Expert: Scott F. Gillman, DC, DACBSP - 8/18/2010

Question
i have had back pain for 15+ years now.. finally my doctor retired, and my new doctor sent me for x-rays, and a ct scan.. as the results show i have a bulging disc... (lower back) i am very athletic.. now volleyball and baseball, i do not want to give these up, but i have found lately my back can easily be "thrown out" per say.  What kind of treatment can i receive without SURGERY! will chiropractor help me? i have also had a patella re-alignment last year, and i am not sure if this has made my back worsen.  I also have pain up my spin, more of a burning sensation..

if there are any suggestions that would be great!!!!! i do not want to give up sports, but i also want to be able to play with my children!!

Cindy

Answer
Hi Cindy,

X-rays AND a CT scan?  The current guidelines recommend against x-rays since they do not tell you much about where the problem is or how to treat it, but there are some exceptions based on an individual's particular situation.    I don't know why a CT scan was ordered as opposed to an MRI.   CT is used to highlight the architecture and detail of bones that X-ray does not show, so CT is good at picking up fractures and bone tumors, but that's about it.  Nevertheless, there is no substitute for a really good musculoskeletal hands-on physical examination.   Keep in mind that many people have disc bulges and no pain, or no disc bulges and lots of pain.   MRI will show if there is a tear in a disc, but with 15 years of pain, I'd bet there is more going on than just the bulge.  If you are a young female and very athletic, you may have a loose lumbar vertebra, and this makes for instability of the spinal joint.  Are you too limber?  A loosy-goosy vertebra bone grinds away at the disc and constantly irritates it.   Google: "Prone Instability Test of the lumbar spine."  Someone has to test this on you.   Also, someone should test your spine endurance.  For example, can you do a side-plank and hold it for one minute?   A keen examiner will look at what other joints might be involved, e.g. hip joints.  Has anyone assessed your deep musculature and tendons for knots and fibrotic/scar lesions?  If you have ropey, tender, irritated tendons at the base of your spine, then finding a provider of Graston Technique would be helpful.   Assuming you are not unstable, and you simply need good manual therapy, one approach for people with disc problems involves a "decompressive manipulation" method flexion-distraction.  You can see video of this on my web site: www.drgillman.com under product/servises.   If you don't have radiating sciatic pain in you calf/leg/foot, and you have strength of your ankle and big toe muscles, then odds are you don't need any kind of surgery.  The exception is if you have a lot of instability.  If your x-rays showed "spondylolisthesis" of L4 or L5, and there is evidence that you have a lot of instability, AND you have debilitating back pain that does not respond to manual methods of different kinds, AND you fail interventional pain managment treatment such as epidural steroid injections, then you might be considered a surgical candidate.  Otherwise, no.   You must find a chiropractor that will provide a good exam and who is  skilled at soft tissue therapy, rehab exercises, and flexion-distraction.   Cindy, sometimes it's a matter of getting the right mix of treatment to make things better.  You have to do some homework on finding a good provider.   

'Hope this helps.