Wednesday, May 21, 2014

Degenerative Disc and Running: A Case History

Copyright 2002
By Dr. Tim Maggs

Too many runners are told to stop running when they’re diagnosed with a degenerative disc in the back. Not only is this inappropriate in many cases, but oftentimes, running is part of the solution for someone in this situation.

Case History

Gina Babin, a 33 year old hairstylist, came into my office in late 2000 with low back pain. Her job, which involved standing all day, produced low back pain. And it was getting worse. When we took an x-ray of her low back, what we found was a bit unusual. Gina had an extremely degenerated disc at the L5 level of her low back (arrow “c”). This is a condition more commonly seen in someone 60 years old. Disc spaces “d, e, and f” were full and healthy. Gravity line “a” should be going through line “b”, and the fact that it wasn’t only added to the stress on the joint.

Discs typically will degenerate with age or trauma. Trauma to an area of the spine without rehabilitation will produce a tightness of the supportive muscles, a fixation of the joint and an ultimate reduction of the normal blood flow to the disc. This is similar to a tourniquet around the arm. Eventually, whatever’s on the other side of that reduction of blood flow will die. And there goes the life in the disc. It will gradually wear down until symptoms begin to occur. Symptoms can come in the form of localized pain, restriction of normal motion or pinching of the nerve that exits the spine at that level. Whatever symptoms you suffer with, they typically will get worse over time without corrective care.

Appropriate Treatment

In most cases, the disc is never going to grow back. You’d probably have better luck waiting for Superman to come than hoping for your disc to return. The next best thing is motion restored back to the joint. This will promote the influx of a rich blood flow back to a withered disc, and time will allow that portion of the disc to resume function to whatever level is possible. To get motion back to this injured joint requires work and patience.

In my office, we treat with a frequency that will allow a patient to get back. When a disc degenerates, adhesions form around the joint as the body tries to “lock up” this injured area. As long as that is allowed, there will be an inability to do many things. So the goal is to go against what the body is attempting to do and work to dissolve as much of the adhesion formation as possible. This is done with ultra-sound therapy. This prepares the joint for rehabilitative exercises that will help to restore motion back to the joint and increase the blood flow back to the remainder of the disc. As a patient, you must be patient. Three to five visits will not do the trick. It may take 30-40, or 60-80 treatments. But, everyone is different, and you must be willing to pay some price in order to get results. And then you must maintain some level of treatment to keep the results. Your ultimate ceiling of potential may be reduced to some degree, but it can certainly be raised from where it is, especially if you’ve only been told to stop running and have not gone through any corrective care.

Along with the ultra-sound treatment, spinal manipulation greatly helps to restore motion back to the locked joint. This will encourage a better blood flow and a reduced likelihood of future injury. A critically important addition to this plan is the fitting for custom orthotics for a patient with a condition such as this. The long-term degeneration of the L5 joint space is clear indication of the instability and increase of stress in the lumbo-sacral region. The degeneration is the body’s response to that instability. Custom orthotics are mandatory for the patient to reach maximum capacity.

Finally, some nutritional support is added, and you’ve got yourself a new lease on life. Glucosamine with a ligament strengthening supplement (minerals) will begin the process of healing. There are also many all-natural anti-inflammatories that can be added to the mix, such as proteolytic enzymes. A daily routine of these will certainly contribute and support the physical treatments that are being given.

Back to Gina

Gina Babin was not a runner when she entered my office in late 2000. Once the process of rehabilitation began to show improvements, Gina wanted to know what more she could do to help herself. When that question is asked in my office, there is usually only one answer---begin running. And that she did. She has now completed 4 races and is well on her way to running a half marathon this year.

A most unusual turn of events occurred approximately one year after fitting Gina with her custom orthotics. She had not even a whisper of back pains, however, she had one orthotic that began to irritate the ball of her foot. As usual, we circled the sight of irritation and sent the orthotic back to the lab. My plan was that she would go without the orthotics for 7-10 days.

Within 48 hours of not wearing her orthotics, Gina’s back went into an acute flare-up unlike anything I had ever seen before. There was severe Psoas spasm, pain in the dorsal-lumbar region, that prohibited her from working or running. The pain worsened each day. We quickly concluded that not wearing her orthotics was the reason, and had a new pair overnighted. After 8 days of suffering, we re-inserted the orthotics and within 2 days, Gina’s back returned to normal. This showed me more than ever the direct benefit orthotics have in a situation like Gina’s.

Persistence, a good game plan and a positive attitude will get anyone ahead in life. Do not accept a proclamation of doom when diagnosed with a degenerative disc. In fact, your new life is just beginning.

No comments:

Post a Comment