Expert: Scott F. Gillman, DC, DACBSP - 2/26/2008

Question
I am considering a consult with a Neurosurgeon for my back pain.  My recent MRI showed - Impression:1.Mild degenerative disc disease at the L5-S1 level with posterior central disc protrusion associated with an annular tear indenting the anterior thecal sac with no significant spinal canal narrowing or nerve root impingement. 2. Diffuse annular bulge at the L4-5 level indenting the anterior thecal sac and also resulting in mild bilateral foraminal narrowing and no nerve root impingement.
I am currently taking NSAIDS and they seem to be helping.  however this isn't the first time I've been given meds for the problem. They always work but the pain comes back.  I have had P.T. for it as well as do home exercises.  What would you recommend at this point? Maybe I am doing the wrong exercises.  My Ortho said I did not have to stop working out nor do I have to stop running. I have been using ice as well as heat after my routines.  Am I doing more harm than good?  Have you heard of VAX-D? If so what do you think about it?  I would really appreciate any input you could offer. Thank you for your time.

Sincerely,
Diana Garrison

Answer
Diana,

I'm assuming you're a runner, and I would suggest that you continue to run, especially if it makes your back feel better.   As for VAX-D, it is an outdated device that has been replaced by newer spine decompression machines.  The downside is that many who use the decompression tables, e.g. DRX-9000, charge an up-front fee of $5000.  This is, in my opinion, a scam.  You really should try different chiropractors to see how you would respond to basic decompressive manipulation via a "flexion-distraction" table.   See this article to get an idea of what this table and technique looks like: http://www.biomedcentral.com/1471-2474/7/16     As far as exercises, the basic idea is to exercise into the positions that reduce your pain, and also to exercise to strengthen your entire trunk and core.   All of this can be done on your own at the gym.  For some people, training on a few select exercises can be key to them feeling better.  This takes one-on-one evaluation to figure out which ones may be best.  I cannot do this on the internet...    You are not doing any harm by using ice/heat.  These have no effect on your condition.  They just provide temporary alleviation.    My hunch is that the annular tear is a cause of some pain.  I've seen this often, as many with bulges and nerve canal narrowing have no symptoms, but those with annular tears do.  I cannot quote research to support my personal observations (sorry).    My recommendation is to check out some evidence-based chiropractors that offer flexion-distraction technique and have skills in strengthening/conditioning and/or rehab.   It may also be worthwhile to consult a physiatrist or other interventional pain management specialist regarding the possibility of epidural steroid injection to reduce your pain.   

'Hope this was helpful.

Dr. G
www.drgillman.com