Ask a PT

156 Posts
 
Posted - 10/03/2006 :  17:37:13  Show Profile  Reply with Quote
Our user asked: "I was diagnosed as having a likely herniated disc L4-5 by my gp and chiropractor due to extreme sciatic pain. I have been working with my chiropractor to get through the acute pain phase and am now able to stand upright, raise my arms,etc. I still have pain, though, and am wondering if there is benefit to seeking physical therapy as well as continueing to see my chiropractor. She and my gp have also both mentioned epidural injections. I would like to have any advice you can give as to the wisdom of this. Thank you!! Saw your article in today's paper and was so happy to have another source of information!!"

Ask a PT Response: "A disc is filled with fluid. Imagine a water balloon with a hole punched through it and using both hands to squeeze it. Water will come out at the weakest point, which would be the hole. In your spine, your discs act like shock absorbers as they are located between vertebrae. Surrounding the vertebrae are ligaments that run on the sides, in front, and in back. When the ligaments get stretched out or become more loose as a result of injury or poor mechanics, the disc will protrude out in that direction. When the disc protrudes out it can impinge on a nerve resulting in radiating pain. Physical therapists can assign you exercises which can help with assisting the healing process. There are various execises and treatment techniques such as the McKenzie method that are effective. For most people with this condition, as they start to feel better their pain will centralize meaning the radiating pain will resolve and pain will primarily be experienced in the low back. Once you are feeling better, one has to also remember prevention which includes postural training and core strengthening. As an analogy, consider individuals who perform a lot of heavy lifting. Often times these individuals will wear belts to give them support. You have your own natural belt which gives you support consisting of your abdominal muscles and back muscles. Most people have insufficient support as they have weak abdominal muscles or don't utilize them with lifting and other activities. Therefore, the back sustains most of the forces which could lead to injury of the back. Therefore, you really want to strengthen your core which can help reduce your likelihood of injury. Physical therapists can asssit you in finding the right exercise for this.

Epidural injections are often the next step when you have tried physical therapy and it has not been effective. An epidural injection contains some kind of antiimflammatory. This medication will reduce the imflammation at or around the disc resulting in less pressure on the nerve which is being impinged. Often times, patients will return to PT after an injection so that PT's can assist in speeding up the healing process and most importantly prevent a recurrence. For more information on a herniated lumbar disc and what PT's would do for this condition, visit the condition and treatments page and click on herniated lumbar disc/bulging disc. I hope this helps and thanks for using CyberPT."