Managing Low Back Disc Injuries

Man suffering from back pain

Managing Low Back Disc Injuries

Low Back Pain and Disc Injuries

The image that comes to mind when thinking of low back pain is a person half-bent over with a hand on the sore spot of their back.  Many of us have experienced low back pain, and you may recall feeling severely limited or even helpless during the acute phase of your last episode.   Feelings of pain and helplessness are some of the reasons why low back pain is one of the most common causes for patients to seek emergency care(1)!

Low back pain Chiropractor

In fact, over 80% of people have experienced at least one episode of low back pain in their lives, and up to a quarter of adults have experienced low back pain in the last three months(2,3)!  That’s pretty… painful to think about, actually.

On top of this, chronic low back pain is considered the second most common form of disability worldwide(3) and one of the most common causes for adults to see a family physician (4).

In the past, patients were told to “take it easy” during a flare-up of low back pain.  They may have been prescribed bed rest by their family physician, thinking that avoidance of movement would help relax spasming muscles and ease pain to more tolerable levels.

However, times have changed.  Treatment guidelines instead recommend specific exercise (4), gentle stretches, and other ways of staying active during the recovery process.  Total bed rest is to be avoided.

Why the change?

Part of the reasoning is anatomical.  Two types of muscles exist in our backs: superficial muscles (or surface muscles) and deep muscles (5).

Superficial muscles are used to perform motions like bending and twisting.  These muscles are strengthened by exercise that places stress on the muscles.  Think of the person at the gym lifting weights: they’re building and growing these superficial muscles.

Deep muscles, on the other hand, help stabilize the spine and maintain posture.  Physical activity such as yoga, walking, and more, helps keep them in shape.  Picture the jogger going for a mile or two before breakfast: they’re working on deep muscle strength.

Common Back Pain Scenario

A common scenario is bending over to pick something off the floor.  You may hear or feel a “pop” in your low back, followed by pain and muscle tightness.  You’re bent over, unable to fully stand upright, and your back suddenly hurts no matter what you do.  You go to bed – and stay there, unable to move because movement equals pain.  You call out of work because you can’t get out of bed.  You remain largely sedentary for a week, under the guise of “waiting it out.”

Man suffering from back pain

When a person goes on lengthy bed rest, the deep muscles in the back will weaken and begin to lose mass and strength.  This is a process known as atrophy (6).

As the pain subsides and the person feels some improvement, activity is slowly resumed.  In order to do this, the body will recruit the bending, twisting, superficial muscles to help stabilize the back.  Although they can function in this capacity, superficial muscles are NOT well-adapted for this function!  These superficial muscles will tire more easily, resulting in impaired normal movement or motor control.

This can place abnormal stress on the structures in the spine such as joints and muscles, as well as joints and muscles in other areas of the body, increasing the risk for additional musculoskeletal injuries (7,8).

There are specific exercises that help strengthen the stabilizing muscles that lie deep in our bodies, close to the spine.  Doctors of chiropractic regularly prescribe exercises to address an acute flare-up of low back pain and may suggest general activities, such as swimming or walking, to improve your overall fitness (8).  

Exercises For Low Back Disc Pain

Some specific exercises, known as McKenzie exercises, are especially effective for patients who are suffering from an intervertebral disc injury (4). “McKenzie exercises” is a term you may not be familiar with. Yet. But hang with me. They have become a staple in the conservative management of low back pain. They entail simple exercises that have very profound impacts on a patient’s low back pain. They are named after Robin McKenzie, the physical therapist who first began using them.

McKenzie exercises are designed to be used after a thorough evaluation from your medical practitioner. In fact, McKenzie refers to a method of mechanical diagnosis and series of therapeutic exercises prescribed based on the determined diagnosis. The exercises I will be teaching here are simply one protocol of McKenzie exercises. It is the most commonly followed protocol; however, it will not help every low back pain patient. This is also not a substitute for a mechanical examination. Instead it is a tool for patients in acute pain seeking relief until obtaining professional care. 

Lower Back Disc Injuries

In their most basic form, McKenzie exercises are most effective for patients suffering from intervertebral disc injuries. Disc injuries can cause a variety of low back symptoms from intense back pain to pain radiating into a lower extremity. These exercises may reduce the intensity of the pain and in some patients, eliminate it completely. 

When you are experiencing a disc bulge or herniation, the disc material will often protrude posteriorly. While there are other kinds of disc injuries, these are the most common. Disc injuries are extremely prevalent in today’s population. Many who seek medical care for these injuries will be told their options are rest or surgery. The body has the ability resorb the disc naturally, although in some severe cases surgery is necessary. McKenzie exercises are a mechanical tool that patients can use to help the body resorb this disc.

McKenzie extension exercises work because they force the spine to go into an extended position (when referencing the lumbar spine this means an “arched” back position). This arch will actually cause the two vertebrae to close down over the disc at the posterior aspect. This “closing” of the disc space can actually cause the protruding disc material to retract back into the spine and relieve many of the symptoms associated with a lumbar spine disc injury.

Before performing these exercises there are a few things you should pay attention to:

While performing the exercises it is common to experience pain throughout the exercise. Often after multiple repetitions the pain intensity will begin to decrease. If you perform the exercises and the pain gets worse and stays worse these exercises may not be right for you.

If you are experiencing symptoms into your lower extremity, these exercises may also help reduce those symptoms. As you perform repetitions, pay attention to the intensity of the pain in your leg. Has it been improving? Does the pain travel as far as it did when you began? If either of these occur continue with more sets and repetitions. These exercises may be right for you. It should be noted that even if symptoms in the lower extremity begin to trace back up the leg or decrease, it is not uncommon to simultaneously have increased pain in the low back. It sounds counterintuitive, but increased back pain is not always a bad sign when the pain in your leg is improving.  Typically, when there is radiating pain in the lower extremity, to get rid of the pain completely (from the leg AND back) the leg pain must be eliminated first. While performing these exercises, we often see the pain tracing up the leg towards the back becoming more intense, but over a smaller surface area. The smaller the area of pain, regardless of intensity, the closer you are to abolishing it completely.

How do we perform these exercises? 

You can begin these exercises in a standing or prone (on your stomach) position. When standing you will put your hands at the base of your spine and drive your hips forward. The goal is to push your hips over your toes or past them. Take the stretch to the point of pain or until you are unable to go any further and repeat.

If you are on your stomach, keep your hips on the floor and bring your hands up to your chest as if you are doing a push up. Push your chest up, going as far as you can without lifting your hips. If you are in a lot of pain, you may only move a couple inches. Do not force yourself through the pain. Let each repetition gradually improve your range through these exercises. 

You can see a demonstration of the above exercise at the 20 seconds mark in this video:

A good place to start is with 3 sets of 10 repetitions. If the pain increases after three sets, it may not be the right exercise for your condition. If you experience no change or even mild improvement, perform more repetitions to see if you can create lasting improvement. For many patients these exercises may not only help decrease overall pain but also are useful for mitigating flare ups.

Remember these are just one of many different types of McKenzie exercises. You may require a different direction or progression of exercises. This is a great place to start if you are on your own but remember – it is highly recommended to get a proper evaluation from a McKenzie practitioner to determine exactly which exercises will treat your individual ailment.

I hope you have found this post helpful and informative. If you would like to keep up to date with our other posts, remember to follow us on Facebook and Instagram

References

Casiano, V.E., and De, N.K. (2020). Back pain. StatPearls. StatPearls Publishing: 2020 Jan.

“Back pain fact sheet.” (2014). National Institute of Neurological Disorders and Stroke. Retrieved March 2020 from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

Allegri, M., et al. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. 

Casazza, B. (2012). Diagnosis and treatment of acute low back pain. Am Fam Physician; 85(4): 343-350.

 Netter, F. (2011). Atlas of human anatomy. Philadelphia, PA: Saunders/Elsevier.

Dirks, M.L., et al. (2016). One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes 65; (10):2862-75.

Belavy, D.L., et al. (2007). Superficial lumbopelvic muscle overactivity and decreased contraction after 8 weeks of bed rest. Spine 32(1), E23-E29.

“Low back pain.” (2020). American Academy of Family Physicians. Retrieved from https://familydoctor.org/condition/low-back-pain.

What will a Chiropractor do on the first visit?

Josh French, sports chiropractor, performing soft tissue release for a shoulder sports injury.

What will a Chiropractor do on the first visit?

A lot of the patients that come in to see us at Pro Chiro for the first time are unsure of what to expect out of their first visit. They wonder what the initial consultation with our Surrey chiropractor entails. This blog post is intended to answer the question “What will a Chiropractor do on the first visit?”

Josh French, sports chiropractor, performing soft tissue release for a shoulder sports injury.

The Importance of the First Visit

The first visit is a very important session because it is where we get to know you and the problem you have come in for. It is this session that sets us up for success and get you back on the road to recovery. The first visit is where we collect all the information we need to diagnose your problem and form a plan of how to get you back pain-free, stronger and more resilient than before. 

Learning Your Motivation

One of the most important parts of the first visit is learning about why you have come in to see us. For example, if someone has back pain for 6 months, it is important to understand why they have decided to come in now rather than earlier. Perhaps the pain worsened recently. Or maybe it has suddenly started affecting daily activities. Or perhaps they have tried everything else and want to give chiropractic treatment a go. Whatever the case may be, it is important for us to understand your personal motivations for seeking our help.

Thorough Health History

A big part of the consultation is taking a thorough health history. We will ask for details about the problem you have come in for. Details such as when the problem started, what activities are affected, any radiating symptoms etc. We need to find out as much as we can about your problem so we can be sure to understand how to correct it in the short term, and in the long term stop it from coming back.

On top of this, we also need to find out about any previous injuries or health problems you have had. Some of this information may seem bizarre and off topic to you, but we can’t leave any stone uncovered. We don’t want to miss out on any information that may give us clues as to your health picture.

Full Body Assessment

After the history taking has been completed, we will move on to the assessment. This assessment is part of what sets us apart at Pro Chiro and allows us to deliver a high level of success. To assess the problem you have come in for, we look at the entire body for information. We will ask you to perform some movements tests as well as some functional assessment tests. We will then feel through the muscles and joints through your spine and also in the area where you are experiencing a problem. While it is obviously important to assess the area where the problem is, it is also important to look at the whole body. Sometimes the root of the problem may be in a different location to where the problem is felt. If we only ever assessed the exact area where the pain is, we may only ever mask the symptoms rather than correct the cause of the problem for good. 

A Full Explanation

After we have enough information from the assessment, we will report our findings to you. We will explain what we have found and how it relates to the problem you have been experiencing. We will explain what we can do about it to fix the cause of the problem and stop it from coming back again. This step is so important because the better you understand the problem the more you will understand how you can help it too.

Your First Treatment 

After we have explained to you your problem and how to fix it, if you consent we will begin with the first treatment. On the first visit the treatment we do is meant to give you the most improvement possible straight away. This will start you on the road to recovery. We will also take the time to show you specific exercises and stretches that will help you manage the problem and correct the underlying cause of the problem. 

Conclusion

We hope this answers any questions you had about what chiropractor’s do on the first visit. If you have any other questions, feel free to get in touch with us on Facebook or Instagram, or send us an email.

What does a Chiropractor do?

Josh French, Surrey chiropractor and clinical director of Pro Chiro spine and Sports Chiropractic, performing a spinal adjustment on a patient with low back pain.

What Does A Chiropractor Do?

First Visit at Surrey Chiropractor

One of the most common questions people have when they wonder whether they should go to a chiropractor is “What does a chiropractor do?” Many people wonder this, and we are frequently asked this question when patients come in for their first visit at our chiropractic clinic in Surrey.

Josh French, Surrey chiropractor and clinical director of Pro Chiro spine and Sports Chiropractic, performing a spinal adjustment on a patient with low back pain.

What Do Chiropractor’s Do?

The short answer is this: Chiropractors are trained to assess, diagnose and manage musculoskeletal and trapped nerve problems. In more detail, this means we are able to help patients overcome problems related to muscles, joints or irritated nerves. This includes things like back pain, neck pain, shoulder problems and nerve entrapments in the neck or low back. We are also able to help patients with disc problems.

The Pro Chiro Approach

The actual assessment and treatment you will receive depends on the individual chiropractor and can differ quite wildly chiropractor to chiropractor. Our Surrey Chiropractor, Josh French, uses a functional approach, trying to find the root cause of the problem rather than just mask any symptoms. This approach allows patients to overcome the problem for good, rather than allow it to return again in the future. This approach is also excellent for when working with athletes as it helps people maximise their performance. Sometimes athletes come in to see Josh with preventable physical limitations such as stiff ankles, hips or a stiff upper back. These limitations stop athletes reaching their optimal performance. It is therefore essential to remedy this for athletes and the general population too.

Progressive Exercise Plan

Chiropractors use a variety of different treatment techniques, depending on the patient preference and the type of problem they have. At our clinic in Surrey, we also use a progressive exercise based approach. This is aimed at getting our patients fitter and stronger than they were before the pain started. This ensures our patients are self-dependent and don’t become overly reliant on chiropractic care to fix them. Rather, our patients are able to help themselves with their exercise programmes.

Conclusion

We hope this answers any questions you had about what chiropractor’s do. At Pro Chiro, we strive to allow our patients to be their best, free from injury and pain. If you have any other questions, feel free to get in touch with us on Facebook or Instagram, or send us an email

Yours in Health, 

Josh. 

Online Consultations with a Chiropractor

A computer set up for Telehealth consultations

Online Consultation with a Chiropractor

On 23rd March, we temporarily closed our clinic due to the Coronavirus. We have since started offering Online Consultations with our Chiropractor – Josh French. We have had a few questions regarding our online consultations in the last couple of weeks. As a result, we have written this blog post to help answer some of these commonly asked questions about online consultations. 
 

Firstly, How Can an Online Consultation Help?

Technology is making all aspects of life more efficient. Healthcare is no different. With online consultations we are able to go through your complete health history, look at your movements and ask you to perform some functional tests. We can then offer you a diagnosis, explain what you can or cannot do and guide you through some exercises to reduce your pain and aid your recovery. MOST IMPORTANTLY – we can hold you accountable and keep you on track. On top of this we can offer reassurance that there is nothing serious going on and that you aren’t going to worsen anything by doing the wrong thing. 
Really, the only thing we can’t do during an online consultation is provide any hands on treatment. We can still do all of the above as well as show you some self care things you can do to provide relief. While hands on treatment is an effective way to reduce pain and recover from injuries, it is only one part of the overall picture. Online consultations can provide you with an abundance of knowledge about your problem and tools to recover as quickly as possible. 

A computer set up for Telehealth consultations with our surrey chiropractor

 

What is Needed For an Online Consultation?

For an online consultation with our chiropractor, all you need is a phone or laptop / desktop with a camera and microphone. A laptop is better for us as it gives our chiropractor a wider field of view so they can see more, but if you only have a phone then that is also fine. If you don’t have a phone with a camera or a laptop, or would just rather not be on video, we can always arrange a telephone consultation instead. 

On top of this, it would help us a lot if you were in a private area so you are not disturbed. You also need a bit of space to be able to perform the movements and functional tests. Lastly, wearing exercise clothing is advised as it will offer you the most flexibility.

How Much Does an Online Consultation Cost?

We have several different online consultations available to people in pain.

We are providing these consultations free of charge. You won’t have to pay anything to us for the appointment. We will still provide the same expert service we would if you were a paying patient. 

What we are suggesting is instead of paying us for our service, patients make a small donation to the NHS COVID19 Appeal fund. 

What Should I expect from a Telehealth Consultation?

Helping you get set up

For the online consultation all you will need is a laptop or computer with a camera, and a reliable internet connection!

At the time of your appointment, your chiropractor will call you on the link provided in the confirmation email. 

History and Diagnosis

In your online health consultation, your chiropractor will take a detailed history of your symptoms, provide a diagnosis, educate you about the problem and provide advice. They will be able to prescribe or demonstrate a tailored exercise programme to help resolve the issue. On top of this they will guide you on how long it will take until you feel better.

Patient performing a home exercise

 

A Tailored Exercise Programme

During your consultation, we are able to create a personalised care plan that consists of various stretches, exercises and care guidance for you to follow at home to help reduce your symptoms and fix the underlying problem. Exercises are provided in video format to show how they should be performed. 

Initial appointments can last up to 60 minutes (but may be shorter).  You will have a chance to email your surrey chiropractor over the following days should you have any follow-up questions. Alternatively, they may recommend a follow-up Telehealth appointment (around 20 – 30 mins) a few days later as your condition improves. This allows them to update the advice and exercises so you continue to see progress.

This video above give you a great summary of the benefits of online health consultations with a chiropractor. Even though we are a chiropractic clinic based in Surrey, thanks to online consultations we have been able to help patients suffering from back pain all the way up in Liverpool and Newcastle.

Conclusion

We hope reading about the benefit of online consultations has helped to answer any questions you had. You can also read more about online consultations with a chiropractor on this webpage.  If you have any other questions or concerns, feel free to reach out to us on Facebook or Instagram, or send us an email at josh@pro-chiro.co.uk and we will get back to you as soon as we can.