ALL YOU NEED TO KNOW ABOUT A SLIPPED DISC – A BRILLIANT GUEST POST BY NEIL VELLEMAN…

A slipped disc? Ouch! 

 By Neil Velleman, of Atkins Physiotherapy Consultants

A slipped or herniated disc is amongst the most debilitating of back pain problems – sometimes with added symptoms such as the grinding leg pain of sciatica.  There are many levels of back and neck pain but a herniated or ‘slipped’ disc is one of the most painful and it can cause long-term immobility if it’s not treated correctly.

This is a condition where the centre of a spinal disc bulges outwards and presses onto a nerve.  The spinal discs act as shock absorbers and through a variety of causes, including injury, poor posture and general “wear and tear” (meaning gradual deterioration), the walls of the disc can become weaker. If the centre of the disc pushes out, this can cause the disc wall to bulge and that can be when pain strikes!

There are six steps of management to consider in this situation:

1) Pain Killers

2) Manual therapy

3) IDD Therapy

4) Injections

5) Surgery

6) Other options including exercise and acupuncture

Pain Killers

When you have a disc problem or simple back pain, the first thing the NHS recommends is to take some anti-inflammatories such as ibuprofen.  Relieving pain is the first step to being able to move, because if you can move, the mechanisms which keep our backs healthy can operate.

This will be what your GP will recommend because in approximately 90% of cases, back pain resolves within six weeks.  But if the pain isn’t going away or it is so severe that you can’t carry out your normal functions, then some form of manual therapy is advisable.

Manual Therapy

There are a variety of types of therapy and we typically think of physiotherapy, osteopathy and chiropractic.  Where there is pain, the body usually limits how we move – it hurts!

Some conditions have built up over time leaving the spine stiff and unable to move properly.  This can put tremendous pressure on the discs.  So generally speaking manual therapists will seek to ease muscle spasm and then, through either some manual mobilisation or manipulation, free the joints which may be stuck They will also look at how our bodies are moving.

This is where we consider the “cause”; what led the disc wall to get weak?  Often some gentle stretches and exercises can help to get movement back, all with the goal to help the body heal itself. Typically, four to six sessions are enough, although you may need to additional exercise sessions.

IDD Therapy

IDD Therapy is the next step when manual therapy and exercise alone aren’t enough.  IDD Therapy is a computer-controlled treatment which helps physiotherapists to decompress the specific spinal segment where the disc is “slipped” or herniated.  Patients lie on a treatment couch where they are connected to a machine with a pelvic harness and a chest harness.

The IDD Therapy machine then applies a gentle pulling force at a precise angle to take pressure off the targeted disc and to gently mobilise the joint and surrounding muscles.  The goal with IDD Therapy is to relieve muscle spasm, reduce or reverse disc bulging and gently stretch the tissues to free the movement in the spine.  As pain subsides therapists use gentle exercise and possibly some manual therapy to strengthen the back or neck to help avoid a recurrence.

Patients typically have a programme of IDD Therapy and long-term problems can need 20 sessions over a six-to-eight week period.  IDD Therapy is still relatively new to the UK but there is a network of providers around the country.

Injections

Injections are quite controversial because until recently they have been given widely to people with long term disc problems.  When a patient has a slipped disc and pain, there can be inflammation in the area.  This inflammation can cause pain on its own.

There are different injections, but a steroid injection with or without some local anaesthetic may be given to reduce the inflammation.  Injections can provide temporary relief with the goal to create a window of pain relief where the body can move or where therapists can work with a patient to address the causes of the problem.

The controversy about the effectiveness of injections is because injections do not address the causes of the problem. They can address inflammation but a slipped or bulging disc will still be bulging after the injection.  Hence the question of whether injections really help or not, and why many NHS trusts are scaling back the availability of injections as the cost/benefit is not clear.

Surgery

Spinal surgery can be a very important step for patients with a slipped disc which has not responded to any of the treatments described.  This is particularly the case if the disc is putting pressure on nerves to such an extent that it causes weakness in the legs or arms, or in very severe cases, if a slipped disc puts pressure on the spinal cord and affects our bowel or bladder control, then emergency surgery can be essential.

The most common surgery for a slipped disc is a “microdiscectomy”.  If the disc material is stubbornly pressing on a nerve, the offending disc material may be cut out surgically and removed.  Such surgery is commonly given for leg pain (sciatica) where the disc is pressing on the sciatic nerve and the pain is intolerable.

Surgery can remove the pain immediately.  However, it is not without risks and surgery does not address the causes which led to the weakness in the first place.  Thus, some patients can get complete relief whilst others the pain may remain or even get worse.

Generally, surgeons will operate as a last resort and it can be advisable to get a second opinion before embarking on surgery.

Other treatments

Yoga and Pilates can be helpful in maintaining your body once you resolve the pain. It is important to find a teacher who suits you and understands your condition.

We hear a lot about “core muscles” and whilst there is some debate about how important our core is, generally the more our muscles can support our spines and move freely, the better our discs are protected.

Acupuncture can relieve muscle spasm and back pain, though for a slipped disc it would work best in conjunction with manual therapy and IDD Therapy rather than as a stand-alone treatment.

What next for slipped discs?

We are potentially going to see more slipped discs because generally, people are less active than they used to be and spend a lot more time sitting.  Discs hate to be squashed!

There is a general move in healthcare away from invasive treatments such as injections and surgery, and the emergence of treatments like IDD Therapy, which has replaced traction, means that, combined with increased knowledge about the spine and exercise, we can keep more people on the non-invasive side of spine care.

If the pain is persisting longer than six weeks, I would advise seeing a professional who works with spines, just to make sure that something short term doesn’t progress into something more debilitating and long term.

ABOUT THE AUTHOR

Neil Velleman is a backpain expert, IDD Therapy provider and owner of Atkins Physiotherapy Consultants in Essex.

 ‘Intervertebral Differential Dynamics” or IDD Therapy is the fastest growing non-surgical spinal treatment for intervertebral discs with over 1,000 clinics worldwide and 34 clinics across the UK. Safe, gentle and non-invasive, IDD Therapy helps patients who need something more for their pain when manual therapy alone is insufficient to achieve lasting pain relief. http://iddtherapy.co.uk/

Facebook: IDD Therapy Europe

Twitter: https://twitter.com/iddtherapyeuro

 

 

 

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HOW WRITING/BLOGGING CAN TURN YOUR LIFE AROUND…

As most of my readers may know I started blogging back in 2007 after I had to sell my previous business due to illness.

I wasn’t the brightest of kids and in fact left school with just 2 GCSE’s in Art and Divinity. I had no idea what I wanted to do in life but had always enjoyed writing at school. This was mainly letters to family and friends but I would write page after page after page on what was going on at boarding school.

When I left school my Mum and Dad suggested I went to secretarial college first and then I had a skill I could use if I wanted to go down that route.

I took to shorthand and typing like a duck to water and for the first time in my life achieved a good grade when I left the secretarial college and immediately went into my first job as a secretary with a team of solicitors in Manchester.

I was happy at what I was doing but always fancied doing something myself and always thought I could write a book. Of course back in that day computers were not around and the only way I could get any information about getting a book published was by going to the local Library and reading up on it.

Situations out of my control changed all my ideas when the whole family moved to warmer climates as our Mum (in her 40’s) had suffered a bad heart attack and they advised somewhere warmer for her health.

I never settled abroad and just played around with part time work and looking after my Mum but unfortunately Mum took a turn for the worst and the whole family came back to the UK. We lost Mum at the early age of 53 and life seemed to change quite a lot after that.

I helped Dad out working for him at his offices and learnt all you would need to know about running a business. I then started a family of my own and worked part time and then stayed at home as a full time Mum which back in that day was the norm.

I started on my books again and entered some competitions and still have pages of children’s stories I had written but done nothing about. Fast forward another 25 years and five spinal surgeries later I sold my business and started writing for the local paper on news in my village.

The writing bug had come back and I set up Back Pain Blog I was on a different platform to WordPress which was mainly UK blogs but it closed down so I had to start again. Second time around I named my blog Back Pain Blog UK so people knew where I was based and amazingly I soon had followers and even some of my old ones that had moved onto WordPress had tracked me down.

Since 2007 I have written blogs and articles in magazines for a number of companies, some voluntary, and written on health, food, beauty and local news. I self published my own book on Baking Tips and a book on Complementary and Alternative Therapies for Pain,

I have also written a book for both my children on their life since the day they were born up until they reached the age of 30 years which included of 250 photos. They both treasured these and I have now promised them that I will write a story of their 93 year Grandad’s life who has passed away recently.

I am busy at the moment with an updated version of my Baking Book with lots of tips and all you would want to know about tea and afternoon teas which includes some of my personal recipes.

To say that writing has turned my life around is an understatement after leaving school with just two qualifications neither of which were related to English. I would encourage anyone who is in constant pain or lonely to try and write a blog and make some new friends along the way. It’s something to get up for and something which keeps your brain active.

I have in the last two weeks bought myself an iPad Mini4 which I am writing on at the moment as I can no longer lift a laptop due to the pain whereas this little iPad is perfect for writing on.

Feel free to ask me anything about blogging or self publishing just pm through my blog and I will happily get back to you.

WHAT IS CHRONIC PAIN? TWO GREAT ARTICLES ON HOW TO EXPLAIN YOUR CHRONIC PAIN…

What is a chronic pain? These two great articles explain how you can tell other people what chronic pain feels like.

New Life Outlook says that it’s almost funny that the single word #pain is supposed to mean all of the different sensations you feel when you live with a chronic pain condition. I find it hard to describe in words how different pains physically feel, especially to someone who does not have chronic pain. Sometimes a metaphorical image captures it best.

Visual metaphors are better able to evoke understanding and empathy in others (G. D. Schott). If I tell you about a large needle being slowly inserted into my eyeball, your reaction is likely to cringe, grimace or squint your eyes. When you hear someone describe an image of something happening to them, your brain will “mirror” that experience – you imagine what it would feel like for the same thing to happen to you. Using visual metaphors can help you to describe your #pain better to your doctors and your family and friends. If you have chronic pain, just reading or hearing descriptions of #pain metaphors might start to make you feel tense and stressed. Images can elicit a very physical response, bypassing the analytical parts of our your brain.

New Life Outlook also points out that using your imagination is a helpful way to distract from focusing on #pain, which is likely another reason that visualization can help to manage #pain. Numerous studies have demonstrated that guided imagery reduces pain and improve physical function.

The National Pain Report says that people who don’t have experience with it seem almost incapable of understanding chronic pain. This is so true. We live it, but we don’t even understand it ourselves, so how can we expect anybody else to? It’s unnatural to have #pain without an injury, it’s unnatural not to heal and get better, but this is exactly what chronic pain is and does. It’s persistent, pervasive, and permanent nature is almost incomprehensible, even to those of us who live with it.

We are expected to “get better”, and people seem to lose patience with us when we don’t. Often we can’t even explain why it hurts, just that it does, and this lack of a clear reason seem to invalidate our experience in others’ eyes. We live in a visual, evidence-based culture. The same doctor that is willing to prescribe us loads of pain medication for a broken bone or after surgery becomes unsympathetic when our #pain isn’t visible. To overcome these obstacles, we must find a way to explain our suffering in a way others can understand.

To start telling someone about your chronic pain, you should explain to them the root of your #pain. You may not feel comfortable giving specific details, and you don’t need to. You may want to tell the person what hurts you, like your back, head, or the entire body. If you don’t feel like going into all the details, you may suggest that the person research the condition. You may also choose to print out basic information for the person to read.

Tell them about the #pain scale. Most people with chronic pain evaluate the #pain on a #pain scale. You should tell the person about this scale so they can understand the intensity of your #pain when you give them a number.

Describe the type of #pain. You could use words like stabbing, dull, sharp, tingling, throbbing, feeling warm/hot/numb, etc. It might also be helpful to compare it to a minor #pain that the other person may have felt (if applicable). “It kinda feels like the pinch from a shot, but never goes away,” or, “It feels like a rubber band snap. This is just like using visual metaphors like New Life Outlook has shown. If your artistic in any way you could maybe draw a person and indicate where you feel the #pain.