Back Clinic Treatments. There are various treatments for all types of injuries and conditions here at Injury Medical & Chiropractic Clinic. The main goal is to correct any misalignments in the spine through manual manipulation and placing misaligned vertebrae back in their proper place. Patients will be given a series of treatments, which are based on the diagnosis. This can include spinal manipulation, as well as other supportive treatments. And as chiropractic treatment has developed, so have its methods and techniques.
Why do chiropractors use one method/technique over another?
A common method of spinal adjustment is the toggle drop method. With this method, a chiropractor crosses their hands and pressed down firmly on an area of the spine. They will then adjust the area with a quick and precise thrust. This method has been used for years and is often used to help increase a patient’s mobility.
Another popular method takes place on a special drop table. The table has different sections, which can be moved up or down based on the body’s position. Patients lie face down on their back or side while the chiropractor applies quick thrusts throughout the spinal area as the table section drops. Many prefer this table adjustment, as this method is lighter and does not include twisting motions used in other methods.
Chiropractors also use specialized tools to assist in their adjustments, i.e., the activator. A chiropractor uses this spring-loaded tool to perform the adjustment/s instead of their hands. Many consider the activator method to be the most gentle of all.
Whichever adjustment method a chiropractor uses, they all offer great benefits to the spine and overall health and wellness. If there is a certain method that is preferred, talk to a chiropractor about it. If they do not perform a certain technique, they may recommend a colleague that does.
El Paso,TX. Chiropractor Dr. Alex Jimenez looks examines a�herniated disc.
Herniated disc is a somewhat common condition that can occur anywhere along the spinal column, but most commonly affects the lower back or neck area. Also known as ruptured disk or a slipped disc, a herniated disc develops when one of the pillow-like pads between the vertebrae moves out of position and presses on nerves that are adjacent.
Herniated discs are usually caused by overuse injuries or injury to the back; however, disc conditions may also develop as a result of the standard aging process. It’s also known that there is a genetic factor that leads to the evolution of herniated disc and disc degeneration. As the size of herniation shrinks with time via resorption, typically, a herniated disc in the lower back will heal within six months. If physical therapy, drugs along with other treatments fail, operation may be needed.
What’s A Disk?
Spinal discs are cushion-like pads located between the vertebrae. Without these �shock absorbers,� the bones in the spinal column would grind against one another. Along with giving the backbone flexibility and making movements like twisting and bending potential, discs protect the spine by absorbing the effect of trauma and body weight. Each disk has a strong outer layer called annulus fibrosus and a soft, gel-like center, called nucleus pulposus. There are fibers on the outside of each disc that attach to adjoining vertebrae and hold the disc in position. A herniated disc occurs when the gel as well as the outer layer tears or ruptures -like middle leaks to the spinal canal.
The spinal canal has only enough space to place spinal fluid and the spinal cord. When a disc herniates and spills to the spinal canal, it could cause compression of spinal cord or the nerves. Alterations in sensation and intense, debilitating pain often happen. Furthermore, the gel-like substance inside the disk releases chemical irritants that bring about pain and nerve inflammation.
What Causes A Herniated Disc?
As we get older, the spinal disks gradually lose fluid volume. This process progresses slowly and begins at about age 30, over time. As the disks dry out, tears or microscopic cracks can form on the outer surface, causing it to become weak, fragile and much more susceptible to injury. The most common causes of herniated disc are:
Wear and tear: Disks dry out and aren�t as adaptive as they were.
Repetitive�movements: Work, lifestyle, and certain sports activities that place stress on the spine, especially the lower back, further weaken an already vulnerable area.
Lifting the wrong way: Never lift while bent at the waist. Proper lifting entails lifting with a straight back and your legs.
Injury: High-impact trauma can create the disk to bulge, tear or rupture.
Obesity: Carrying excess weight places an undue amount of strain on the back.
Genetics: There are a few genes which might be more typically present in individuals with disc degeneration. More research is necessary to investigate the role of those genes�they could be targets of biological treatment in the future.
Which Are The Symptoms Of A Herniated Disc?
Pain from a herniated disc can fluctuate, determined by severity and the place of the harm. It is typically felt on one side of the body.
Little or no pain could be felt in case the injury is minimal. Pain might be severe and unrelenting, in the event the disk ruptures. If significant nerve impingement has occurred pain may radiate to an extremity in a certain nerve root distribution. For instance, sciatica is often resulting from herniated disc in the low back. Herniated disc can manifest itself with a variety of symptoms, including:
Dull ache to severe pain
Numbness, tingling, burning
Muscle weakness; spasm; altered reflexes
Loss in bowel or bladder control (Note: These symptoms constitute a medical emergency. When they occur, seek medical attention immediately).
How Is A Herniated Disc Diagnosed?
History and physical examination point to some diagnosis of herniated disc. A herniated disc is likely if low back pain is accompanied by radiating leg pain in a nerve root distribution with positive straight leg raising test (ie, elevating the leg while lying down causes radiating pain down the leg), as well as other neurologic deficits for example numbness, weakness, and altered reflexes.
Imaging studies usually are ordered to confirm a diagnosis of herniated disc. X rays are not the imaging medium of choice because soft tissues (eg, discs, nerves) are hard to capture with this specific technology. However, they might be used as an initial tool to eliminate other illnesses such as for instance fracture or a growing. Confirmation of the feeling of herniated disc is generally achieved with:
Magnetic Resonance Imaging (MRI): This technology shows the spinal cord, surrounding soft tissue and nerves. It really is the best imaging study to support the identification of a herniated disc.
Nerve Conduction Studies (NCS) and Electromyogram (EMG): These studies use electric impulses to measure the level of harm to the nerve/s brought on by compaction from a herniated disc along with other conditions that cause nerve impingement may be ruled out. NCS and EMG are not routine evaluations to diagnose herniated disc.
Herniated discs occasionally heal independently through a process called resorption. This means the disk fragments are consumed by the body. Most people suffering from herniated disc do not need surgery and react well to conservative treatment.
Sciatica, medically defined as a set of symptoms rather than a single disorder, is commonly characterized by pain in the lower back and buttocks. This pain can radiate down one or both legs to the thigh, calf, ankle and foot. True sciatica occurs when pain begins to travel below the knee.
Sciatic pain frequently results when the nerve roots surrounding the spinal column are compressed or when pressure has caused the impingement of the spinal roots of the sciatic nerve. The sciatic nerve systems are found in in the sacral regions of the back and the lumbar spine. Sciatic pain or sciatica could be identified as sharp, dull, burning, tingly, numb, constant, or intermittent and usually affects only one side of the body. It may radiate throughout the whole length of the nerve, in certain cases, all the way to the toes.
Sciatic pain is usually the result of a herniated disc, spinal stenosis, or in exceptionally rare instances, infection or tumour. The cause of your pain determines your treatment options to relieve sciatica.
Sciatica Treatment Options
Several of the most popular sciatica treatment options include: alternative treatments, such as acupuncture, chiropractic care, drugs, physical therapy, and surgical interventions.
Once a qualified and experienced healthcare professional has diagnosed you with symptoms of sciatica, many individuals with prevalent lower back pain are prescribed bed rest as a way to offer relief for aching bones and joints. Current research, however, has implied that bed rest alone cannot offer relief for those suffering from nerve pain due to sciatica.
Remaining active might be more beneficial for people who suffer with back pain. Not to say that you should be running marathons! Action means being mobile and active for periods of time which aren’t enough to cause additional pain and/or to aggravate other symptoms of sciatica. Specific exercises may be recommended by your healthcare professional or some may simply suggest walking.
Sciatica Pain Relief
Pain is best treated with non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen or codeine (in acute cases).
In some instances, a cortisone-like drug may be injected to the epidural space enclosing the spinal column. This process is similar to the epidural used during childbirth, and it’s called an epidural steroid injection. A class of this sort of treatment may offer temporary relief, but it does not address the source of the issue.
Surgery for Sciatica Symptoms
Some patients with sciatica may discover significant relief from surgery. In the case of herniated discs, a surgical procedure called a laminectomy may be performed. In this process, a percentage of the posterior arch is removed to relieve pressure on pinched nerve tissues.
In cases of spinal stenosis, the part of bone that is putting pressure on the sciatic nerve system may be removed.
Operation is not for everyone. Nonetheless, for people who have shown no sign of improvement in 4 to 6 weeks and who have had CT scans (computed tomography) or MRI that show a herniated disc or spinal stenosis, surgery may offer considerable relief.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Chiropractic and Sciatica
Sciatica is a common group of symptoms reported by a majority of the population alongside symptoms of back and low back pain. Sciatica, or sciatic nerve pain, is frequently the result of compression or impingement of the sciatic nerve and its nerve roots, generally from a spinal misalignment or subluxation. Chiropractic care is a safe and effective form of alternative treatment utilized to restore the natural alignment of the spine, ultimately reducing the pressure being placed against the sciatic nerve and relieving symptoms of sciatica.
Chiropractic care focuses on the diagnosis, treatment and prevention of a variety of injuries and conditions associated with the musculoskeletal and nervous system. Specializing on the spine and its surrounding structures, chiropractic treatment commonly utilizes spinal adjustments and manual manipulations to restore the proper function of the body, however, many chiropractors use other therapies to treat patients.
The following are other common therapeutic treatment methods that chiropractors can additionally offer along with a brief description of each.
Rehabilitation Stretches
After an individual has experienced an injury or aggravated a previous condition, rehabilitation stretches can be essential to prevent the formation of scar tissue. Even after the damage has healed, maintaining a regular program of stretches recommended by a healthcare professional or chiropractor can help maintain and improve flexibility and mobility as well as help protect the tissues from suffering further injury. Your chiropractor will instruct you on the best stretching techniques for you depending on your specific injury or condition and they will supervise you throughout the process.
Rehabilitation Exercises
Together with the recommended set of stretches, a healthcare specialist or chiropractor can follow up by recommending specific exercises to strengthen the structures surrounding the spine of patients with neck and back complications. Strengthening exercises can help eliminate symptoms of pain as well as help prevent the degeneration of the muscles, promotes joint health and can increase strength, stability and range of motion to protect the body from suffering further injuries or aggravating conditions.
Your chiropractor will demonstrate how to do the exercises and supervise you until you are comfortable doing them on your own. It’s fundamental to keep up with your exercises as recommended by your healthcare provides. Research studies have demonstrated that individuals who follow their specific exercise instructions carefully heal faster than those who do not.
Traction
Many chiropractors utilize traction devices to apply traction to different areas of the body in order to distract different regions of the spine. This treatment helps separate the vertebrae, decompressing the discs to reduce and eliminate nerve root pressure.
Soft-Tissue Manual Therapy
Many chiropractors will utilize a variety of hands-on soft tissue therapies to help improve the function of the soft tissues, including muscles, ligaments, tendons and joint capsules. Soft-tissue manual therapies such as the pin and stretch, best known as the active release technique, or ART, and instrument-assisted soft tissue mobilization, best known as the Graston technique, are some of the most common soft-tissue manual therapies used.
Muscular Stimulation
Muscle stimulation is performed by transmitting light electrical pulses to specific areas of the body through electrodes placed against the skin. There’s a variety of electrical stimulation therapies available. Several types can be more beneficial towards eliminating pain, reducing inflammation and for treating muscle spasms while others may actually cause muscles to contract in order to reduce muscle atrophy. Some forms of electrical muscular stimulation can have a combination of benefits and effects.
TENS
A transcutaneous electric nerve stimulation or TENS unit is a small, battery-powered, portable muscle stimulation machine which can be utilized at home to help control pain. Variable intensities of electric current can be utilized by healthcare professionals to control the symptoms of pain. This treatment is recommended to help patients get through periods of severe or acute pain caused by their specific type of injury or condition. TENS units are generally not recommended for chronic pain, however. As a matter of fact, a 2009 report from the American Academy of Neurology determined that transcutaneous electric nerve stimulation units may not be effective for treating chronic low back pain.
Ultrasound
Therapeutic ultrasound is a form of deep heat therapy created by sound waves. When applied to soft tissues and joints, the sound waves function as a form of micro-massage which helps decrease pain, reduce swelling, stiffness and spasms as well as increase blood flow.
Ice and Heat Therapy
The application of ice and heat have been used for many years to treat many painful injuries and conditions. Ice therapy is often recommended to reduce swelling and help control pain immediately after an injury. Heat therapy is often recommended to relax the muscles, increase circulation, and can provide relief to patients with chronic pain. According to the patient’s condition, a combination of ice and heat can be used.
Nutritional Counseling
Research studies have concluded that following an improper diet and nutrition can provide imbalances in the body which may contribute to a variety of serious illnesses, such as heart disease, stroke, diabetes, and even cancer. Many chiropractors are especially trained in diet and nutritional counseling. Your chiropractor can design a nutritional program depending on your needs in order to help you maintain overall health and wellness as well as to minimize the risk of developing these serious health conditions.
Lifestyle Modification Counseling
Good health is much more than the absence of pain or disease. The lifestyle choices you make on a daily basis can greatly affect your entire well-being. Over time, a lifestyle of unhealthy lifestyle choices can ultimately lead to a wide array of health complications. Examples of lifestyle choices and behaviors that can have negative effects on your health include:
lack of regular exercise
smoking
poor diet
excessive mental stress
over-reliance on medication
excessive consumption of alcohol
poor posture
improper lifting
A healthcare specialist or chiropractor will discuss a patient’s lifestyle choices and habits in order to help them identify which of them could be considered an unhealthy health habit. These can then be altered and modified using practical strategies.
Chiropractic care focuses on using much more than spinal adjustments and manual manipulations to ensure the patient achieves their health goals. Doctors of chiropractic use a variety of treatment modalities to help the body naturally heal itself and return the patient to healthier life.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
What is a Herniated Disc?
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber).
A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body’s weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.
The progression to an actual HNP varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
Progression of Herniated Disc
The extremities affected are dependent upon the vertebral level at which the HNP occurred. Consider the following examples:
Cervical – Pain in the neck, shoulders, and arms Thoracic – Pain radiates into the chest Lumbar – Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation and is serious requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.
Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation of a spinal nerve) may increase when pressure is applied to the affected spinal level.
A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed.
Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.
Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance Imaging (MRI) provides more detail. The MRI is the best method enabling the physician to see the soft spinal tissues unseen in a conventional x-ray.
Radiographic Evidence of HNP
The findings from the examination and tests are compared to make a proper diagnosis. This includes determining the location of the herniation so treatment options can be reviewed with the patient.
Whether your doctor recommends surgery for a ruptured Achilles tendon may depend partly on your age and activity level, foot experts say.
The Achilles tendon is a band of tissue that runs down the back of the lower leg and connects the calf muscle to the heel bone. A rupture is a complete or partial tear of the tendon that leaves the heel bone separated or partially separated from the knee.
Length of recovery from this type of injury varies depending on whether a patient undergoes surgical or nonsurgical treatment.
“Treatment processes are dependent upon a patient’s overall health, activity level and ability to follow a functional rehabilitation protocol,” said Dr. Jeffrey McAlister, a foot and ankle surgeon in Sun City West, Ariz. Advances in treating Achilles tendon rupture were discussed by McAlister and other specialists at a recent meeting of the American College of Foot and Ankle Surgeons, in Las Vegas.
Typically, less active and unhealthy patients receive nonsurgical treatment, since they are not trying to return to active sports, McAlister said in a college news release. But this approach usually involves a long rehabilitation/recovery period (9-12 months). Also, these patients may be at increased risk of potentially dangerous blood clots due to inactivity during this period.
“For more athletic and younger patients, the surgical option may be best,” said Dr. Michael VanPelt, a Dallas foot and ankle surgeon. “We anticipate these patients have shorter healing times.”
But because there is low blood flow to the Achilles tendon, healing after surgery can be tricky.
“Advances in surgical techniques to repair Achilles tendon ruptures include limited incision, or smaller incision, surgical approaches to help patients have smaller scars, and less of a chance of wound complications,” said Dr. Jason Kayce, a Phoenix foot and ankle surgeon.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Preventing Sports Injuries
Many athletes largely depend on chiropractic care to enhance their physical performance. New research studies have determined that aside from maintaining overall health and wellness, chiropractic can also help prevent sports injuries. Chiropractic is an alternative treatment option utilized by athletes to improve their strength, mobility and flexibility. Spinal adjustments and manual manipulations performed by a chiropractor can also help correct spinal issues, speeding up an athlete’s recovery process to help them return-to-play as soon as possible.
One of the main symptoms of fibromyalgia is extreme sensitivity to touch, so it�s understandable that some people with fibromyalgia avoid getting massages. However, they are missing out on something great.
Massage treatment might seem like the very opposite approach to take for fibromyalgia pain, but the right amount of pressure and manipulation can actually do a lot for your congested muscles and tissues. In reality, massage is a perfect natural remedy for fibromyalgia. Therapeutic kneading will stimulate blood flow, eliminate metabolic waste, and lengthen muscle fibers. The right fibromyalgia massage treatment will work within the limits of your condition to release pockets of tension, and improve your physical wellbeing and quality of life.
Recommended Fibromyalgia Massage Treatment
There are many types of therapeutic massage treatments, and the right style for your fibromyalgia pain will respect your muscle sensitivity and particular pain issues. Stick with these massage techniques for the most healing benefits:
Swedish massage techniques. This classic relaxation technique ��using the hands, arms or mechanical means ��will gently manipulate tense muscles to relieve long-standing tension.
Myofascial release. Focusing on the connective tissue called fascia, this technique aims to release pressure where the tissues connect to the bones. Muscles will relax and lengthen, leaving more space for the organs to expand.
Reflexology. A safe and gentle approach that stimulates points on the hands and feet that are believed to be connected to various organs and tissues. This may help to relax certain areas that would be difficult to stimulate directly.
Cranial-sacral therapy (CST). Using very mild pressure on strategic points at the base of the skull and along the length of the spine, the CST therapist can detect interruptions in the flow of spinal fluid, and improve the balance and function of every muscle area.
Massages to Avoid
The types of massage that are out of the question if you don�t like touch because of sensitivity include:
Thai massage treatment. It puts you through different poses for an entire hour.
Reflexology foot massage treatment. Presses on reflexology points that often hurt.
Barefoot massage treatment. The massage therapist walks on your back while holding onto a supportive rack suspended from the ceiling.
Rolfing/structural integration. You�ll feel beat up with this one.
Before proceeding with any fibromyalgia massage, be sure to consult a healthcare professional who has properly diagnosed your condition and who has recommended you to follow up with any of the above mentioned therapies. Preventing further aggravation of any type of symptoms is best to promote a healthier lifestyle and improve overall symptoms.
While fibromyalgia has been known to cause symptoms of chronic pain, many individuals with the condition avoid massage or other forms of similar treatment to avoid aggravating their symptoms. However, massage therapy performed by a qualified healthcare professional can not only be beneficial, it can help reduce and manage the pain caused by fibromyalgia.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Athletes are at higher risk of experiencing injuries or aggravating a previously existing condition due to the constant exposure to rigorous training and competitions. Although the lower extremities most frequently result in damage or injury, lower back complications have only been increasingly reported among the wide majority of athletes alike.
Among the young college athletes and professional athletes alike, low back pain is considered to be one of the most common complaints, estimated to affect more than 30 percent of athletes at least once in their career. A wide number of back injuries can affect the athlete, including muscle spasms and stress fractures, spondylosis, spondylolisthesis, disc degeneration, facet joint arthropathy and disc issues, such as lumbar disc herniation.
Lumbar disc herniation is a well-known type of injury which often causes impairing low back pain, however, it can also compress the nerve roots in the area and generate radicular pain and other symptoms along the lower extremities, such as altered sensations and muscle weakness. Furthermore, this type of injury will not only affect the athlete�s ability to perform during their specific sport or physical activity, it may also become chronic and affect the athlete in the future.
Conservative treatments are frequently utilized when managing lumbar disc herniation in athletes, although surgical options may be considered if the injury is too severe. Many elite athletes often request faster recovery methods for their type of injuries and symptoms in order to minimize their time spent away from training and competition. As a result, a wide number of athletes will seek surgical alternatives earlier than recommended, provided they meet the criteria for lumbar spine surgery. The most popular surgical procedure for athletes with a low back disc herniation is the lumbar disc microdiscectomy.
Anatomy & Biomechanics of the Lumbar Spine
The intervertebral discs of the lumbar spine perform an essential biomechanical role within the spine. These function to provide mobility between the segments of the spine while distributing compressive, shear and torsional forces. These discs are made up of a thick, outer ring of fibrous cartilage, known as the annulus fibrosis, which surround the gelatinous core of the disc, known as the nucleus pulposus, which is contained within the cartilage end plates.
Each intervertebral disc consists of cells and substances, such as collagen, proteoglycans and scattered fibrochondrocytic cells, which function to absorb and conduct increased forces from body weight and muscle activity. In order to effectively perform its function, the disc depends immensely on the structural condition of the annulus fibrosis, nucleus pulposus and the vertebral end plate. If the disc is healthy, it will evenly spread the forces being applied against the spine. However, disc degeneration caused by cell degradation, loss of hydration or disc collapse, can decrease the disc�s ability to withstand external forces and these will no longer be absorbed and conducted evenly across the spinal structures.
Tears in the annulus fibrosis of the disc along with extrinsic loads may ultimately cause the disc to herniate. Alternatively, applying a large, biomechanical force against a normal disc, such as a heavy compression on the spine due to a fall on the tailbone or strong muscle contraction from heavy weight lifting, can also damage the healthy structures of the disc and cause a rupture.
Disc herniation is characterized when the nucleus pulposus, the soft, jelly-like material in the center of a disc, pushes through a tear in the annulus fibrosis, the fibrous exterior of the disc. If the protrusion does not compress the nerve roots that travel along the spine, the individual may only experience back pain. But, if the herniated disc pushes against the lumbar nerve roots or other structures within the lower back, the individual may experience radicular pain along with neurological symptoms, such as numbness and paresthesia.
The pain and other symptoms associated with lumbar radiculopathy occurs due to a combination of nerve root ischemia from compression and due to inflammation caused by the chemicals released from a ruptured disc. During a herniation, the nucleus pulposus places unnecessary pressure against the weakened areas of the annulus, protruding through these weakened sites in the outer structure of the disc, ultimately forming a herniation. It�s important to note that when a lumbar disc herniation occurs, in a majority of cases, some form of disc degeneration may have existed before.
The Process of Lumbar Disc Herniation
Unlike other musculoskeletal tissues of the body, intervertebral discs generally degenerate sooner than other structures. Some studies have shown adolescents between the ages of 11 to 16 with signs of degeneration. As people age, the discs will naturally degenerate further. In a research study conducted using normal, healthy subjects between the ages of 21 to 30, more than one third of the individuals presented degenerated discs.
While the spinal discs may be at risk of injury in practically all fundamental planes of motion, these are often more susceptible to damage or injury during constant and repetitive flexion or hyperflexion along with lateral bending or rotation. Trauma from an injury caused by an excessive axial compression can also harm the internal structure of the discs. This can commonly result after the individual has suffered a fall or due to strong muscular forces being placed against the spine during specific activities, such as heavy weight lifting.
When it comes to athletes, they are frequently exposed to conditions of higher loading. A herniated disc can be categorized according to its location: central, posterolateral, foraminal or far lateral. Herniation varieties can also be classified as: protrusion, extrusion or sequestered fragment. Finally, disc herniation may be identified according to the level where they occurred on the spine. Most develop along the lumbar spine, often affecting the lumbar nerve roots which may lead to symptoms of sciatica. Upper lever herniated discs are rare, but when they do occur along with radiculopathy, they generally affect the femoral nerve.
Disc Herniation in Athletes
Athletes who participate in sports or physical activities which utilized combined trunk flexion and rotation have an increased chance of experiencing herniated discs. Individuals between 20 to 35 years of age are the most common group to herniate a disc, most likely as a result of the nature of the nucleus pulposis and due to behavior. This age group is most likely to be involved in sports which require higher loads of flexion and rotation or they may practice improper postures and positions when carrying weight.
The sports most at risk of disc herniation include: hockey, wrestling, football, swimming, basketball, golf, tennis, weight lifting, rowing and throwing activities, because these sports involve either high loads or high exposure to combined flexion and rotation mechanisms. Additionally, athletes who engage in more intense, continuous training routines appear to be at an increased risk of developing spinal injuries or conditions, similar to those involved in impact sports.
Signs and Symptoms Indicating Discectomy
An athlete is generally driven by motivation and goals when they choose to undergo surgery to treat a lumbar disc herniation. Rather than waiting for the symptoms to decrease over a period of rehabilitation, athletes prefer a relatively simple microdiscectomy.
A conservative period of management for symptoms of a lumbar herniated disc may involve: medication therapy, epidural injections, relative rest and trunk muscle rehabilitation, acupuncture and chiropractic care with massage. However, athletes who experience low back pain with pain radiating down one or both legs, neurological signs and symptoms, mild weakness of distal muscles, such as extensor hallucis longus, peroneals, tibialis anterior and soleus and those who demonstrated positive on the straight leg raise test, may meet the criteria to follow through with a surgical intervention for their lumbar herniated disc.
Generally, elite athletes have a shorter time span in which to allow conservative rehabilitation to be effective. For a majority of the population, medical practitioners often prescribe a minimum 6-week conservative period of treatment with a review at 6 weeks to decide whether they should extend the rehabilitation or to seek treatment from a specialist. This particular healthcare professional may then offer other alternative interventions to treat the issue.
For athletes, however, these time frames are compressed. Epidural injections are often offered to athletes to assess the issue quicker, and if there are no results within a determined period, an immediate lumbar spine microdiscectomy may follow.
Imaging
Magnetic resonance imaging, or MRI, are considered to be the preferred method for identifying lumbar disc herniation, as these are also very sensitive when detecting nerve root impingements. Because abnormal MRI scans can occur in otherwise asymptomatic individuals, it�s essential to establish a clinical correlation of symptoms before any surgical considerations. Additionally, individuals may present clinical signs and symptoms suggesting the presence of a lumbar herniated disc but they may lack sufficient evidence on MRI to meet the criteria to follow through with surgical interventions. Accordingly, it�s been proposed that a volumetric analysis of a lumbar herniated disc on MRI may be potentially valuable for assessing an individual�s and athlete�s suitability to receive surgery.
MRI Lumbar Spine Disc Herniation
Chiropractic and Massage
Fortunately, before considering surgical intervention, although more time and patience may be required, there are several effective, alternative treatment options that can help reduce and eliminate the symptoms associated with a lumbar herniated disc. Chiropractic is a healthcare profession that focuses on injuries and conditions of the musculoskeletal system and the nervous system as well as the effects of these on general health. Chiropractic care emphasizes the treatment of the body as a whole rather than focusing on a single injury or condition. Through the use of spinal adjustments and manual manipulations, two of the most common techniques used in chiropractic, a chiropractor can carefully re-align the spine, helping to restore and reduce the pain and swelling caused by a lumbar herniated disc.
Along with a combination of massage, chiropractic care can ultimately help rehabilitate an injured athlete or individual. A massage, best referred to as myofascial release, is a hands-on technique that involves applying gentle, sustained pressure into the myofascial connective tissue restrictions, to eliminate pain and restore function. Massage can increase blood flow, which delivers more oxygen and nutrients to the muscles surrounding the affected region of the spine. The increased blood flow may also help carry away unnecessary substances which may have accumulated through time. Chiropractic care and massage are safe and effective treatments that can help rehabilitate athletes with lumbar disc herniation without side effects.
Sports injuries can become a difficult situation for any athlete, especially if the symptoms become more severe, leading to further complications. When recovering from an injury, an athlete’s main concern involves them returning to play as soon as possible. Chiropractic care and the use of physical therapy as well as other types of treatment methods and massage can help individuals effectively recover from their injuries.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
