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As most of my readers know I suffer from chronic back pain. Nowadays spinal fusion is not used as the first choice for prolapsed discs with pain management being the first treatment and only if nerves are compressed is it used as another option.

The problem with spinal fusion especially if you have more than one surgery is the pressure it puts on the disc below and above your fusion.

Another condition which you can also suffer from after any type of surgery is Myofascial Pain Syndrome which is a chronic painful muscle disorder and is common if you have experienced a muscle injury. Over time these myofascial restrictions can lead to poor biomechanics, altered structural alignment, compromised blood supply and pain. Other causes of myofascial pain are injuries to an intervertebral disc, general fatigue, repetitive motions, and some medical conditions.

The symptom of the condition includes muscle pain that feels like a firm knot, which is accentuated when moved. Myofascial pain syndrome gets worse or fails to improve over time. Muscles feel weak, stiff and inflexible and have a reduced range of motion. Due to the pain, there may be difficulty in sleeping, which may also affect a person’s mood.

It is characterised by the myofascial trigger points and the symptoms include persistent or worsening pain, deep and aching muscle pain, tender knots located in the muscles and pain after exercise or sporting activity.

Myofascial Pain Syndrome (MPS) is the name given to pain caused by trigger points and fascia (connective tissue) adhesions in the body, usually in muscle tissue, and inflammation in the body’s soft tissues. The myofascial pain is usually caused by overuse of the muscle, trauma (injury) or psychological stress. Other contributing factors may include bad posture, small lesions, soft tissue tension or rheumatic arthritisgoutthyroid problems, or psoriasis among other diseases.

Myo = muscle
Fascia = the main connective tissue in the body
Release = to let go, ease pressure

Treatments include anti-inflammatory medication, pain killers, physical therapy, stretching, massage therapy and trigger point injections.

A trigger point injection is either a cortisone injection or dry needling. Pain relief is quick and helps in continuing physical therapy. Trigger point injections can also be used for people suffering from degenerative disc disease.

Understanding the cause of your pain is an important step to finding an effective solution. It may involve a series of sessions and an at home program to keep the area strong.

Disc pain can come from a disc bulge or prolapse but you can also get myofascial pain which could be treated conservatively instead of surgery. Fibromyalgia patients can also suffer from myofascial pain. According to history, Sir William Gowers introduced the term fibrositis for a common, but idiopathic, localized form of muscular rheumatism that is now recognised as myofascial pain syndrome in 1904. And, despite the intervening years, it still constitutes the largest group of unrecognised and undertreated acute and chronic pain problems. Some people (like myself) have also been told they could have Fibromyalgia, previously named ‘fibrositis’.

Nerve block injections into your neck for a disc bulge can be quite dangerous as they are quite tricky to do and they go through the front of your neck.

I guess with any spinal pain after you have had all the tests it’s then worth trying alternative treatments well before you resort to surgery which is something I have always said I would avoid having.

Source: Top Doctors

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Massage can bebut some very relaxing and some can work better than others. There are a number of different types of massage. Here’s a list of them…

  1. Chair Massage – this can be very handy if you cannot get out for a massage. It is performed fully clothed by a professional for instant stress relief. This is an efficient way to unwind especially effective for shoulder tensions.
  2. Trigger Point Massage – trigger point massage is a form of bodywork that focuses on identifying knots in your muscles and then breaking them up, or releasing them, by bringing fresh blood to the area. This type of massage is particularly popular among those who suffer from chronic pain. You don’t usually need to strip down for the session, though lightweight clothing is recommended.
  3. Aromatherapy Massage – During an aromatherapy massage, essential oils may be applied directly to the skin or simply diffused into the air—either way, the idea is that these oils have benefits when it comes to relaxation, mood and pain management.
  4. Sports Massage – The masseuse typically uses a combination of multiple techniques (stroking, kneading, compression and trigger points, to name a few) to improve joint range of motion and flexibility while reducing muscle tension. 
  5. Thai Massage – Thai massage is distinct from the rest in that it combines yoga-like body positioning with massage techniques. The end result is a far more participatory massage experience that involves stretching and movement, in addition to pressure being applied to certain areas of the body. Thai massage can help reduce back pain, increase joint mobility and relieve headaches.
  6. Reflexology – Reflexology is a type of massage that revolves around the traditional Chinese belief that certain pressure points in the hands, feet and ears correspond to other organs in the body. It can be an effective way to ease stress and anxiety.
  7. Deep Tissue Massage – Deep tissue massage involves applying considerably more pressure than Swedish massage in order to target the inner layers of muscle tissue. It can reduce muscle tension and considerable relief for those who suffer from chronic pain.
  8. Shiatsu Massage – This form of traditional Japanese bodywork involves using the fingers, thumbs, palms and sometimes elbows to apply relatively deep pressure to specific areas in an effort to reduce tension and improve blood flow. It has a wide range of health benefits, inluding alleviating lower back pain.
  9. Hot Stone Massage – This moderate pressure massage therapy combines Swedish massage techniques with the use of heated volcanic stones to improve blood circulation and ease pain. This massage might involve both hot and cold stones and is designed to reduce pain, ease muscle tension and promote a general sense of well-being. 
  10. Swedish Massage – The Swedish massage relies on a variety of techniques—effleurage, percussion and kneading, among others—to relieve tension, improve blood circulation and give your mood a boost.
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What is the difference between a disc protrusion/bulge/herniated and a slipped disc?

A disc protrusion is typically classified as a disc with less than 180 degrees of the disc displaced, while a bulging disc is more than 180 degrees.

A healthy intervertebral disc comprises two parts. The centre of the disc is called the nucleus pulposus, which comprises a strong gelatinous like substance. The outer part is the annulus fibrosis. This is rich in pain carrying nerve fibres called nociceptors, in particular the outer 1/3 of the disc. When the disc loses its elasticity, it may protrude outside its normal boundary and may compress the spinal nerves or spinal cord.

A ‘disc bulge’ is a word used to describe findings seen on an MRI study of the spinal discs. The spinal discs are soft cushions that rest between the bones of the spine, the vertebrae. A normal spinal disc is critical to mobility of the spine. The disc functions to absorb energy in the spine, yet also allow the spine to bend and rotate.

A disc bulge is more common in the lower back (Lumbar Spine), but can occur anywhere in the spine, including your neck (cervical). If the disk bugle is progresses and the outer layer of the disc starts to rupture it is referred to as a herniated disc.

Similar to a disc bulge, a disc herniation or protrusion can also extend into a tunnel and compress a nerve. However, unlike a disc bulge, a disc herniation involves tearing of the disc. The fibrous outer ring of the disc tears creating a fissure from the edge of the disc to the nucleus (the jelly-like inner core). This allows the core to protrude, creating an out pouching. This is a Disc Herniation or sometimes called a Disc Protrusion.

Symptoms of a bulging disc include:

  • Numbness
  • Weakness
  • Tingling
  • Muscle spasms or cramping

These will depend on the region of the spine where nerve compression occurred, but they typically occur along the spine.

A slipped disc is when a soft cushion of tissue between the bones in your spine pushes out. It’s painful if it presses on nerves. It usually gets better slowly with rest, gentle exercise and painkillers.

A slipped disc (also called a prolapsed or herniated disc) can cause:

  • lower back pain
  • numbness or tingling in your shoulders, back, arms, hands, legs or feet
  • neck pain
  • problems bending or straightening your back
  • muscle weakness
  • pain in the buttocks, hips or legs if the disc is pressing on the sciatic nerve (sciatica)

Not all slipped discs cause symptoms. Many people will never know they have slipped a disc.

In reality, the term disc protrusion or slipped disc is a ‘catch-all’ term for a range of disc problems where a portion of the disc wall becomes weakened and bulges or ultimately disrupts with the soft “Nucleus Pulposus” extending backwards into the spinal canal and irritating or compressing the descending or exiting nerves.

A recent MRI of my spine showed that I have a number of broad based disc protrusions in my lumbar and thoracic spine as well as large disc herniation in my cervical spine but at the moment none are needing surgical intervention.

Source: Spinal Foundation, NHS Spinal Stenosis