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Thread: Someone explain Physical Therapy. page

  1. #1
    astronmr20's Avatar
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    Someone explain Physical Therapy.

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    I know what it "is," but never done a PT routine with a doctor before.

    I have an extruded/ herniated disc at L5/S1. It's taken me down pretty hard-- been living with the condition for about 12 years. Yoga, chiropractic, medication, etc.

    My question is-- what is the actual mechanism by which it can potentially give me relief-- and how is it "beter" than what I was already doing? What "exercises" are focused on, and how, mechanically, does this take the herniated disc off my nerve root?

    I am primal but this has pretty much taken me out of any LHT (I was making nice progress)... so I'm walking and stretching when I can, but am in a "holding pattern" for treatment until I decide what to do next. My doc wants to try physical therapy before trying injections.

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    john_e_turner_ii's Avatar
    john_e_turner_ii is offline Senior Member
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    I work with doctors that review occupational injury cases and treatment. Physical therapy has its benefits. Evidenced based guidelines such as ODG, state that about 8-10 sessions over 4-8 weeks is about all that is beneficial. A good PT, will educate you in exercises and postural changes. There are some exercises that in theory can relieve the disc pressure on the spinal cord, but it will likely not be more than temporary.

    Have you had an MRI that confirms a herniated disc is impinging on the nerve root? Even so, pathology on MRI is rarely an indicator of the back pain generator. The spine is very tricky. Studies have confirmed that the majority of the working population have bulging and herniated discs with no symptoms at all. Then there are those with excruciating and debilitating back pain, but have no findings on imaging studies whatsoever. I found this out for myself last year when I hurt my back stretching of all things. I had terrible back and right leg pain to the point I could hardly walk for weeks. I finally went to an orthopedist, had a x-rays and and MRI, which were virtually normal. The main thing found was that I had a congenitally fused sacrum and L5 vertebrae, which means my back is not flexible like everyone else's. No more deep yoga stretches for me. Since then, my back pain resolved and my chiropractor's postural recommendations and changes to how I position myself when sleeping have made all the difference.

    Therefore, choose your physician wisely. Many doctors are quick to do the old school routine of 4-6 weeks of PT, a series of three epidural steroid injections, and when those fail they finally suggest surgery such as discectomy or foraminotomy. When these surgical procedures fail to relieve the pain, then the physician often suggests spinal fusion. This is no longer considered medically reasonable according to evidenced based criteria.

    If you are only having pain in your back, then continue your search for conservative treatment that does not include injections or surgery. However, if you are having radicular symptoms such as leg weakness, leg pain and/or leg paralysis, then you probably have a more serious issue that needs to be addressed.

    I have reviewed thousands of medical files dealing with failed back surgeries, and I personally know family members and friends who have suffered greatly after their spine surgeries. All of them agree that they were better off before surgery. Surgery should be your last option once the pain keeps your from being able to perform normal daily activities and work.

    As far as injections, I know of many people that have found relief afterwards, but it is normally short lived. Some have relief for only 4-6 weeks, and some for several months. It's an option, but does have risks since the injection is deep into the spine.

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    Adrianag's Avatar
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    Traction, massage, electrical stimulation and specific strengthening exercises can be very helpful.

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    astronmr20's Avatar
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    Quote Originally Posted by Adrianag View Post
    Traction, massage, electrical stimulation and specific strengthening exercises can be very helpful.
    Are these all considered part of a PT regimen?

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    astronmr20's Avatar
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    Quote Originally Posted by john_e_turner_ii View Post
    I work with doctors that review occupational injury cases and treatment. Physical therapy has its benefits. Evidenced based guidelines such as ODG, state that about 8-10 sessions over 4-8 weeks is about all that is beneficial. A good PT, will educate you in exercises and postural changes. There are some exercises that in theory can relieve the disc pressure on the spinal cord, but it will likely not be more than temporary.

    Have you had an MRI that confirms a herniated disc is impinging on the nerve root? Even so, pathology on MRI is rarely an indicator of the back pain generator. The spine is very tricky. Studies have confirmed that the majority of the working population have bulging and herniated discs with no symptoms at all. Then there are those with excruciating and debilitating back pain, but have no findings on imaging studies whatsoever. I found this out for myself last year when I hurt my back stretching of all things. I had terrible back and right leg pain to the point I could hardly walk for weeks. I finally went to an orthopedist, had a x-rays and and MRI, which were virtually normal. The main thing found was that I had a congenitally fused sacrum and L5 vertebrae, which means my back is not flexible like everyone else's. No more deep yoga stretches for me. Since then, my back pain resolved and my chiropractor's postural recommendations and changes to how I position myself when sleeping have made all the difference.

    Therefore, choose your physician wisely. Many doctors are quick to do the old school routine of 4-6 weeks of PT, a series of three epidural steroid injections, and when those fail they finally suggest surgery such as discectomy or foraminotomy. When these surgical procedures fail to relieve the pain, then the physician often suggests spinal fusion. This is no longer considered medically reasonable according to evidenced based criteria.

    If you are only having pain in your back, then continue your search for conservative treatment that does not include injections or surgery. However, if you are having radicular symptoms such as leg weakness, leg pain and/or leg paralysis, then you probably have a more serious issue that needs to be addressed.

    I have reviewed thousands of medical files dealing with failed back surgeries, and I personally know family members and friends who have suffered greatly after their spine surgeries. All of them agree that they were better off before surgery. Surgery should be your last option once the pain keeps your from being able to perform normal daily activities and work.

    As far as injections, I know of many people that have found relief afterwards, but it is normally short lived. Some have relief for only 4-6 weeks, and some for several months. It's an option, but does have risks since the injection is deep into the spine.
    Yes- MRI confirmed this. Just had one done on Monday.

    Pain is sciatica sometimes, local others. Occasionally I have a flare-up and can barely walk for a few days. My nerve root runs through my periformis muscle, so I'm constantly trying to stretch and work out tightness in the hips, but often, the pain is unavoidable.

    Had initial progress with a Chiro, but recently gotten back to where I started. He's referring me to PT before I go with injections/ Osteopath/ Neurologist.

    I'm not considering surgery at this point.

    Do you know how the PT works, essentially? For example, what muscles are conditioned and how this relates to the disc on the nerve root?

  6. #6
    Adrianag's Avatar
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    Quote Originally Posted by astronmr20 View Post
    Are these all considered part of a PT regimen?
    Most definitely.

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    Physical therapists are highly trained, licensed professionals who spend 2-3 years after college specializing in how the body works and how to fix when it malfunctions. They may use all of the above as well as heat and cold, ultrasound, water therapy, lifestyle modification and body mechanics training to help with a back injury.

    source: I'm an occupational therapy student (I'll be done with school next week!) and work with PTs every day.

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    Mike Gager's Avatar
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    only thing PT will do for your back is try to get the surrounding muscles stronger which will do little if any thing for the pain. no amount of muscle is going to keep the herniated disc from pressing on your sciatic nerve. i say skip the PT and get the shots. avoid the surgery at all cost unless you have a year or so to recover
    Primal Chaos
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    I'm big-time in favor of PT (I used to be in confined to a wheelchair and my first physical therapist got me walking again, so, yeah, you could say I'm a fan....) BUT, man, an extruded disc? I just don't see how PT is gonna patch that monster up.

    ETA: Something much less severe, like your garden-variety bulging disc, is totally fixable on one's own (I did it with a rebounder), but not something of this magnitude.
    Last edited by TigerLily; 11-12-2011 at 05:04 PM.
    "Let food be thy medicine and medicine be thy food." -- Hippocrates

  10. #10
    TigerLily's Avatar
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    I don't know if any of the things I am going to mention are appropriate for your situation. I've never had an extruded disc, and I wasn't researching for that. Here are a few modalities that I've personally done that I've found to be helpful. I would (and have, actually) pursue every avenue before I finally succumbed to surgery. Don't think that surgery for sure will fix everything; it often creates new problems. Keep in mind that if you go to a surgeon, of course his/her solution is going to be, uh... surgery.

    It's up to YOU to read until your eyes bleed and find something that will work for you. You've got to take matters into your own hands. Nobody is going to give a shit more about getting your back healthy and strong again than YOU.

    Some amazing treatment modalities I've discovered on my own that most of my PTs (I've had 4 now and still go 2x week 3-1/2 years after my accident) didn't even know about:
    Egoscue
    McKenzie Method -- particularly well known for relieving all sorts of back pain quickly
    Foundation

    Again, I don't know if they are even close to effective for what ails you specifically, but it's a head start in the right direction.

    All my best,
    Ginger
    "Let food be thy medicine and medicine be thy food." -- Hippocrates

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