By: Jean Johnson for Back1Physician Heidi Prather, DO – associate professor of physical medicine in the department of orthopaedic surgery at Washington University in St. Louis, physiatrist, and spokesperson for the North American Spine Society (NASS) – acknowledges that 80 to 90 percent of patients with a new or recent acute disc herniation will improve without surgery.
| Take Action |
The North American Spine Society suggests the following diet, lifestyle, stretching, and flexibility tips:
Overall fitness will contribute to the health of your spine.
Weight control is important for a healthy back. “Additional weight, especially in the stomach, shifts your center of gravity forward and puts additional strain on your back muscles.”
The NASS recommends keeping weight within 10 pounds of your ideal.
Avoid extreme diet changes. Frequent fluctuations in weight can cause loss of muscle and bone density along with fat. “Lost fat and muscle can come back, but bone could be gone forever and put you at greater risk for osteoporosis, which can affect your spine.”
Avoid smoking. “Nicotine restricts the blood flow to the discs that cushion the spine and increases the rate of degenerative change.”
Try the doorway-chest stretch. Place your arms on the door frame and with the back straight, step through to feel the stretch in the chest area.
Do slow circular shoulder rolls in each direction. “Begin with little circles and progress to large circles. Do this several times a day to relieve tension. These are good if you spend a lot of time at a computer.”
Backward bending is another stretch that “is especially good if you’ve been sitting at a desk.” Standing, place the hands on the hips and arch gently letting the head drop back. |
As a doctor of osteopathic medicine (DO), Prather’s medical school training placed special emphasis on the body’s musculoskeletal system, preventive medicine, and holistic patient care. Once armed with her DO, a degree that carries the same privileges and responsibilities as an MD, Prather developed her interest in physical medicine and rehabilitation through four additional years of postdoctoral residency training, earning a specialization as physiatrist (fizz-e-AT-trist). Physiatry is a relatively small but increasingly in-demand specialty focused on physical medicine and rehabilitation. Practitioners are board certified and trained to treat acute and chronic pain and musculoskeletal disorders. Prather works with performing artists in the symphony and dance departments at Washington University where she is also on the faculty at the medical school.
“We do preventive seminars for musculoskeletal problems,” she said. “I also treat members of the symphony, particularly the cellists and violinists who tend to cave inward when they play. These problems are similar to the ones people who are at the computer a lot can encounter.”
Herniated Disc 101
The spine, spinal cord, and associated nerve structures are nothing short of miraculous. There are 31 independent vertebrae, their bony surfaces padded by discs, and the spinal cord runs through the middle. Nerves branch out like tributaries in reverse to enervate the limbs, trunk, and head.
The discs between the vertebrae function as strong connective tissue that holds the bones of the spine in place even as they provide cushioning. Each disc is composed of two parts – an inner gel-like center and an outer, tough protective layer.
Age can cause this inner gel-like center to lose water content and thus, lose cushioning power and the ability to stay securely in one place. As a result, discs can enter into the space occupied by the nerves and spinal cord. This effect is termed a herniated or ruptured disc.
The NASS explains that “most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist.” Sciatica, or pain, numbness, tingling or weakness in the leg can result from herniated discs in the lower back. Similarly, herniated discs in the cervical or neck region that press on nerves can cause problems in the shoulders or arms.
Diagnosis of Herniated Discs and Musculoskeletal Pain
Many patients with a herniated cervical disc improve without any treatment, according to the NASS. Other nonsurgical, conservative approaches include “short period rest (one to two days), a neck collar, anti-inflammatory medications to reduce the swelling, analgesic drugs for the pain, physical therapy, exercise, or epidural steroid injection therapy [if a patient has severe arm pain].”
As Prather observes, pain or tingling in the arms does not necessarily indicate a herniated disc in the spine. “Sometimes it’s the nerves in the arms themselves that are causing the problem. So that’s what physiatrists do – diagnosis to see if people can avoid surgery.
“People are going more and more towards minimally invasive procedures. The idea is that if we can do less, it will probably be better for folks.
“Also there are more collaborative groups,” she added. “The older model was one in which the surgeons were in one place and those like myself were elsewhere, so there wasn’t a lot of communication.
“But now in spine care, it’s becoming in vogue to have multi-disciplinary centers with physicians in a range of specialties like pain, musculoskeletal problems, surgery, and anesthesiology working together. So what we have is health care providers talking to one another and trying to provide more holistic care for patients.”
As far as herniated lumbar discs go, the process is much the same as for those in the neck area. Leg pain, tingling, numbness, or weakness resulting from herniated lumbar discs, though, has been so common in people between the ages of 30 and 50, that it even has a name: sciatica. Indeed, the NASS states that “most disc herniations occur in the bottom two discs of the lumbar spine, at and just below the waist.”
Non-Surgical Treatment of Herniated Discs and Musculoskeletal Problems
The first question Back1 had for Prather was how long to suffer with aches and pains before professional assessment. “My rule of thumb is if you are starting to limit your activity, that’s a good time to go,” she said. “Or if the problem hangs around for three to four weeks without starting to resolve. In short, any time a person has numbness, tingling, or weakness that progresses, it’s definitely time to get it checked out.”
Our second question was, what happens when we go in? How does a physiatrist figure out just what’s happening?
“In general we talk about the things patients do repetitively during the day. For example, if a person sits in front of a computer, the spine will bend forward and that puts extra strain on the neck. If people do that repetitively, it can cause pain,” Prather said. “In general, anything that’s nerve related is what we can take care of – that includes pain in the neck, shoulder, back or legs.”
As far as recommendations for computer users, Prather said to “make sure you have good posture. You can also work on good flexibility in the upper thorax wall. Also, what’s really important is to work on the muscles between the shoulder blades and to change positions throughout the day, avoiding sitting at the computer for two hours in a row, for example, without moving.”
Issues related to the arms and torso are quite common today since they can arise from driving as well, said Prather. She underscores that when at the gym, as well as frequently throughout the day, people should stretch to keep the carriage erect and balanced.
Prather observes that it’s just the nature of things in an increasingly sedentary culture. And as for the people in the symphony that she works with, she said, “with these folks we have to adjust for the different instruments. With violinists, for example, the type of chair they sit in is very important. We also work on their neck posture and figure out the nuances associated with that.”
So, what is Prather’s bottom line? What does a physiatrist with 12 years of practice behind her have to say about the longer term consequences of herniated discs and musculoskeletal pain?
“The North American Spine Society and the field of physiatry is trying to educate people with the message that: you don’t have to live with chronic pain and that usually there is an intervention that is not surgical,” said Prather.
“Along with that, I’d like patients to appreciate that many times it’s a matter of finding the right physician. It’s like locating a comfortable pair of shoes. The fit is highly individualized, and it’s the same with health care providers. So it’s important to realize that shopping around works in medicine just like it does when it comes to finding that great pair of shoes.”
.jpg)
