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Q&A with Australian Health Practitioners
What are bulging disk treatment options?
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My GP and physio think I have a bulging disc. I have pain that starts from the back and goes to my hip and in front of my thigh. I have numbness and twitching in my leg and a limp. My physio is doing traction which has helped slightly but I am also experiencing lots of pain below my knees but he didn't seem concerned. I do have a previous knee injury. Could this be the cause of the pain or something else? Are there any other treatments available? -
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Dr Peter Dun
Chiropractor
Rehab - Sports - X-Ray - Standing MRI - Second Opinions. We provide strategies for chronic and more complex function problems to help restore active … View Profile
You might find the answer I provided to a similar question helpful: How to treat my back pain and numbness in leg?
Best wishes, Peter
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Treatment for disc injuries ranges from exercise and yoga to surgical intervention. The difficulty is determining which will work best for you. This is where your GP and physio will be able to guide you to the best available approach.
As your GP and Physio will be aware of, there are specific guidelines that can be utilised to best treat your condition. Currently it is recommended that initial intervention is aimed at reducing the pain and undergoing conservative management. If the practitioner notes that there is deterioration in your condition or there is no change over a 6-8 week period, they may refer you for specialists opinion.
Most often, conservative managment for lumbar spine disorders is all that is needed to get you back to your normal activity. This includes chiropractic, physiotherapy, osteopathy, acupuncture, exercise and yoga/pilates as well as medications that your GP may give you to manage your pain levels during this period.
Currently, the Americal College of Physicians and the American Pain Society recommend the treatment approaches chiropractors use alongside exercise therapy and acupunture in the treatment of chronic and subacute low back pain.
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Dr Greg Sher
Chiropractor
I am the Clinic Director of the Sydney Spine and Sports Clinic.At our clinic, we see an equal mix of city office workers and elite … View Profile
The key issue to sort out is the extent of the disc bulge, the location (i.e. the level it is at - low back, neck?) and exactly what direction the disc is bulging in.
Many disc bulges are not identified, as they don't always cause symptoms.
One theory out there is that traction (or stretching) of the disc can help to improve the mobility of the whole vertebral segment, leading to decreased pain and numbness.
Our clinic uses a specialised table, called a Motorised-Flexion-Distraction Table, which can help to cause traction on the local disc level. Check out our website for a video of the table in action (www.sydneyspine.com.au). The key issue to sort out is the extent of the disc bulge, the location (i.e. the level it is at - low back, neck?) and exactly what direction the disc is bulging in.
Many disc bulges are not identified, as they don't always cause symptoms.
One theory out there is that traction (or stretching) of the disc can help to improve the mobility of the whole vertebral segment, leading to decreased pain and numbness.
Our clinic uses a specialised table, called a Motorised-Flexion-Distraction Table, which can help to cause traction on the local disc level. Check out our website for a video of the table in action (www.sydneyspine.com.au).
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Sandra McFaul
Physiotherapist
Do you suffer from chronic lower back pain or neck pain? Based in SYDNEY, Sandra is 1 of ONLY 15 Physiotherapists in Australia with ADVANCED … View Profile
A McKenzie Physiotherapist has post-graduate training in spine probelms. They will get you to perform numerous movements with the aim to find one key exercies to rapidly reduce the pain. If the pain centralises - ie less in your leg and more in your back, then that's a good sign.
Watch this video clip to find out more http://www.youtube.com/watch?v=8BXDe5fcp7IReport this post
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anneHealthShare Member
My pain is more in the leg then in my back I do get back/hip pain but the pain is more in my leg I have had a few scans done and MRI the other day I think I have presure on the nerve but will be seeing the doc on friday to pick up the results and discuss further, my doctor has also referred me to a nerosurgeon to which I have an appointment next week. Can this still be resolved by physio? what are you thoughts.
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Sandra McFaul
Physiotherapist
Do you suffer from chronic lower back pain or neck pain? Based in SYDNEY, Sandra is 1 of ONLY 15 Physiotherapists in Australia with ADVANCED … View Profile
It is really a matter of testing it out. By using the McKenzie Method, if you can be in a position or do an exercise which reduces the leg pain then this is a good sign.
The Method is a step by step approach and once a certain number of movements and positions are explored by a trained McKenzie therapist, you would then have an idea of the prognosis. You usally just 2 or 3 consults to determine if it will work.
(While most physio's have heard of the McKenzie Method, you need someone who is at least credientialled, the basic level, or preferrably the advanced level.)
Surgery is generally indicated if the pressure on your nerve is increasing and you are therefore experiencing worsening neurological problems. ie. increasing weakness in certain muscle groups, increasing numbness or pins and needles. If you have bladder problems - not able to pass water or not able to control then you should seek immediate medical care.
You may want to check out the book "Treat Your Own Back" by Robin McKenzie and the 3rd video on this page will give you more info.
I hope this has helped you further.Report this post
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Dr Peter Dun
Chiropractor
Rehab - Sports - X-Ray - Standing MRI - Second Opinions. We provide strategies for chronic and more complex function problems to help restore active … View Profile
For the types of disc problems (along with taking each patient’s symptoms and clinical assessment findings into consideration) that do not require immediate back surgery, a trial of conservative care - which includes a quality spine rehab program - is recommended. It is suggested that this be carried out for a period of up to 3-4 months after the onset of initial symptoms. During this time, it is also advisable to be as active as possible without aggravating the symptoms - particularly those in the leg. Like Ryan, we are also called upon by GPs to provide an opinion as to whether a course of conservative care may be worthwhile.
If there is no overall improvement in leg symptoms by around the 3 month mark, a neurosurgeon or orthopaedic surgeon opinion is recommended. Of course, as Sandra has correctly highlighted, a surgery opinion is necessary at any time if there is worsening and/or onset of some types of symptoms and clinical assessment findings. Current research suggests that for back surgery (such as a discectomy) to have the greatest likelihood of success, there is a window of opportunity to be mindful of; it seems that this is, ideally, no later than 4 months after the onset of initial symptoms.
Best wishes in your journey to recovery.Report this post
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
As there is a vast array of severity in radiculopathies (pain in the limb due to nerve compression) this question will best be dealt with your primary health care provider. In our practice we are often called upon by GPs and neurosurgeons to trial a conservative approach to this issue before the neurosurgeon will recommend surgery.
Ask your neurosurgeon if he/she feels that conservative management may be right for you. Unfortunately, not everyone can avoid surgery for resolution, but there are specialists there to assist when things have gone too far.Report this post
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anneHealthShare Member
thanks will do that especailly after seeing GP;last week with my MRI he thinks I need to have an operation but last few days I am not getting as many shooting pains as I was or the drugs I am on are helping. but will ask the neurosurgeon what he thinks regarding conservative management. What are your thoughts about getting cortisone injection if this is offered?
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Dr Peter Dun
Chiropractor
Rehab - Sports - X-Ray - Standing MRI - Second Opinions. We provide strategies for chronic and more complex function problems to help restore active … View Profile
Glad to hear that you are a bit more comfortable.
Patients with certain types of sciatica can gain some benefit by having an injection procedure called a peri-radicular infiltration of cortisone and local anaesthetic. This procedure is performed by a type of medical practitioner called an interventionist radiologist.Report this post
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Neil Synnott
Exercise Physiologist, Physiotherapist
I am qualified as a PHYSIOTHERAPIST and ACCREDITED EXERCISE PHYSIOLOGIST.I primarily use the McKENZIE METHOD for assessment and management of musculoskeletal pain disorders. The McKENZIE … View Profile
Hi Anneabell,
Sounds like you are having appropriate management directed by your GP… An MRI to assess the integrity of the discs in the lumbar spine and possible nerve compression helps with the diagnosis.
As Sandra mentioned earlier, a credentialled or diploamed McKenzie physiotherapist is very well skilled to direct your treatment. My suggestion to you… please go to www.mckenziemdt.org.au to find a McKenzie physiotherapist near you.
A key feature of the Mckenzie Method is to educate YOU ON HOW YOUR BACK MOVES. This education is vital with or without surgery! A neurosurgeon I work with has suggested that education is the first part of treatment! Having a read of TREAT YOUR OWN BACK is a great place to start. I have used this with a couple of patients in the last week with good effect!
If you have tried treatment to date, and had limited benefit, the cortisone injection may well help. Approximately 40% of people who have a cortisone injection for back pain, then benefit from the McKenzie Method.
All the best with your recovery!
Neil
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Louise Meek
Physiotherapist
Shoulder & Spinal Rehabilitation | Pilates IntructorLouise has a passion and expertise for sports injuries after working with Wynnum Manly Seagulls rugby league, the Australian … View Profile
For starters your clinicial needs to determine if your pain is coming from the disc area or possibly related to other lumbar/pelvic regions. Alot of people have bulging disc on scans but are non-symptomatic as disc degeneration is a normal occurance of life. The therapist firstly needs to assess if there is neural impingment? Referred pain you are experiencing can come from poor muscular support, poor posture or any thing that can cause irritation/compression to the nerve.
You mentioned you ahve bilateral leg pain? If it was your knee you would have only pain in that knee and possiblity below. This is easily rulled out by a good assessment of the knee.
There is solid eviedence that if your symptoms are disc related stability and postural exercises will help if you do not have significant nerve impingment. Most other therapies like traction/manipulation massage have great short term effects but you really have to correct the underlying issue (strength, posture, work environment) which your therapist can help you with.
Good luck with your rehabilitation.Report this post
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