- Degenerative Discs (AKA: Degenerative Disc Disease or DDD)
- Herniated Discs
- Spinal Stenosis
- Facet Arthropathy
- Facet Syndrome
- Numbness/Tingling/Pain in the arms or legs
- Neck or low back pain
- Patients with Failed Back Surgery
Degenerative Discs (AKA: Degenerative Disc Disease or DDD)
Often, degenerative disc disease can be successfully treated without surgery. One or a combination of treatments such as physical therapy, anti-inflammatory medications such as non steroidal anti-inflammatory drugs, traction, or epidural steroid injection often provide adequate relief of troubling symptoms.
A combination of the following conservative treatment options can be used through at least the first six weeks of discomfort and pain: Physical therapy, exercise and gentle stretching to help relieve pressure on the nerve root. Ice and heat therapy for pain relief. Manipulation (such as chiropractic manipulation)
PT usually combines inactive therapy and therapeutic exercise. Inactive therapy includes heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments help to ready the patient for active therapy by relaxing tight muscles and easing pain or discomfort. Therapeutic exercise includes stretching and prescribed exercises to help stabilize the spine, build strength and endurance, and increase flexibility.
Depending on their philosophy, physicians will either recommend surgical or non-surgical treatments for sciatica pain. While surgery may be the only option in severe cases that do not respond to other types of therapy, it is always smart to try non-invasive methods first, to try and prevent potential complications that can arise from spinal surgery.
Rest and Relaxation. Sometimes, the best method for alleviating sciatica pain is to simply rest for at least a few days. Physicians often recommend that over-the-counter medications, such as Ibuprofen, be combined with bed rest. However, in more severe cases prescription muscle relaxant drugs may be recommended.
Physical Therapy. It is not always necessary to work one-one-one with an actual physical therapist to help alleviate sciatica pain. Physical therapy can be as simple as stretching, taking short walks, and being as active as possible when the pain is not too much to bear.
Heat and Ice. Hot and cold packs are often recommended to help reduce swelling and to provide relief from nerve pain. Ice is used to numb the areas that are experiencing pain, and heat is used to help speed the recovery process by causing increased blood circulation in the affected area.
There are a number of nonsurgical treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:
Successful long-term treatment involves proper exercises, with instruction by a trained physical therapist or other healthcare provider.
See Physical Therapy Benefits For Back Pain
Good posture (maintaining a normal curvature of the spine such as pulling the car seat quite forward or when standing at a sink, putting one foot up on a ledge, bending that knee a bit), support to the low back when seated or riding in a car (particularly in the acute phase).
A very useful posture when standing or sitting is the pelvic tilt, where one pinches together the buttocks and rotates forward the lower pelvis, and holding that position for several seconds, done several times per day.
See Posture to Straighten Your Back
Heat (e.g. heat wraps, a hot water bottle, hot showers) or cold (e.g. cold pad applications) may help alleviate painful episodes.
Changes in daily activities (e.g. shortening or eliminating a long daily commute), and adding frequent rest breaks
The use of anti-inflammatory medication, such as various non-steroidal anti-inflammatories, called NSAIDs (e.g. ibuprofen) and the more recent COX-2 inhibitors (e.g. Celebrex)
Most conservative treatments for facet syndrome involve postural correction, soft tissue massage and manipulation of the affected areas. Physical therapists, osteopathic clinicians and chiropractors are adept at restoring restricted and painful facet joints to move and can reestablish normal motion. Treatments are usually combined with a course of anti-inflammatory medications to decrease inflammation. Muscle relaxers may be used to decrease local muscle spasms.
Numbness/Tingling/Pain in the arms or legs
Tingling hands, feet, or both is an extremely common and bothersome symptom. Such tingling can sometimes be benign and temporary. For example, it could result from pressure on nerves when your arm is crooked under your head as you fall asleep. Or it could be from pressure on nerves when you cross your legs too long. In either case, the “pins and needles” effect—which is usually painless—is soon relieved by removing the pressure that caused it.
In many cases, however, tingling in the hands, feet, or both can be severe, episodic, or chronic. It also can accompany other symptoms. such as pain, itching, numbness, and muscle wasting. In such cases, tingling may be a sign of nerve damage, which can result from causes as varied as traumatic injuries or repetitive stress injuries, bacterial or viral infections, toxic exposures, and systemic diseases such as diabetes.
Such nerve damage is known as peripheral neuropathy because it affects nerves distant from the brain and spinal cord, often in the hands and feet. There are more than 100 different types of peripheral neuropathy. Over time, peripheral neuropathy can worsen, resulting in decreased mobility and even disability. More than 20 million Americans, most of them older adults, are estimated to have peripheral neuropathy.
Neck or low back pain
Many studies have concluded that manual therapies commonly used by chiropractors are generally effective for the treatment of lower back pain1-2, as well as for treatment of lumbar herniated disc for radiculopathy3-4 and neck pain, among other conditions.
In fact, when patients with non-specific chronic low back pain are treated by chiropractors, the long-term outcome is enhanced by obtaining maintenance spinal manipulation after the initial intensive manipulative therapy.
The core of chiropractic usually involves treatment of common lower back pain conditions through manual therapy:
Spinal manipulation and manual manipulation.7 This type of manual manipulation refers to a high-velocity, short lever arm thrust that is applied to abnormal vertebra with the goal of improving functionality, reducing nerve irritability and restoring range of motion in the back. It is also commonly known as “chiropractic adjustment”.
There is firm literature support for chiropractic treatment of lower back pain. Many of the published guidelines recommend chiropractic manipulation to be included in the treatment plan early in the care of lower back pain.
Mobilization.7 Chiropractic mobilization refers to low velocity manipulation, movement and stretching of the muscles and joints, with the goal of increasing the range of motion within those areas.
Patients with Failed Back Surgery
Failed back surgery syndrome is a term that is used to describe pain that starts or persists after spine surgery. The important thing to remember is that spine, in itself, serves a certain purpose; it solves a number of problems, but, as with any other tool, it has its own limitations. So, sequelae of the surgery can cause pain, but also at the same time, surgery cannot address all the pain generators. So in looking at it like this, we can actually turn our attention away from the aspect of the surgery and now refocus on the patient and look at the pain generators in that patient in the context of their life and in the context of their overall function. By looking at it like that, we can actually start treating the pain generators and really get to the source of the majority of the pain that’s generated after the surgery.
So what we need to look at is the physiologic changes after the surgery. Those are:
Depending on the surgery, the mechanics of the spine will change. Now, if it’s fusion surgery, then what happens is that two segments, for instance, that are being fused are no longer moving on their own. They are now moving in unison, which in effect creates a single segment. Because that single segment is no longer taking up the work of two segments, separately, it is now functioning as a single segment, which means - and this is for simplicity sake - we can say five segments doing 100% of work and that’s 20% per segment, now we eliminate two or three segments, per se, and now 33% falls on each segment. Now you can imagine that with additional force going through that segment, there’s going to be motion, more wear-and-tear, and more potential pain caused by that segment. And that’s usually referred to as “adjacent segment disease.” And that’s one of the post-surgical effects.
Another effect is the actual tissue damage that can happen after surgery. So, myofascial pains can happen after a separation of tissue. When that tissue comes back together, the connective tissue may cause fibrosis - and that can trap nerves - or in itself become tight and painful. That can be treated in a separate way.
Going back into the increased motion at separate segments, we have to remember that the motion actually happens across facet joints. Those joints are hinge-like joints - they are small joints - and those joints are just like any other joint in our body, which means it can get inflamed just like any other joint and that usually happens through overuse. Treating those joints usually resolves the pain that is associated with those joints and in that way, we can restore the function that was lost through the inflammation and alleviate the pain.
There are many other pain generators that need to be looked at and can certainly be treated with appropriate diagnosis and treatment.
Treatment of pain persisting after surgery should be approached in a systematic way. Diagnosing each pain generator and eliminating the pain generators can serve to restore function and eliminate pain and in order to do that, we can employ a number of different tools that are available to us. And those include a wide array of the tools. Now it can be manipulations, it could be physical therapy, at times injections, or at times if we need to things like spinal cord stimulation or implantable pumps that can supply a steady state of medication can be used to control the pain. By using all the tools that are available to us, we can really improve the patient’s quality of life by doing two very important things: decreasing the pain and restoring function. That way, they can reintegrate back into life and not be limited by pain or by mobility.