AVB
Jesus of Cool, I'm bad, I'm nationwide
A fifth of Wild Turkey will cure anything.
At least temporarily.
At least temporarily.
I am a chiropractor and treat these injuries daily. In the acute phase do not use heat. Heat will dilate the blood vessels sometimes to the point where they will leak fluid into the tissue which will then likely compress the blood vessel allowing for no blood flow/exchange at the site of injury. You are always safe at home using cold. The thing to understand about disc herniations as compared to a disc bulges is that herniations are permanent injuries. The nucleus pulposes of the disc (the center gelatinous portion) has actually started to force or herniate its way through the outer annular layers causing the outer periphery of the disc to protrude outward. This will cause either foraminal or spinal stenosis so most likely a nerve root or the spinal cord/thecal sac will be impinged upon. Every nerve root from the lower extremity originates at the low back so any derivative or numbness, tingling, weakness, or pain in the legs can be expected in severe cases. Although the etiology or these symptoms can be somewhat different they are usually lumped into a general category called sciatica.
Depending on your therapy of choice, the outer periphery of the disc that is protruding may be reduced...but the internal portion of the disc that is internally deranged will always be that way. Think of a dry creek or stream. When it rains the immediate path that water takes is just like they way it was previously. You now have a disc that will never function again like a normal disc in its ability to absorb shock or provide a central pivot for the motor unit to move and will result to consistent abnormal mechanical behavior. The plus side to this is that spinal foramina (the holes on each side of the spine where the nerves come out) are classified as functional spaces. Meaning that half of that hole is made from the bone above and half is made from the bone below. The more ranges of motion that the motor unit ( vertebra/disc/vertebra) has intact, the bigger the foramina will stay. The bigger the foramina stays, the less likely the disc and the nerve root will interact which means less pain and problems for you. Depending on the level of severity, a regimen of manipulative treatment from a chiropractor may be beneficial for you because it will instill/maintain those ranges of motion at that affected level . An active regimen of physical therapy may also help. There will be no other treatments besides something like disc decompression that will address your injury functionally from a mechanical standpoint. Another equally powerful benefit of manipulation in trauma through the acute phase is the prevention of fibrosis or scar tissue formation as a normal sequele to inflammation. Scar tissue can form around the spinal facet joints as well as in the foramina itself and tether the exiting nerve root causing serious long term problems and neurologic defecit. Some of the more chronic cases I have with these issues need to be treated under sedation with a procedure called MUA (manipulation under anesthesia) to remove and break up that scar tissue.
Traditional allopathic practitioners will use a regimen or anti inflam meds. If those do not work they should send you for a consult with an interventional pain specialist for possible epidural steroid injections. Usually done under general anesthesia for the lumbar spine and usually ordered in a series of three injections. If those do not work they may order one more round of injections or refer for a test known as a discogram. Only after a positive discogram should anyone even mention the word surgery to you.
In the three offices that we have, all of these practitioners exist. Chiropractor, Medical Doctor, Pain Management, Physiatrist, & Physical Therapist. Every case is different and every case responds to its own set of therapies. In my career so far I have never seen a case that has gone to surgery that had favorable results. In fact the surgeon usually refers them to me for something called "failed post surgery syndrome" which again usually requires a MUA. If you have any other questions shoot me a PM I will gladly give you my direct line if you want to talk more in depth. Hope this helps and best of luck!
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