical aches and pains but have other health issues or questions, go ahead and ask what he or she can do for you! Even if your chiropractor doesn’t practice that way – he may be able to point you to someone that can. The best solution to any health problem is prevention – that’s the maintanence of your health and wellness. And no one on the block is better suited to help you do that than your chiropractor.
Why You Should Take Supplements
Hello, all. Dr. Lell here. Today a family came in for general wellness support so during the intake, I asked them about their typical diet and what kind of supplements they take. They eat the Standard American Diet (SAD) of processed meats, grains, simple sugars, and fast food. That’s pretty typical. But then they said they don’t take any vitamins because they eat a balanced diet. They figure they should get all they need from the food they eat. Makes sense, right? Well guys I’m sorry to say that it’s not that simple anymore. So today I’m going to explain why most people would benefit from a taking some sort of supplements. (if your first thought is “supplements don’t work” then I suggest you read this post)
First a technical point. The word vitamin gets thrown around interchangeably for anything that you take that isn’t considered “medicine” but it’s actually a specific organic compound. Supplements are the better term. You’re supplementing your diet with vitamins, minerals, herbs, and other micronutrients. Okay. That’s enough of the technical jargon.
First, what do these micronutrients (and vitamins specifically) do for our bodies? Everything that you allows you wake up, walk, think, bleed, and live your life is largely governed by complex biochemical pathways in your body. These micronutrients serve as the cogs and gears for those mechanisms. Without them, or without enough of them, your body is running inefficiently making you less able to adapt to life’s physical, emotional, and chemical stresses. Think about it like driving a car that hasn’t had the engine serviced in a few years. Yeah it may still run but nearly as well as it could.
So you think you get all the nutrients you need from what you eat? –WRONG!
A carrot grown today doesn’t have the same nutritional value as a carrot grown 30 years ago. It’s due to what’s called “soil depletion” and also how we’re engineering food. Modern agricultural practices leave fewer and fewer nutrients in the soil which means fewer and fewer go into the food that comes from that soil. On top of that, we’re engineering food plants to grow bigger, faster, with less water, and more hardier. But less attention has been paid to increasing how efficiently that plant uptakes and stores nutrients. In 2004, the University of Texas released a landmark study where they compared nutritional values of 43 different fruits & vegetables grown in 1950 and in 1999. What they found is that all the vegetables showed a “reliable decline” in several nutrients, especially protein, calcium, phosphorus, iron, riboflavin, and vitamin C.
Graphic courtesy of myhealthystyleblog
Where did that carrot come from? Across the country? The minute you pull a plant from the ground, the nutritional content starts to deplete. Within three days of picking, a vegetable will lose about 30% of its nutritional value. How much time passess between farm to table if you buy your produce at a typical grocery store?
Then there’s the cooking and processing which further lessens the nutrients. Some medications even keep the body from using and processing those of those nutrients correctly.
So what’s bottom line? The food we typically eat isn’t nearly as healthful as you think it is and whether or not you can actually take notice, your body is paying the price. This is why most americans can greatly benefit from regular supplementation of quality micronutrients. Don’t believe me? Get a quality multi (GNC makes a good one) and take them as directed for 1 month. You’ll be amazed at how much better you feel.
Garbage Supplements Don’t Work
Of the many controversial topics in in health care, the benefits of over the counter supplements has been hitting the news lately. GNC, Walmart, Walgreens, and Target are being investigated for selling supplements that didn’t contain nearly (if any) of the product advertised on the bottle. So the $17.85 bottle of St. John’s Wort that you got for your minor depression is mostly just filler.
But this is just a recent story in a arduous history of headlines. Consumer groups will come out with reports like this, but then healthcare advocate groups and industry leaders will support the opposite. This scientist says this vitamin causes prostate cancer and then the other scientist says that’s because the synthetic was used and tested and not the natural. This is just on the popular media side of things. Then when you dig a little deeper into the rabbit hole, you’ll learn that there are many forms of the same vitamin some of which work better and others that don’t. Some need to be taken with food, others with milk, never with coffee, before bed, yadda yadda. It’s just confusing. I can’t tell you how many times I’ve had a patient tell me that they feel like they’d benefit from supplements, but they don’t take them because they don’t know how to choose a good one.
Why does all of this confusion exist? Vitamins have been around forever, shouldn’t there be a consensus by now? There are a few things that add to the ongoing controversy of supplements and vitamins that if you can understand, you’ll be able to appreciate the finer points of these ongoing debates.
Supplements are an under-regulated industry
There are TONS of supplement companies out there. Some are amazing. Others are garbage. No one is really watching how closely these companies adhere to consumer protection standards and the bad-ones are usually weeded out after the fact. Many supplement companies submit themselves to rigorous third party reviews, tests, and trials but independent universities and labs to prove their claims. Look for special seals on supplement bottles. Some great brands that I always trust are Integrative Therapeutics, Standard Process, and Enzymatic Therapy.
Supplements and Nutrition Therapy is an under-funded area of research.
Good solid clinical trials and tests cost a lot of money and the funding is hard to come by. Good studies on nutrition usually come from Europe, where the pharmaceutical industry doesn’t hold such a monopoly on available funds. There are some very good trials out but none that I know of come close to the magnitude of prescription drug trials.
Not all vitamin E is the same.
There’s much diversity even among a single micronutrient. Is it natural or synthetic? Which molecular form is it? Is it whole or standardized? All of these things matter. They affect the cost of production and the clinical effectiveness. You can’t take a single supplement, vitamin E for example, ignore its qualities, run a test, and apply the results to every vitamin E. The results are only true to that one form.
The bottom line is that good quality supplements are clinically effective and useful, especially as a natural alternative to prescription drugs. But just like everything else, there’s quality and there’s crap. Don’t let the poor examples speak for the bunch.
In future posts, I’ll explain some general rules for selecting a supplements and multivitamin and I’ll talk about why the most american’s can benefit their health with regular supplementation of micronutrients.
Listen Up! Your Body is Speaking
I was sitting at a Portland coffee shop this morning going over my news feed and I came across an article explaining that we’ve created a robot that passed the self-awareness test. Without a doubt it’s an impressive achievement but the article inadvertently struck a note of fear and impending doom within me. Scenes from I-Robot started playing in my head. But then the barista brought me my latte and I started feeling more optimistic.
Then I thought to myself, I wish those programmers could do something like that for people. It’s been my experience that the majority of people simply aren’t aware of the most important thing of their lives – their health. Knowing what’s going on isn’t difficult, it’s just a matter of listening to what your body is trying to say and knowing how to interpret it.
Here’s something I come across every day. Just because something is usual doesn’t make it normal. I had a patient who had minor headaches every day for two years. She didn’t think much of them (she came to see me for knee pain) and they were never too severe so she decided to just live with them – they were her normal. A headache every day for two years?!? Come on. A headache is a sign that somewhere in your body – something is going wrong – and your mind doesn’t know how to interpret it. If her car made a funny noise every day for two years, you can bet she would have gone into the mechanic. But why didn’t she bring herself into the doctor? -Because she was unaware that her body was trying to tell her something.
The body’s signaling systems range from soft to loud and usually pain is the signal that gets the most attention. But the body has other ways of communicating. Have an insatiable sweet tooth or can’t stop craving dirt? -Maybe you’ve got a mineral insufficiency. Did you just eat dinner but you’re still hungry? -Try a glass of water. The list goes on and on. I know it isn’t normal for most people to be able to decipher and differentiate these messages; that’s why doctors exists. To take it back to the car analogy, I don’t know what the noise coming from my engine means but I know it’s not normal and I know I should get it checked out. It’s the same thing with our bodies. The ability to discern normal from abnormal is a HUGE first step to preventing problems down the road that are impossible to ignore. How many diabetics would have benefited earlier in their lives from a knowing what sugar addiction feels like?
The body does such a good job at telling the story that when I take a patient’s chief complaint history, I just keep quiet and let the patient explain things in their own words after prompting them with a few questions that force them to look within and pay attention. You’d be amazed at what you’ll learn, especially from your body, if you just quiet your surrounding and be self-aware.