Expert: Dr. Victor Dolan, DC, DACBSP - 12/2/2008

Question
Hi. I had an MRI 2 months ago and I have a herniated disc in the l4 and then I have a bulgin disc in the l5. I just started rehab. I was wondering a couple of things.......First of all what is the best way for me to sleep.......and second of all how long of rehab do you think I would have to do in order to get back into shape to workout and play sports. Thanks alot. By the way im 21 years old

Answer
Bulging Disc , Herniated Disc , HNP , low back pain , sciatica , slipped disc ,

Hello Mohannad,

Sorry to hear of your HNP (herniated disc) at L4 and the bulging  disc at L5.

You are 21 years old, so young to have such problems.  Do you have a physically active life- lots of physical stress/ wear/ tear?  Do you have an activity where you do a lot of repetitive motion, the same bending and lifting over and over? Did you have some type of injury, accident, trauma?  Did you get hurt in an athletic event?  Did you get hurt at work (workers compensation)? auto accident?

You are 21 years old. Good!  You should heal.  You are young, you should heal.

Q) Best way to sleep:
A) Sleep on your back or side, legs bent at the knees, on a firm bed.  It is NOT an old wives tale that sleeping on a firm mattress is best; it is actually true.  Sleep on a firm mattress, do not sleep on a couch, chair, whatever.  If you sleep on your back, place a thick pillow underneath your knees, sleep on your back with your legs bent at the hips and knees.  If you sleep on your side; also sleep with your hips and knees bent, with a thin pillow between your knees.  People usually find the best side position is with the 'bad side' up,,,,,, if one side, one leg hurts worse then the other, sleep with that side up when on your side. Do NOT sleep on your stomach.

Q) Length of rehab:
A) It is good you had your MRI test.  Now you know you have damage, the extent of damage, it has impressed your mind, it has explained the need for treatment and rehab.  BUT - do not go crazy - a herniated disc is a serious problem, BUT - it is highly variable in it's course and affect upon your life.

In my Staten Island Chiropractic office I utilize information handouts, this may help you:
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Lower  Back  Pain  (LBP):          
Low  Back  Pain  can be caused by many different things.  Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).  Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).  

Bad things, like  - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic.  LBP can come from a motor vehicle accident, sport injury, slip, trip, fall, arthritis, lifting improperly, or even bad posture in standing, sitting or sleeping.  All of these things often have a Lumbar (Low Back) Vertebral Subluxation involved.

              Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems. A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.



This is a serious condition identified by its five parts:

    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.



The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.

         Workers Compensation Injury, Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical-  problem requires a mechanical   correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians;  Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine
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Herniated disc in the lumbar spine can often result in Sciatica.  Sciatica is an irritation or inflamation of the sciatic nerve.  Your HNP may or may not include sciatica, leg pain, muscle weakness.

If you only focus upon pain,  be aware- pain medication may take away the pain, but may cause other problems.  Another office handout:


PAIN     Pain  is a  ‘red light on the dashboard’.  
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car- -- do you ignore it until the car breaks down, or do you get it checked and correct the problem?  Pain, pain in your body- -- do you ignore it until your body breaks down, or do you get it checked and correct the problem?   Pain,  do you cover up the pain by taking a painkiller?  Take a painkiller, mask the pain, and allow a problem to progress in your body?

    NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;

The  American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse.  These medications cover up the pain, and cause the problem to worsen.


Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.  VSC can cause pain - correct the cause rather than mask the pain.

Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.
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You seem very interested in returning to Sports, if ATHLETIC PERFORMANCE is important to you, rest assured- going to the Doctor of Chiropractic will not only help your Herniated Disc, but will improve performance once you are able to return to competition:


Athletic  Performance  Improvement,  Accelerated  Recovery

Chiropractic is well known to improve athletic performance, prevent sport injury, and accelerate recovery from injury or hard training.  With Doctors of Chiropractic serving on almost every nation’s Olympic Team, with Chiropractic holding official status with the USOC and serving almost every US Olympic Athlete:  the results of chiropractic cannot be  denied.     Coaches  and  athletes  are  aware  of  terms  such  as                                 
    enhanced  performance,
    performance improvement,                         .
    accelerated  recovery,   
    restoration   and   regeneration.
                           .
Many coaching conferences   discuss   strategies   on   these   aspects   of   exercise,   competition,   sports  and  athleticism.

An interesting study was performed and published way back in 1991.   The January 1991 issue  of  the  Journal  of  Chiropractic  Research  and  Clinical  Investigation  published findings that  demonstrate  significant  increases  in  athletic  performance after  a  twelve  week  program  of  Chiropractic  treatment.
    

Athletic  Ability  Research:

Male and female athletes between the ages of 18 and 42, representing a variety of sports backgrounds, were recruited to participate in this study. None had ever before been under chiropractic care.  Each of these participants underwent eleven separate tests, each test designed to measure a specific aspect of athletic performance. Then, half the participants were evaluated through chiropractic analysis and placed on a twelve week program of chiropractic  treatment   ( consistent regimen of chiropractic, similar to a consistent regimen of physical athletic training/ exercise ).  ( measured aspects: side step test, dodging run, right boomerang run, modified bass tests of dynamic balance, vertical power jump, standing broad jump, distance perception jump, horizontal linear space test, nelson hand reaction test, nelson speed of movement test, nelson choice of response-movement test )

All subjects continued to train and practice as usual in their sports.    At the half-way point of six weeks, they were all reevaluated and changes in scores for each group were compared.   All increases in performances by each group were measured by the average percent  of  change  in  all  eleven  tests  combined.

The control group,  those  not  receiving  chiropractic care, showed slight improvement in  eight  of  eleven  tests  ( this group had been training ‘as usual’ for the time period ).    By combining the average percentages of change on each test it was found that the control  group  showed  an  overall  improvement  of  4.5%.

Those  receiving  chiropractic  treatment   (along with their ‘usual training’),  the  test group, had dramatically different results. They showed improvement on all eleven tests for a total   10.7%  average  increase  after  six  weeks.    And  when  retested again  after  the  second  six  week  period  of  care  this  test  group  demonstrated  a remarkable      16.7%    average   increase   in   athletic   ability.
(  consider  that  one/ onehundredth of a second  ( 1/100th ) is the difference between win – lose,,, 16.7%  is HUGE )
What Do Chiropractors Do?
Chiropractors analyze the structure of the body, looking for misalignments, primarily in the spine, and also the extremities.    Spinal misalignments,   termed      vertebral subluxations,     irritate   the  nerves  which  in  turn  inhibits  the  body’s  ability to function optimally.     Like a high performance automobile,  the human structure must be balanced and in alignment to be at it’s best.    A Ferrari with pistons that don’t fire in sequence,  wheels that are out of balance or alignment,  and high performance specifications  that  are  improperly  set   will   not   only   have   it’s   performance compromised    but  will  also  have  dramatically  increased  potential  for  parts  to  wear  out  and  breakdown.   The  human  body, far more delicate and complicated than even the most advanced automobile is similar.    If  the framework,  particularly the spine,  isn’t properly aligned and balanced-  the body cannot perform  to it’s  potential and is more susceptible to illness and injury,  with  slower  recovery  when  injury does  occur.


What Do Vertebral Subluxations Do?

Vertebral subluxations cause nerve conduction interference.  This inhibits millions of messages from the brain from flowing smoothly along the nerves and in this in turn interferes with the coordination of the actions of the body.  The only health care provider trained to diagnose and correct vertebral subluxations is the Doctor of Chiropractic.  Like a properly tuned Ferrari,  the chiropractic patient athlete,  when properly aligned, functions at a level of peak performance.

Famous Athletes Utilize Chiropractics.

Many athletes have discovered the relationship between proper spinal  alignment and their own level of achievement. San Francisco Forty-Niner Greats Joe Montana and Roger Craig as well as heavy weight champion Evander Holyfield are examples of  professional and world-class athletes who realize(d)  the value of proper structural alignment and balance in their bodies.   They have learned through their own experiences what  research  has  shown;   that  through  chiropractic  care -  one  can demonstrate faster reaction time,  better balance,  improved coordination, increased muscular power;  and when injured-  accelerated recovery and regeneration.

The Competitive Edge.

Emphasis on athletic excellence continues to escalate in this country in terms of both dollars and extremes in personal sacrifice. Though the dangers of taking anabolic steroids have been widely publicized for years, the number of athletes who suffer serious health problems caused steroids continues to grow.  Now, however, the athlete looking for the competitive edge  need not look beyond the framework of  his(her)  own body.  Increased  public  awareness  is  leading  many  to  realize  that  a  natural  method  is  available  in achieving  performance  enhancement.     The  method  is  Chiropractic!
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Your MRI shows the severity of your condition.  It is serious and will require a serious commitment on your part and serious treatment.
I do not know the rest of your health status, so I really cannot hazard a guess at how long this will take you to recover from.  I will give you a very broad range: at the least, I would avoid 'strenuous' activity for a minimum of two months, and it could take a full year of rehab.

Rest and Rehab:  Research shows that ABSOLUTE rest----
bed rest---- is RARELY needed, and if utilized as a treatment approach, ABSOLUTE rest should be used for only the shortest amount of time: hours, a day or two.

Absolute rest allows quick atrophy of the tissues. RELATIVE rest is a different story. IF you have a physical job, and as a mover I would call that physical- relative rest would allow you to walk about, drive, perhaps even go to the store (but do not carry heavy bags!).

'Relative rest' may allow you to go to work, and do desk duty- answer a phone, may allow some limited physical activity.
If we are used to running a marathon every day; walking to the store is relative rest.

Your rehab is specific to you and your individual condition.  If you run 15 miles a day usually,,,,,,, you may not be able to run that now for rehab, but you may run 1/2 a mile now, a mile in a week, two miles in a couple of weeks--- progressively betting better.  I do not know where you are starting at, so I cannot guess your needed length of time to return.  You want to play sports- I do not know where you started; are you a professional,  intercollegiate,  intramural?  I do not know where you are starting from, I do not know where you want to end up.

Back to that MRI,,,  The MRI is very important, BUT, how you feel is even more important.  As stated previously- some people run marathons with herniated discs, some people cannot get out of bed.  You should do what you can.  You should progress as you can.  You have to listen to your body and communicate with your Chiropractor as to your progress, lack of progress, what seems to work, what aggravates your condition.

Your Doctor of Chiropractic will help you tremendously in your rehab.  Traditional chiropractic works wonders for spinal complaints, including herniated discs.  Many chiropractors also utilize noninvasive nonsurgical spinal decompression therapy in their practice.  In my Staten Island Chiropractic office I utilize noninvasive spinal decompression as well as the more traditional chiropractic methods.  

As a DACBSP (Chiropractic sports injury specialist) I utilize exercise, nutrition, rehab, physiotherapy in treatment of the herniated disc.  Most Doctors of Chiropractic utilize a comprehnsive approach now-a-days.  My Staten Island Herniated Disc patients usually fare very well on their road to recovery; but it is VERY individual.

I hope all this information helps answer your questions.  Do not hesitate to recontact me at ALLEXPERTS.com if you have further questions  ( http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm ).



I wish you Good Luck, and
Good Health Naturally !


Dr. Victor Dolan, DC

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Blog article on Workers Compensation:
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