Disc Herniation and Treatment Options for Back Pain

Q: Disc Herniation and Treatment Options for Back Pain

Hello： Currently, the blood test for ankylosing spondylitis has a diagnostic certainty of 95%, therefore, the likelihood of having ankylosing spondylitis is low. <br>However, the possibility of muscle stiffness and limited joint mobility is higher. <br>Pain in the lower back, but

Cervical and lumbar disc herniation (suspected ankylosing spondylitis)

Hello doctor, a few years ago I started experiencing severe pain in my lower back when bending over, and I have had acute episodes of lower back pain every year.
Since the year before last, I have also been experiencing intermittent sharp pain in the dorsum of my right foot.
I underwent three months of rehabilitation for my back, and the sharp pain subsided, so I stopped the therapy.
However, around mid-last year, I began to feel a stabbing sensation in my lower back (I had an MRI of my lumbar spine which showed a herniation), and my toes also felt swollen.
I then went to a rehabilitation specialist for back therapy, but I experienced a sudden electric shock sensation during the treatment, which made me anxious, so I only attended a few sessions and then stopped.

Due to the stabbing pain when bending over, I have been bending very little, and I later realized that I cannot arch my back; my lumbar curve is very straight.
I had blood tests at Chang Gung Hospital, and the results indicated that it is likely not ankylosing spondylitis.
Subsequently, I began to experience swelling and tingling in my fingers, a sensation of dizziness, and discomfort in my neck.
An MRI of my cervical spine revealed herniations at levels C5-6 and C6-7.
Every time I try to stretch my neck, I feel discomfort in my cheeks and the back of my head.
During this time, I attempted to lie flat with my legs raised and my arms hugging my knees close to my chest, but I found that my thighs were very far from my chest and felt as stiff as a rock.

Could this stiffness be caused by spinal adhesions, or is it due to muscle tightness? Currently, my symptoms include stabbing pain in my lower back, buttocks, and posterior pelvic area, as well as tingling in my toes and swelling in my fingers.
The orthopedic specialist mentioned that stretching my back would not be able to restore the curvature to my straightened spine.
Should I continue with lumbar traction or cervical traction, or do you have other recommendations?

A-Zhi, 40~49 year old female. Ask Date: 2016/01/28

Dr. Li Weiqiang reply Rehabilitation

Hello: Currently, the blood test for ankylosing spondylitis has a diagnostic certainty of 95%, therefore, the likelihood of having ankylosing spondylitis is low.
However, the possibility of muscle stiffness and limited joint mobility is higher.
Pain in the lower back, buttocks, and tingling in the toes and fingers may be due to nerve irritation.
Stretching the lower back can help alleviate symptoms, but it is important not to force the lower back into an exaggerated curve.
Appropriate stretching of the lower back is acceptable.
The most important thing is to maintain movement in the lumbar region.
Wishing you peace and health.
Sincerely, Dr.
Li Wei-Chiang, Director of the Rehabilitation Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/28

More Info

Understanding disc herniation and its treatment options for back pain can be quite complex, especially when symptoms are persistent and multifaceted. Based on your description, it seems you have been experiencing a range of symptoms related to your lumbar and cervical spine, including pain, tingling, and stiffness. Let's break down the situation and explore potential treatment options.

Understanding Your Symptoms
1. Disc Herniation: A herniated disc occurs when the soft inner gel of the disc bulges out through a tear in the tougher exterior. This can lead to nerve compression, resulting in pain, numbness, or weakness in the affected areas. Your MRI findings indicate that you have herniated discs in both your lumbar (lower back) and cervical (neck) regions, which likely contribute to your symptoms.

2. Pain and Stiffness: The sharp pain you experience when bending or the "electric" sensation during physical therapy could be due to nerve irritation or compression from the herniated discs. The straightening of your lumbar curve suggests that your muscles may be compensating for pain, leading to stiffness and reduced mobility.

3. Neurological Symptoms: The tingling in your fingers and toes, along with the sensation of heaviness, could indicate nerve involvement. This is often seen with herniated discs, especially if they are pressing on spinal nerves.

Treatment Options
1. Physical Therapy: While you have previously undergone physical therapy, it may be beneficial to revisit this option with a focus on specific exercises designed to strengthen the core and improve flexibility. A physical therapist can tailor a program to your needs, emphasizing safe movements that avoid exacerbating your pain.

2. Manual Therapy: Techniques such as myofascial release or gentle manipulation may help alleviate muscle tightness and improve mobility. However, it's crucial to communicate your discomfort during these sessions to ensure that the therapist adjusts their approach accordingly.

3. Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If your pain is severe, your doctor may prescribe stronger medications or muscle relaxants.

4. Injections: Corticosteroid injections can provide temporary relief by reducing inflammation around the affected nerves. This may allow you to engage more effectively in physical therapy.

5. Surgical Options: If conservative treatments fail and your quality of life is significantly affected, surgical options such as discectomy (removal of the herniated portion of the disc) may be considered. This is typically a last resort after exhausting other treatments.

6. Alternative Therapies: Some patients find relief through acupuncture, chiropractic care, or yoga. These approaches can help with pain management and improve overall well-being, but should be pursued with caution and ideally under the guidance of a healthcare professional.

Lifestyle Modifications
- Posture: Maintaining good posture while sitting, standing, and lifting can prevent further strain on your spine. Ergonomic adjustments in your workspace may also be beneficial.

- Activity Modification: Avoid activities that exacerbate your pain, such as heavy lifting or prolonged sitting. Incorporating regular, gentle movement can help maintain flexibility and strength.

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

Conclusion
In summary, your symptoms suggest a complex interplay of disc herniation and muscular issues. While traction therapy may provide temporary relief, it is essential to approach it with caution, especially given your discomfort during previous sessions. A comprehensive treatment plan that includes physical therapy, medication, and possibly injections or surgery, depending on your progress, may be the most effective approach. Always consult with your healthcare provider before making changes to your treatment plan, and consider seeking a second opinion if you feel uncertain about the recommended course of action. Your health and comfort are paramount, and a tailored approach will likely yield the best results.

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