Monthly ArchiveMay 2009
Herniated Discs 18 May 2009 04:28 pm
I haven’t written much about surgery on this site mainly because most of the people who come here are already looking for an alternative and don’t need much convincing.
That’s my story anyway, and I’m sticking to it.
But as luck would have it, I receive email from time to time asking for my advice concerning microdiscectomy. They usually go something like this…
Dear Dumbass on the Internet,
I have just been diagnosed with a herniated disc at L4, L5 and my orthopaedic surgeon is recommending a microdiscectomy. What should I do?
My Usual Response
Thanks for your email.
As far as your surgery question is concerned, keep in mind that I’m not a doctor and can’t diagnose, treat or give specific medical advice to individuals. As a journalist, all I can do is write in general terms. My advice is for educational purposes only and should not be construed as a specific recommendation for your situation.
However, having said that — if there is one thing (in terms of back treatment) I’m more opposed to than chiroquacktic adjustments, it’s back surgery. I believe real candidates for surgery to be a rare minority.
Granted, for some people, there is no alternative. Exercise just isn’t going to fix what’s wrong with their back. The good thing is, most orthopedic surgeons are honest and will tell you when they believe that to be the case. I suggest that you always follow their advice.
Dumbass on the Internet
What I Really Think of Microdiscectomy
Regardless of what terms you put it in; it is essentially a partial amputation. There is no way to get around it. The part of your disc they’re going to remove is never going to grow back.
What you have to ask yourself is, would you agree to that procedure if it were another part of your body? Say a finger or hand, for example.
If you had an injured hand — and there was any chance that it could heal and be rehabilitated — would you take that chance or would you just give up and go for the amputation?
I can’t make that decision for someone else, but I know what my answer would be. They would have to drag me kicking and screaming into the O.R.
Keep in mind that the part of your disc they are going to trim off still has to heal. It will probably take just as long to heal as the bulge itself. It is going to leave the disc thinner and more vulnerable to bulging or rupture in the future.  And you’re still going to have to do physical therapy after the surgery.
The only difference is they hope that by removing the bulge, it will stop the sciatica symptoms. It is a symptomatic approach to treating the problem and that is seldom the best choice.
What I Would Do
My advice is to wait at least three to six months. And, according to Dr. Nelson of the Physician’s Neck and Back Clinic, this is also the recommendation of the American Academy of Orthopaedic Surgeons. 
In the mean time, try rebuilding your back through physical therapy and see if you can’t rehabilitate your spine and this wayward disc. 
Even if you’ve already tried some form of physical therapy and had disappointing results it doesn’t mean that PT isn’t going to work. Just as not all doctors are the same, physical therapists and physical therapy programs can vary widely.
Talk it over with your surgeon and see what he thinks. If he’s okay with it, I would put surgery off for as long as you can.
1. Deyo, R.A., and Weinstein, J.N. (2001, February). “Low back pain.” New England Journal of Medicine 344(5), pp. 363-370.
Patients with suspected disk herniation should be treated nonsurgically for at least a month… Even with successful surgery, symptoms often recur after several years.
2. Nelson, B. Disc Syndromes. Physicians Neck & Back Clinics 
Studies show that only about 1 in 10 disc syndromes eventually need surgery so non-operative care is often very successful… In fact, the American Academy of Orthopedic Surgeons recommends delaying surgery for 3-6 months [except for extremely rare conditions].
3. Orthogate, Lumbar Disc Herniation (eOrthopod) Friday, 28 July 2006
Most people with a herniated lumbar disc get better without surgery. As a result, doctors usually have their patients try nonoperative treatments for at least six weeks before considering surgery.
Neck Pain 18 May 2009 04:07 pm
Neck pain can be caused by anything from sleeping at a bad angle, a sudden movement, a sports injury or the ever-popular wife-parks-a-truck-on-top-of-your-Ferrari type automobile accident.
And, as luck would have it, the only real cure for strained neck muscles is rest. You just have to give them time to heal.
However, there are several options available to help you minimize the pain while your body is going about the healing process. (And some of them actually work.)
Why Not Try Ice?
It may not be very glamorous, but one of the best pain relief treatments available is just plain old ice.
Ice reduces pain by reducing inflammation and swelling, numbing the injured area and slowing nerve impulses that carry pain signals to the brain. What’s more, many doctors and physical therapists believe that applying ice to soft tissue injuries assists with the healing process.
How Ice Works
Most neck pain is the result of minor soft tissue injuries such as strained or sprained ligaments. And like any sprain, this can lead to inflammation, muscle spasm and stiffness as the body tries to protect the injured area.
Ice helps reduce the inflammation, which in turn greatly reduces the pain.
Another way ice assists with the healing process is by reducing the swelling, which can help decrease tissue damage.
Ice also acts like a local anesthetic by numbing the area and slowing the nerve impulses that carry pain signals to the brain. These nerve impulses are what cause the muscles to spasm.
Another Way Ice Helps
As you might expect, when applying ice to an injured area the cold causes the veins and capillaries to contract. This temporary contraction of the blood vessels reduces circulation — which helps to reduce the swelling — but also produces a beneficial side effect.
When you remove the ice, the veins and capillaries will respond by dilating and this in turn brings a rush of new blood directly to the injured tissues. This fresh blood caries nutrients that are vital to the healing process.
So you see, ice therapy actually works on several levels.
General Guidelines for Ice Therapy
Ice usually works best if it is applied during the first two days following an injury. After that, heat is usually more effective.
If you wish to try this technique, be sure not to place the ice directly against your skin. Instead, wrap it in a towel or use an ice pack so that you don’t burn the underlying tissue. (I like using a plastic bag half full of ice water so that it can be molded around the injured area.)
You should only keep the ice on for about 5 minutes at a time.
The treatment can be repeated two or three times a day.
(Please note: Ice should not be used if you have rheumatoid arthritis, Raynaud’s Syndrome, or you are suffering from paralysis or other form of impaired sensation.)
While muscle strains and pulled ligaments are not very serious injuries, they can be extremely painful. Fortunately, ice therapy is a quick and easy way to obtain significant pain relief without breaking the bank.
So the next time life hands you an unexpected surprise, just remember that good old-fashioned ice is still one of the most effective forms of neck pain relief available.
Neck Pain 18 May 2009 04:00 pm
Compared to most therapies heat is pretty hard to beat. It’s very inexpensive, it’s easy to do, it doesn’t require an appointment and it carries no side affects. You can do it while relaxing at home and there are even portable heat wraps you can use in the car or at work.
Physical therapists will often combine heat therapy with other treatment modalities, such as ice therapy, electro therapy, stretching and exercise. Heat therapy is highly effective for anyone looking for a non-pharmaceutical form of back pain relief.
Choosing the Right Product for You
Appling heat therapy starts with getting the right heat source. You want something that can hold a constant temperature for an extended period of time. Nothing is worse than having your hot pad go cold half way through the session.
An adjustable thermostat is also handy for setting just the right temperature and taking the guesswork out of the process.
Your hot pad just needs to feel warm. It isn’t necessary to have the thing so hot that you risk burning your skin.
Secondly, you need heat that will penetrate deeply into the muscles. Heat sources – such as creams and sprays – that just warm up the skin will do little to relieve that back or neck pain.
Which is Best, Moist Heat Or Dry Heat?
Dry heat such as you get from electric heating pads is far easier to apply to the lower back and neck than say a sloppy wet towel for the simple fact that you don’t have to worry about getting your clothes wet. Plus, electric heating pads are adjustable and will remain at a constant temperature for as long as they’re plugged in.,/p>
Towels lose heat rapidly and have to be constantly changed.
Moist heat tends to penetrate better because the water molds to the body and thus, provides better heat transfer. This leads some people to conclude that moist heat provides more pain relief than dry, but this is really a matter of perception rather than fact. If you have access to a hot tub or whirlpool bath then moist heat becomes a little more convenient plus the additional massage feature is a nice bonus.
Actually deciding between moist heat verses dry heat doesn’t really matter. Both are equally effective. What it really comes down to is a matter of personal preference and practicality.
Heat Therapy Options
You have a number of options for applying heat therapy to your aching back or neck some of which we’ve already discussed.
There is the old-fashioned hot water bottle, which will stay warm for up to 30 minutes but it isn’t adjustable, doesn’t maintain a constant temperature and has to be refilled if you need it to go longer.
Then there’s my favorite – the electric heating pad – which comes with an adjustable thermostat, maintains a constant temperature and can be applied anywhere, anytime with no muss and no fuss.
Next are the moist heat options such as the hot tub, sauna, steam baths or even a good old hot bath… all very effective and definitely enjoyable… but not as convenient as the above options in my opinion.
Finally, you have the newer high tech toys like heat wraps and gel packs that you can heat in the microwave or in hot water. These are fine products and definitely do the job, but they can be expensive and don’t really match the electric heating pad for convenience. (Can you tell I’ve already made my choice?)
How Long To Apply Heat
If you’re like me, the longer you can spend relaxing the better. But sometimes that just isn’t possible.
Generally speaking, for minor back pain 15 to 20 minutes should be sufficient. For more severe pain – or in really stubborn cases – you may need to spend anywhere from 30 minutes to as long as 2 hours for the treatment to be effective.
How long you apply the heat will depend on the severity of the pain and how long it takes for you to experience relief. In other words, you’re going to have to experiment a little to find what works best for you.
Heat Therapy Precautions
Before we wrap up this discussion on using heat for back pain relief, there are some things you should keep in mind. Namely, that heat is not always appropriate for all situations.
For example, you should not apply heat to a new injury that might be swollen or bruised. The heat will simply cause additional swelling and ice would be a better solution. The accepted rule is to use ice for the first two days following an injury, after which you can then apply heat safely.
In addition, heat should not be used if you have the following conditions: Heart disease, high blood pressure, peripheral vascular disease, deep vein thrombosis, diabetes or dermatitis.
And, as with any form of treatment, always check with your doctor before attempting to handle the matter yourself. Chances are, he’ll give you the go ahead, but it’s always better to be safe than sorry. Right?
Heat May Just Be Neck Pain’s Nemesis
So, if you’re after a simple, easy to apply, natural form of back or neck pain relief, don’t overlook the benefits of heat therapy. Unlike the pharmaceutical options, heat therapy doesn’t just mask the pain. It actually works with your body to promote the healing process.
Till next time,
1. Press Release: Heat Halts Pain Inside The Body, University College London, July 5, 2006