Do's and Don'ts for Suspected Disc Problems (Part 2 of 2)

Look at the image.

What do you ask yourself when you see the image of a stop sign in the middle of an empty dirt road?

Why stop? What's the purpose? If you've been driving for miles on this road, why make this travel inconvenient with a brief stop?

This image is an analogy for the feedback system that operates at all times in your body, and is a way to check your body's functions to make sure it procedes forward with the least amount of subsequent breakdowns and trouble in the future. You can ignore these signs for a while, but driving on a dirt road, exposed to the elements, the rough patches, and the accumulation of impact on the vehicle can be costly down the line, resulting in breakdowns that need imminent intervention.

When it comes to your spinal disc, (read Part 1 of 2 on "Elastic properties of spinal discs") warning signs can appear in many ways. This can include pain, swelling, inflammation, loss or altered function. Understanding spinal disc behavior and it's properties will give you a way of proceeding with caution when it comes to daily activities, choice of exercise, and length of time to rest, among other needs for a disc to recover.

INFLAMMATION

The process of inflammation is one that is both therapeutic and punitive. Our body uses mild forms of inflammation including in the spinal disc to adapt and increase it's strength over time when exposed to exercise and force. If inflammation is prolonged, severe and unattended, it can become diminutive to the integrity of the disc. Future problems will arise, such as degenerative effect, bulges, protrusions, herniations, and disability.

PAIN

Discomfort is a small degree of pain, it is also a signal that tells you to pay attention to the activity or the load to a body part. Discs that are feeling pain has exceeded sensations of discomfort and is now experiencing inflammation, wear and tear, and possible disability of function to a small or large degree. Pain in the disc definitely requires a modification in activity, and attention to recovery strategies.

MODIFIED ACTIVITY DURING EPISODES OF DISC PAIN

This is a guide, and is not a diagnosis, and each presentation should be assessed by your provider, not google or YouTube, and is never an absolute rule. But pay attention...Disc pain tends to be central to the spine, or near the spine. Muscle pain to the lower back tends to be very lateral and away from the spine. Disc episodes may or may not have a referral pattern down the leg, side of the thigh, or stay localized to the spinal region. Disc pathologies present in a predictable context that is similar to predicting the behavior of an elastic material under stress (see Part 1 of 2 of this article), and can be a good predictor of what would cause pain or worsening during a disc flare up. Modifications of activity, exercise, and load patterns are listed below, and not an absolute rule, but complies with the kind of stresses that produce further injury to a disc that is under stress or having symptoms of pain and inflammation.

DONT LIST WHILE ACUTE/SUBACUTE:

• Plank/Pushup, Mountain climbers

• Explosives: Kettlebell swings, Burpees, Box jumps

• Sit-ups, leg lifts, bicycle abs

• Impact: Olympic lifts, squats, deadlifts, suitcase lifts, running/jogging, treadmill running

• Rotations: sit-ups, trunk twists, golf/tennis/baseball etc

• Slouch, Couch, cycling

• Driving and travel should be with lumbar support

• Work chairs ok w/ lumbar support. Change from sit/stand every 20-30min.

DO LIST:

• Crunches, as many as tolerated

• Partial body wt. squats

• Standing abdominal crunches

• Eliptical machines or treadmill walking

• Conventional upper body machines (bi/tri/chest/shld) to tolerance only

• Heat 15min to entire lumbar is ok

• Ice 4-5min ONLY to the small disc regions, no ice on muscles!

• Stretch throughout the day without bouncing

• Be patient, transition to increased activity under guidance

The above list is a guide, and each disc episode is always going to be unique to the individual, and MUST be applied in context of the symptom severity, lifestyle and occupational demands. When the stop sign pops up in your life because of a disc related pain, pay attention! Modify your activities, pursue therapeutic strategies, and be patient. Healing involves a timeline that is dependent on so many factors....age, exposure, severity, occupation, history, medications, cause of injury...etc. Artificial Intelligence cannot guide you enough (maybe somewhat), but a disc that is injured needs authentic intelligence and guidance from your provider so that the right treatment, right activity, and right intensity can be prescribed to your care.

Good luck!

-Dr. Adrian