Back problems

[macp]

Can anybody comment or have any experience of the following product

http://www.qvcuk.com/ukqic/qvcapp.aspx/app.detail/...

swmbo suffers with sciatica and (we think) a herniated disc.

[E21_Ross]

macp said:

Can anybody comment or have any experience of the following product

http://www.qvcuk.com/ukqic/qvcapp.aspx/app.detail/...

swmbo suffers with sciatica and (we think) a herniated disc.

hi again,

sorry to hear she is still suffering the problems. i will re-email the guy here to see if he can get a good contact for you. what happened with the GP?

regards the product, i would be weary of buying that, especially before any imaging has been done. you mention possible herniated disc...but if it's herniated to the more posterior aspect, then extending the spine like that could do more harm (if you extend the spine, more pressure is placed upon the posterior aspects of the motion segment; vice versa for full spinal flexion)

I would certainly wait before spending. I will try desperately to get you a decent chiro near there and get back to you within a day or so.

Ross.

Edited by E21_Ross on Monday 15th March 15:17

[macp]

Hey Ross thanks for the reply

Well she is in a lot less discomfort than she was thats for sure but she only has to twist or make some kind of movement which will trigger a short spasm.Her doctor wants to liase with the physio in the same clinic and come up with a treatment plan.My sister works for Total Fitness who have special facilities for such injuries and she is looking into a special membership plan.

We have been reading up a lot on tinternet and believe it is a herniated disc from her sypmtons.I also remembered that she saw an NHS physio a few years ago when she had the same problem and was advised she had a cracked disc.

[E21_Ross]

macp said:

Hey Ross thanks for the reply

Well she is in a lot less discomfort than she was thats for sure but she only has to twist or make some kind of movement which will trigger a short spasm.Her doctor wants to liase with the physio in the same clinic and come up with a treatment plan.My sister works for Total Fitness who have special facilities for such injuries and she is looking into a special membership plan.

We have been reading up a lot on tinternet and believe it is a herniated disc from her sypmtons.I also remembered that she saw an NHS physio a few years ago when she had the same problem and was advised she had a cracked disc.

so she still hasn't received any actual treatment or had any imaging done to check whether it's a herniation or not? as long as she gets some treatment which helps then that's brilliant, but make sure she doesn't have to wait too long! glad to know she's not in as much discomfort any more; probably local tissues have calmed down a bit and inflammation has calmed too.

a physio advised she had 'cracked' a disc!? interesting terminology there a tear will probably be the more apt word. that will be great if you can get that total fitness thing. i would just be weary of doing any exercises etc without really knowing what the cause could be. like i said, if it's a posteriorly herniated disc then you don't want to do too much extension or rotation. any exercises which aggravate the surrounding area could bring some more inflammation about which would only make her pain worse.

i hope she manages to get some treatment soon and it helps her. if things don't go to plan, you always have my email and i'll be more than willing to see what i can do to help you out.

i'd ask the physio about that "back stretcher" thing, though i think at this stage it would be best to leave it.

all the best,

Ross.

[996 sps]

As E21 has already said don't purchase that,a rolled up towel could offer the same job and as already mentioned get the physio to give you advise you.

Has she been given piriformis/Gluteal stretches for her sciatica nerve pain? Just out of interest.

Ross just out of interest why don't you issue extension exercises for suspected IVD bulges? i.e prone laying and person pushing up onto elbows to increase ext.

[E21_Ross]

996 sps said:

As E21 has already said don't purchase that,a rolled up towel could offer the same job and as already mentioned get the physio to give you advise you.

Has she been given piriformis/Gluteal stretches for her sciatica nerve pain? Just out of interest.

Ross just out of interest why don't you issue extension exercises for suspected IVD bulges? i.e prone laying and person pushing up onto elbows to increase ext.

well...if there is a disc herniation (which we obviously don't know yet) it could have herniated posteriorly (like this image taken, courtesy of the good ol' wikipedia)




can you imagine that if you extend the spine (i.e. bend backwards) can you see that you are going to put yet more pressure upon that herniated disc? potentially causing further damage? it is the exact same for an anteriorly herniated disc...the last thing you want to do is fully flex the spine, it could cause more damage (fully flexing the spine is not great anyway, especially if you've just woken up!!)


I personally would not want to give any exercises/treatment etc at all without imaging in this case. that would mean MRI or CT scan.


edit: piriformis and gluteal stretches could help but certain stretches could put the spine in positions which could potentially cause more damage if it's a herniation, so again, i would be weary unless advised by someone who has had a good poke around and knows the exact situation.

Edited by E21_Ross on Monday 15th March 19:57

[davhill]

In my experience, a prolapsed (herniated) disc starts off by feeling like a dislocated hip. Mine, at the lowest, most likely joint S1 (sacral), L5 (lumbar) pressed on my right sciatic nerve. This level is the most likely to prolapse, it takes most of the strain.

Just FYI, each disc has a tough, fibrous outer 'ring' (the annulus) and a jelly-like centre (the nucleus pulposus). The annulus splits and the nucleus material gets pushed out - that's what presses on the nerves.

Some say that a 'slipped disc' will fix itself with time. Mine didn't, nor have two surgeries fixed it.

My recommendation is to get the MRI imaging organised asap. There's too much risk of doing some damage by trying to exercise the problem away first.

Good luck!

[macp]

996 sps said:

As E21 has already said don't purchase that,a rolled up towel could offer the same job and as already mentioned get the physio to give you advise you.

Has she been given piriformis/Gluteal stretches for her sciatica nerve pain? Just out of interest.

Ross just out of interest why don't you issue extension exercises for suspected IVD bulges? i.e prone laying and person pushing up onto elbows to increase ext.

Thanks
Regarding excercise she has been told to pull her knee up then across her body but she hasnt been doing them.

[macp]

Ok many thanks all I think we have got the message.

Diagnosis,diagnosis,diagnosis!!

She will call her doctor tomorrow with the intention of pushing for a scan.How likely is she to get one and how soon ?

Anybody know ?

[E21_Ross]

macp said:

996 sps said:

As E21 has already said don't purchase that,a rolled up towel could offer the same job and as already mentioned get the physio to give you advise you.

Has she been given piriformis/Gluteal stretches for her sciatica nerve pain? Just out of interest.

Ross just out of interest why don't you issue extension exercises for suspected IVD bulges? i.e prone laying and person pushing up onto elbows to increase ext.

Thanks
Regarding excercise she has been told to pull her knee up then across her body but she hasnt been doing them.

this atleast will not be extending the spine at all, and will possibly relieve tension on the posterior (towards the back) part of the disc. it will probably help relax piriformis and the gluteal muscles too which can only help. i strongly advise...if she's been told to do them then do them. if it causes her much pain to do, then stop immediately. there is no harm trying.

regarding how long to get a scan done through NHS i have absolutely no idea i'm afraid! i know privately they are quite costly, i think the clinic here charge around the £200 for an MRI scan but that's private, so it's probably more expensive, but at least same day.

keep pushing for that scan, keep pestering the GP until she gets what she deserves! at the end of the day, in this situation, a proper treatment plan can't begin without a scan so just get them to get off their arses to sort her a scan out

best of luck!! you are doing well so far.

Ross.

[996 sps]

macp said:

Ok many thanks all I think we have got the message.

Diagnosis,diagnosis,diagnosis!!

She will call her doctor tomorrow with the intention of pushing for a scan.How likely is she to get one and how soon ?

Anybody know ?

Can't help you here MACP but fingers crossed you get it sorted.

E21 I get the picture if the hernia is that severe the nerve impingement would be painful (understatement), our patient population would are far less of an end state than that and we do issue ext exercises (Mobility). Flexion in the morning!!!! Oh my McGill would shake in his boots......

[E21_Ross]

996 sps said:

macp said:

Ok many thanks all I think we have got the message.

Diagnosis,diagnosis,diagnosis!!

She will call her doctor tomorrow with the intention of pushing for a scan.How likely is she to get one and how soon ?

Anybody know ?

Can't help you here MACP but fingers crossed you get it sorted.

E21 I get the picture if the hernia is that severe the nerve impingement would be painful (understatement), our patient population would are far less of an end state than that and we do issue ext exercises (Mobility). Flexion in the morning!!!! Oh my McGill would shake in his boots......

what is it you do if you don't mind me asking?

for sure, extension exercises are absolutely fine, it's just in this case i wouldn't advise any until we know what's going on. we don't know if it's herniated or not, it could be severe, it could be minor.

i seem to remember you mentioned mcgill in another thread...IMO at least, he's very, very good. his research is fantastic! going to one of his talks later in the year (or is it early 2011, i can't remember!) should be very interesting.

cheers mate

[E21_Ross]

just sent you an email peter.

Let me know if you got the forwarded text ok. Sent from phone so not 100% sure it went ok.

Ross.

[macp]

Got your email thanks Ross

She tried to book an appt with her doctor this morning but her doctor has buggered off on holiday for two weeks which means she has to see somebody who will only be working off notes.How the hell does she get a diagnosis and begin to get herself fixed.

I guess your contacts can help with this Ross,any idea of the rates for a decent chiro.Not that a begrudge paying anything within reason and she cannot work and thus earn a living until she is healed but it would be good to get an idea

[E21_Ross]

macp said:

Got your email thanks Ross

She tried to book an appt with her doctor this morning but her doctor has buggered off on holiday for two weeks which means she has to see somebody who will only be working off notes.How the hell does she get a diagnosis and begin to get herself fixed.

I guess your contacts can help with this Ross,any idea of the rates for a decent chiro.Not that a begrudge paying anything within reason and she cannot work and thus earn a living until she is healed but it would be good to get an idea

best bet would be to ring those 2 contacts i gave you and ask for quotes. it's not cheap, but it won't be stupid by any stretch of the imagination. it varies between clinics and experience so just call them. my guess, £30 for a treatment? but if it gets her up and working sooner, then it probably a price worth paying.

no harm ringing them mate. sorry about the GP. no consideration for their patients at all really.

cheers.

[Bill]

996 sps said:

Ross just out of interest why don't you issue extension exercises for suspected IVD bulges? i.e prone laying and person pushing up onto elbows to increase ext.

Because he's never heard of McKenzie...

There's no reason not to (and according to McKenzie every reason to do) extension exercises. Certainly I've treated discogenic back pain successfully with prone extension and variations.

There is also no need for a scan in the absence of neurological signs (ie weakness or reflex loss) as a MRI isn't very specific (so there are plenty of false positives where there is a symptomless disc bulge).

[E21_Ross]

Bill said:

996 sps said:

Ross just out of interest why don't you issue extension exercises for suspected IVD bulges? i.e prone laying and person pushing up onto elbows to increase ext.

Because he's never heard of McKenzie...

There's no reason not to (and according to McKenzie every reason to do) extension exercises. Certainly I've treated discogenic back pain successfully with prone extension and variations.

There is also no need for a scan in the absence of neurological signs (ie weakness or reflex loss) as a MRI isn't very specific (so there are plenty of false positives where there is a symptomless disc bulge).

excuse me, but i have said multiple times (in the other thread) that a physical/neuro-orthopaedic exam should be done prior to see if imaging was necessary. and without having done a physical, it's not reasonabe to issue extension exercises and say of course they will work, or they certainly won't cause any further potential damage. in further regard to back extension exercises, you may have seen earlier i did not say 'in every disc herniation you should never do them', quite the contrary, i said they could well be issued, but only once it is known exactly whats wrong, following physical or imaging modality.

Edited by E21_Ross on Tuesday 16th March 15:25

[Bill]

E21_Ross said:

excuse me, but i have said multiple times (in the other thread) that a physical/neuro-orthopaedic exam should be done prior to see if imaging was necessary. and without having done a physical, it's not reasonabe to issue extension exercises and say of course they will work, or they certainly won't cause any further potential damage, that is quite frankly absurd. in further regard to back extension exercises, you may have seen earlier i did not say 'in every disc herniation you should never do them', quite the contrary, i said they could well be issued, but only once it is known exactly whats wrong, following physical or imaging modality.

So, what did you mean when:

you said:

if it's a posteriorly herniated disc then you don't want to do too much extension or rotation.

And this bit is over the top, no?

E21_Ross said:

I personally would not want to give any exercises/treatment etc at all without imaging in this case. that would mean MRI or CT scan.

E21_Ross said:

keep pushing for that scan, keep pestering the GP until she gets what she deserves! at the end of the day, in this situation, a proper treatment plan can't begin without a scan so just get them to get off their arses to sort her a scan out

There is no justification for imaging in simple mechanical back pain and sciatica.

[E21_Ross]

Bill said:

E21_Ross said:

excuse me, but i have said multiple times (in the other thread) that a physical/neuro-orthopaedic exam should be done prior to see if imaging was necessary. and without having done a physical, it's not reasonabe to issue extension exercises and say of course they will work, or they certainly won't cause any further potential damage, that is quite frankly absurd. in further regard to back extension exercises, you may have seen earlier i did not say 'in every disc herniation you should never do them', quite the contrary, i said they could well be issued, but only once it is known exactly whats wrong, following physical or imaging modality.

So, what did you mean when:

you said:

if it's a posteriorly herniated disc then you don't want to do too much extension or rotation.

And this bit is over the top, no?

E21_Ross said:

I personally would not want to give any exercises/treatment etc at all without imaging in this case. that would mean MRI or CT scan.

E21_Ross said:

keep pushing for that scan, keep pestering the GP until she gets what she deserves! at the end of the day, in this situation, a proper treatment plan can't begin without a scan so just get them to get off their arses to sort her a scan out

There is no justification for imaging in simple mechanical back pain and sciatica.

for all you know, couldn't there be a spondylolisthesis your extension exercises won't help there will they. you don't want to issue extension exercises (or any for that matter) without having a full exam which i clearly stated should be done in the previous thread. you have no patient history, for all you know, she could have been a gymnast who does repeated hyperextension, which could cause a fracture of the pars (i.e. in a spondylolysis which could lead to a spondylolytic spondylolisthesis). i haven't just said don't do these exercises because if it's a herniated disc etc etc, i've said it (or at least meant it!) because there is no way of knowing what is going on. if you say to her do extension exercises, it's absurd to just say they will make her get better, or, in the (albeit probably unlikely) case of a spondy for example, make it worse.

and i said "you don't want to do too much...." not "you don't want to do any...."

it's not because i've not heard of mckenzie, it's because i'm being cautious!


just out of curiosity, in physiotherapy, do you do learn about stuff like HADD, DISH, OPLL and so on? random question i know

edited

Edited by E21_Ross on Tuesday 16th March 16:03

Edited by E21_Ross on Tuesday 16th March 16:23

[Bill]

She could also be fast bowler or Inuit