How do I fix a lumbar disc prolapse?
After you’ve winced at the video below, underneath that is a transcript of the audio file above, and so excuse my conversational tone – and poor grammar! You may be better just listening to the audio file above… But enjoy the video first – I’m thinking of enrolling in his online course 😉
‘How do I fix a lumbar disc prolapse?’
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Posted by Michael on Saturday, 19 August 2017
‘How do I fix a lumbar disc prolapse?’
Now this question is assuming that you’re asking it, rather than I am. I know how I fix it, but how do you fix a lumbar disc prolapse? So, we are making a big assumption in this question and that is that you actually have a lumbar disc prolapse, and it’s worth just making sure that you do; so check up all that I’ve written on this subject in the blog. Bear in mind, and again this is covered in numerous articles in the blog, that there is poor correlation between what you see on an MRI and your actual symptoms. So there are lots of people who have symptoms suggestive of sciatica or lower leg or lower back pain, who do not have disc prolapses; and equally there are people who have disc prolapses who have never experienced lower back pain and/or sciatica. So to make that evaluation you want to make sure you’ve seen a skilled clinician specialising in lower back pain or even consulted one online. However, for the purposes of this article lets assume that you have a lumbar disc herniation or prolapse that needs fixing.
Now you could go and see a surgeon – and lots of people do – and I’ve unfortunately seen a few myself over the years and that may be the best course of action for them at that point in time. Now it’s worth bearing in mind that any good surgeon will tell you that the long term outcome for those who have disc surgery are no better than for those who don’t have disc surgery; this is based on research evidence. How does this work? Well again, a surgeon will tell you that surgery itself is risky, things can go wrong and even if they go well it turns out that a year later people who did not have disc surgery tend to be at least as good as those who have had disc surgery, and it doesn’t decrease the likelihood that you will have a future disc proplase. So bear that one in mind when you consider the merits of surgery. Now as I said, some people are definitely better in the short term, so within the first three months of surgery many people are better than those who have not had the surgery. So short term outcomes could be good; long term outcomes less good with surgery.
Now how do you fix a lumbar disc prolapse? It’s important to understand that we all have self healing mechanisms; we call that homeostasis. So basically how does the body stay the same. And there are all these homeostatic mechanisms in all of us which are more usually described as self healing mechanisms. So your disc can heal itself. How does that work? It’s important to understand what happens when you injure a disc – and to understand that, I have articles on this on the blog, so check that out. The perimeter of the disc is fibrous and is called the annulus fibrosus and if you tear those fibres, it’s a bit like slashing a tire, so that the inner tube bulges through the defect. Now that’s called a disc herniation, where the disc in essence is still intact and that none of the jelly stuff is squeezed out, but it is changed in shape, so it’s bulging through the tear in the disc; tthat’s called a disc herniation. Now if enough of those fibres tear, some of the nuclear material – called the nucleus pulposus, which is gelatinous, just like tooth paste – squeezes out thorough that tear and that’s called a disc prolapse. And once that nucleus material – the jelly – has squeezed out, it is not going back where it came from. That’s like trying to get tooth paste back in the tube – it doesn’t work. However, in all of these cases, when you tear the annular tissue, this fibrous tissue, it will heal initially by the initation of inflammation – so it’ll become inflamed and inflammation is painful, bear in mind, so inflammation will tend to build over a couple of days. So often the pain is at it’s worse on day two or even three or four, and then gradually the inflammation causes or initiates the formation of scar tissue or what we call the granulation tissue – but basically scar tissue. It’s just like cutting your skin; it will heal by the formation of scar tissue. Now this process can be long and time-consuming, because the disc does not have a direct blood supply, so it heals very slowly. However it will heal! And over time you’ll create more scar tissue and fibrous tissue that bonds the end of that disc annular material back together again.
So it will heal and the inflammation will die down over the time.. But it’s very important you give it time to heal. Inflammation will be washed away. Now what happens with the nuclear material that’s come out through the defect? It will be broken down by the inflammatory process and removed by your immune system, it’s in the wrong place, it’s a foreign invader –and so your immune system will remove it. So you don’t need a surgeon. So almost everything else is going well and we’ll cover how to achieve that – your own immune system will break down and remove that nuclear material from where it should not be. Now it does take time – there is a very poor blood supply in that area and so it has what we call a low metabolic rate. So it takes time for this to happen; many weeks… Sometimes for some people months.
Now what hinders that process is doing all the wrong things; and that broadly can be summarised in my principle of ‘Use it or loose it but don’t abuse it’. So it’s vitally important that you keep moving, because movement stimulates blood flow, and blood flow is important for healing; but try avoid the things that clearly make the pain worse – so “don’t abuse it”. Your pain system’s main – perhaps only – biological purpose is to warn you; it’s an alarm system. So if you do something that is more painful at the time or more painful afterwards, that’s your body saying don’t do that! So try avoiding the things that increase the pain. Now typically if you have what most people do, a disc prolapse at the back corner of the disc, stretching that back corner of the disc will stretch the scar tissue and cause more inflammation; and therefore it’ll take longer to heal. So try to avoid stretching the back corner of the disc. “How do I do that?” I hear you ask. You simply try to avoid bending forwards or sitting in a way in which your lower back bends forwards or indeed bends off to the opposite side; and usually we can work this one out by – as I said earlier – pain. So if you sit, how does it feel and how does it feel afterwards? If the answer is worse, then you’d be best avoiding sitting in that way. So try not to stretch the scar tissue while it is healing – that is vitally important. It’s a bit like coming to me saying “I need your help with these headaches but I’m a bit busy to follow your advice as I’m banging my head against this wall”. Don’t do things that will make it more sore or it will not heal or it’ll take much more longer to heal.
So as I said ‘Use it or loose it but don’t abuse it’ And it’s it worth stressing the importance of the ‘Use it or loose it’ part of that principle. It’s absolutely essential that you move. Without movement your blood will slow down and that will result in prolonged healing time. People then often get dissatisfied with the lack of progress, depressed, they do less, so it becomes a self-sustaining cycle.
No medication will increase the rate of healing; it may make your symptoms more bearable taking painkillers and anti-inflammatories and other medication, but they will not speed up the rate of healing. The only thing that will do that is appropriate movement. If you feel you need help with what is specifically good for you then by all means get in touch with me, but broadly following that ‘Use or lose it but don’t abuse it’ principle should get you at least half way there.
I hope you’ve learned from this episode that you can fix your disc, it does take time, and also what the ideal circumstances are to facilitate that healing; and what should you avoid doing. If you’d like any more specific advice please get in touch. You can either make an appointment to see me in person or online via Skype and you can do so simply on the website backpainandsciatica.co.uk.