Rehabilitation for Spinal Compression: Managing Pain and Treatment Options

Rehabilitation for Vertebral Compression Fractures

Hello, Doctor: Two years ago, I lifted a heavy object and accidentally strained my back.
I did not seek any medical treatment at that time, but recently I have been actively pursuing treatment.
An X-ray revealed that my spine does not show any signs of scoliosis; however, the space between the second vertebra from the sacrum and the others is particularly narrow, while the spaces between the third, fourth, and fifth vertebrae are unusually wide.
The physician treating me has prescribed medication and rehabilitation therapy, which includes heat therapy, lumbar traction, and electrical stimulation.
The issue arises with the lumbar traction; after lifting 23 kg, I experienced such severe back pain upon standing that I was unable to stand.
After electrical stimulation, I felt much better, but now I have a cold.
Yesterday, during lumbar traction, I accidentally coughed, and the sharp pain in my back has persisted since then.
Doctor, could you please advise me on the following: 1.
What is the name of my condition? 2.
Should I continue with this rehabilitation? 3.
Would heat therapy and electrical stimulation alone be beneficial for my spine?

A-Mao, 30~39 year old female. Ask Date: 2004/09/18

Dr. Chen Xianchang reply Rehabilitation

1.
It is likely a lumbar disc herniation, as coughing increases abdominal pressure, causing the already herniated disc to protrude further and intensifying the pain.

2.
Based on the symptoms and X-ray, it may be a herniated disc at the fifth lumbar vertebra; however, the X-ray findings are unclear.
You can bring it to my clinic during office hours for me to review (no appointment necessary) for further assessment.
The traction should be determined based on your body weight, ranging from 1/4 to 1/3 of your weight, up to 1/2 or an additional 5 kg.

3.
Heat therapy and electrical stimulation can enhance circulation and alleviate pain (providing symptomatic relief), but they are not beneficial for the underlying issue of disc herniation.

4.
Traction should consider the patient's body weight, the specific lumbar vertebra involved, the angle of traction, the weight applied, and the X-ray findings.

Reply Date: 2004/09/18

More Info

Based on your description and the details provided, it seems you are experiencing significant discomfort due to spinal compression, likely exacerbated by your previous injury from lifting heavy objects. The narrowing of the intervertebral spaces, particularly in the lower lumbar region, can lead to nerve compression, resulting in pain and mobility issues. Here’s a comprehensive approach to managing your condition, including rehabilitation strategies and treatment options.

1. Understanding Your Condition
From your symptoms and the findings from your X-ray, it appears you may be dealing with a condition known as lumbar spinal stenosis or degenerative disc disease. These conditions can cause narrowing of the spinal canal or intervertebral spaces, leading to pressure on the spinal nerves. This can manifest as pain, numbness, or weakness in the lower back and legs, especially after activities that strain the back.

2. Rehabilitation and Treatment Options
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a. Continuing Rehabilitation
Given your experience with rehabilitation, it’s essential to approach it cautiously. If the stretching or pulling exercises are causing significant pain, it may be wise to reassess your rehabilitation plan with your healthcare provider. Here are some considerations:
- Modify Exercises: Instead of traditional stretching or pulling exercises that exacerbate your pain, consider gentler forms of rehabilitation. Physical therapy can include specific exercises designed to strengthen the core and back muscles without putting undue stress on your spine. A physical therapist can tailor a program to your needs, focusing on stability and flexibility.

- Pain Management: Continue with the prescribed medications for pain relief. Over-the-counter NSAIDs (like ibuprofen) can help reduce inflammation and pain. Always consult your physician before starting or changing any medication regimen.

- Heat and Electrical Therapy: Heat therapy can help relax muscles and alleviate pain, while electrical stimulation (like TENS) can provide pain relief by interrupting pain signals. If these modalities are effective for you, they can be continued as part of your treatment plan.

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b. Alternative Therapies
- Chiropractic Care: Some patients find relief through chiropractic adjustments, which can help realign the spine and reduce pressure on nerves. Ensure you consult with a chiropractor experienced in treating spinal conditions.

- Acupuncture: This traditional Chinese medicine technique may also provide pain relief for some individuals suffering from chronic back pain.

- Massage Therapy: Therapeutic massage can help relieve muscle tension and improve circulation, which may alleviate some of your discomfort.

3. Lifestyle Modifications
- Posture Awareness: Maintaining good posture is crucial. Be mindful of your body mechanics when sitting, standing, or lifting objects. Ergonomic adjustments to your workspace can also help.

- Weight Management: If applicable, maintaining a healthy weight can reduce the strain on your spine.

- Regular Low-Impact Exercise: Activities such as walking, swimming, or cycling can improve overall fitness without putting excessive strain on your back.

4. When to Seek Further Treatment
If your symptoms persist despite conservative management, it may be necessary to explore further treatment options. This could include:
- Injections: Corticosteroid injections can help reduce inflammation around the affected nerves.

- Surgery: In cases of severe nerve compression or if conservative treatments fail, surgical options such as decompression surgery or spinal fusion may be considered.

Conclusion
Your situation requires careful management and a tailored approach to rehabilitation. It’s crucial to communicate openly with your healthcare providers about your symptoms and the effectiveness of your current treatment plan. If certain rehabilitation exercises cause pain, they should be modified or replaced with alternatives that promote healing without exacerbating your condition. Always prioritize your comfort and safety during recovery, and don't hesitate to seek a second opinion if you feel your current treatment isn't addressing your needs effectively.

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