Questions about spinal disc trouble
Questions about or following surgery
Questions about lower back pain

Questions about spinal disc trouble

My MRI shows a bulged disk and I am in constant pain. Can anything be done?

You might ask the person who ordered your MRI to explain the results one more time, describing the source of your pain and what the treatment options are. There are many treatment options for the condition you describe, both surgical and non-surgical. For some patients non-surgical treatment may include physical therapy or exercise and sometimes pain management. A suggestion would be to find a qualified orthopaedic spine surgeon who knows how to deal with these types of problems and seek his or her advice.

What are your recommendations for someone with persistent neck and shoulder pain due to a bulging disk in the neck area?

Patients with neck and shoulder pain caused by disc problems are usually treated non-surgically. Non-surgical approaches could include injections, taking anti-inflammatories or exercise. If that sort of approach doesn’t help the patient get better, some may opt for surgical intervention.

People with persistent pain, similar to what you describe, usually have a doctor do a series of tests to evaluate their situation, and then diagnose appropriate treatment. It is important that the patient understand all non-surgical alternatives and be given a full explanation of any possible surgical intervention. If surgery is a possibility, an orthopaedic spine surgeon can help explain various treatment options and educate the patient, but in the end it is up to the patient to decide if surgery is right for them.

I have a herniated disc and degenerative disc disease. I’m in pain, and am afraid my problems will lead to surgery. Is there any chance of improving without surgery?

Disc degeneration (aging of the disc) is part of life. It’s very common, and begins around the age of 30. Most people seem to either tolerate the pain, or the pain seems to go away. Statistically, a very small percentage of people across the country, just three to five percent, end up opting for surgical intervention.

If a patient is considering surgery, a doctor who specializes in spine disorders can help evaluate the intensity of the patient’s pain, quality of life, and just how badly function is restricted. These factors can help a patient decide what is necessary. Only the patient can decide if their pain is troublesome enough to opt for surgery. Those who keep aerobically fit and do their best to maintain a high level of functional activity will most likely do well in the long run, and may never need to consider surgery.

I have disc herniations and bone on bone in one area of my spine. I am in a lot of pain, what can I do?

Most disc herniations can be treated without surgery. There are many causes of back pain; most are also treated without surgery. Is there hope? Yes. There is always hope. There are many approaches, surgical and non-surgical for treating lower back problems. They include physical therapy and pain management. With respect to disc herniation in your neck, the same holds true. Visit with an orthopaedic spine surgeon and have it evaluated. Certainly bring your diagnostic studies to the office visit so the information form those studies can be explained to you.

I have a slipped disc. Physical therapy is not helping much. Is there anything else I can do to relieve my pain?

A slipped disc is not a specific source of pain itself. Many studies show there are a large number of people who have herniated discs, but are not in pain. There are many options patients pursue, including different types of physical therapy. Medical management may also be helpful in order to tolerate therapy. Injection therapies are often used to boost the person’s own ability to participate in treatments. A specialist in conservative spinal care would be a good starting point to help you choose these options if the first attempt at physical therapy has not helped.

I have a bulging disc and degenerative disc disorder. I swim, exercise and do physical therapy. I have been told surgery is not recommended. Is sound wave therapy a good idea?

Using sound waves in the treatment of back pain is not a new concept. Ultrasound provides deep heat to soft tissues in the body, and is commonly employed as a passive modality. We’re unaware of any scientifically acceptable breakthroughs in the use of ultrasound, except for diagnostic purposes. Individuals should take responsibility for their pain and not rely on passive treatments by others.

Back pain can be caused by muscle spasms. You may want to talk to your specialist about trying one of the many newer medications for painful muscles. It appears you have taken an active role in treating your pain syndrome. You may want to read John Sarno’s books on dealing with the emotional issues surrounding this often frustrating problem, or some patients enjoy “A Whole New Life,” a story about author Reynolds Price’s experience with pain.

I have a paracentral disc herniation with a mild to moderate axonal irritation. I have had physical and injection therapy as well as acupuncture, and am still in pain. Is there any other course I can take?

Chronic nerve root injury is often the consequence of discal disruption. In some patients, even after doctors try to desensitize a painful nerve with injections, or patients try to dissipate stress around the nerve through physical therapy, the physiology of the nerve remains unchanged.

Managing this kind of pain medically has advanced over the last few years: there are several new agents doctors use to control neuropathic pain that many patients find dramatically helpful, with few side effects. Imaging and EMG studies can be used to indicate to doctors that surgical solutions need to be considered.

Coping with chronic pain is certainly a struggle. Perhaps you’d find it helpful to use strategies employed and taught by psychologists. There are several authors whose books seem to help people with chronic back pain. Some patients enjoy “A Whole New Life,” a story about author Reynolds Price’s experience with pain.

Maintaining physical activity, either land- or water-based, is essential to a patient’s wellness, and should be continued at whatever level a patient can tolerate and eventually come to enjoy.

I am recovering from two epidural treatments on a herniated disc. I’m starting to excercise again. Do sit-ups, bench excercises, push-ups or jogging pose any danger to the disc?

Herniated discs are often evidence of a weakening of the disc structure, and can predispose one to additional episodes. If recommended by your doctor, an exercise program similar to the one you describe is often a good idea, and my patients frequently use exercise as a way of avoiding future disc problems.

Talk to your doctor about a routine of trunkal strengthening, stretching and aerobic exercise, and vary your routine by including oblique abdominals. If you like to jog, do so on a running surface that has more “give,” like macadam, a local high school track or a treadmill. Swimming is also an excellent alternative.

I suffer from hip pain which usually radiates down my leg and centers around the hip region. The pain keeps me awake sometimes. Is there anything new for non-surgical degenerating discs?

There are a number of non-surgical alternatives to disc disease. Recent published research describes much of disc degeneration many people experience as a natural process, and it doesn’t always cause pain. It could be possible that you are experiencing some nerve irritation as a result of disc breakdown. If that is the case, and depending on the extent of the nerve injury, there are a combination of medical and physical therapies geared toward desensitizing those nerves and stabilizing the pelvis and lower back muscles to prevent further stress on these structures.

There are more advanced techniques than epidurals to reduce inflammation or block pain from the disk itself. You will most likely need ongoing expert medical advice about your type of pain and strategies for controlling it.

I’ve been diagnosed with degenerative disc disease and a herniated disc, which is pressing on my sciatic nerve. Physical therapy resulted in greater pain. What should I do next? Is seeing a chiropractor a good idea?

In many patients, nighttime back pain is caused by a mass effect or direct pressure on the nerve, usually by a large herniation or a cyst-type structure. In patients who fail to respond to conservative care, many doctors will choose to re-evaluate the state of the spine, either through a new MRI or EMG. Patients suffering from a large amount of pressure on the nerve may have no other recourse than surgical decompression. Most spine physicians don’t feel comfortable with manipulative techniques in these sort of circumstances (even those who provide manipulation). You may want to consider reviewing your options with a spinal care specialist and also consider the risks of not doing anything at all, which may have its own consequences.

I have herniated two discs in the past seven years, and want to begin a workout program to strengthen my back. How much weightlifting should I do? What about yoga or tai chi?

Many spine physicians ask patients with a prior history of disc problems to ease off on static weightlifting routines, especially for arm and upper-back definition. Instead, telling them to focus on trunk stability through active abdominal, oblique abdominal and paraspinal muscle strengthening. A well-designed Pilates program is also a good idea, and more health clubs are offering them now. Tai chi and yoga ultimately provide a balance of stretching and strength training. Patients should incorporate elements of flexibility, strength, endurance and mind-body awareness into their daily hygienic back care program.

Questions about or following surgery back to top

Is it common for a patient of spinal surgery to later have a child?

Generally, women who have had previous spinal surgery can go on to have children. What they will note in the course of their pregnancy is that as they may have more back pain than most of their friends. Often, people who have spinal problems will find that as they gain weight during a pregnancy, the pain in their back increases. In most cases, that pain will subside after delivery. If you do decide to have children, you should talk to your gynecologist. Depending upon what kind of surgery you have had, your doctor may want to discuss with you the option of having a cesarean section rather than a normal delivery.

Are there any new less invasive operations or nerve ablation procedures for the lateral type of lumbar spinal stenosis?

There really have not been any “new” operations developed. There has been progress in understanding that not all patients require the same procedure and that tailoring the decompression treatment to the problem is increasingly possible. If you are facing this type of surgery, speak one-on-one with a specialist about how the procedure would be carried out in your specific situation.

I have had a discectomy and would like to know about exercises to flatten and strengthen my stomach.

Stomach exercises for back pain prevention are generally a good idea. Strength of the abdominal muscles helps redirect mechanical stress around the entire trunk, avoiding overload to just the back muscles when lifting or working. Exercises for the “abs” include the classic “crunch.” The person lays with his or her back to the floor and knees bent, raising the chest toward the knees just a few inches–until the natural curve of the lower back is flat to the floor. This can be done with arms reaching out toward the knees, or clasped across the chest or behind the head.

You may want to check out the many videos on abdominal exercises at the video store, or your library may also have some available. Try out more than one routine. Variety is the spice of live when it comes to “ab” exercises.

I recently had a laminectomy, and now I am suffering from radiating pain in my thigh and below. What can I do?

Many problems can cause back pain to radiate into the thigh and below. In some cases where the surgery has been recent, patients need to make sure they have not had an infection. If the wound is clean, and has healed, the chances of that are pretty low. The most common source of this type of pain is called post-laminectomy discogenic pain. That means, in some patients the problem was not just the herniation, but the disc was also involved. That creates some type of minor or more serious instability. Patients with this problem can potentially get better with time and exercise. If your symptoms do not subside with time and and whatever exercises your doctor may have recommended, you should consider undergoing another series of tests.

I had been recovering well from back surgery until I started experiencing lower back pain. Could my pain be caused by a post-operative infection? What other causes are there?

Infection after surgery is generally uncommon, but it does happen in approximately one to three percent of elective surgery patients. There are several ways to rule out infection. For patients in which infection is ruled out, the doctor may choose to start from scratch with a basic work-up in order to identify the exact source or generator of the pain. That means taking a patient’s basic history, performing a physical exam, getting plain X-rays and performing an MRI with gadolinium. The next step depends on what those tests indicate. The goal is to specifically identify what is generating the pain. Once that is identified, an intervention, surgical or non-surgical, can be determined.

Do you perform laser disc decompression on an outpatient basis?

Laser disc decompression is not performed at all at Albert Einstein Medical Center. A multi-hospital study of this technique has shown it to be a less effective treatment than both open discectomy and conservative management. Most patients who have the type of lesion that responds well to laser surgery usually do just as well with non-surgical types of treatment. That’s why laser disc decompression isn’t used here.

Lower Back Pain back to top

Where can I find a sculptured pillow to help me sleep in the proper position?

There are several different kinds of products available to help you with your back pain. Of course the best way to track them down is by searching the web. A comprehensive site is www.comforthouse.com or you can call 1-800-359-7701. They have a wide variety of contoured pillows for sleeping, sitting or driving. Two other sites offer good selections. They are www.backtohealth.com or 1-800-950-0250, and www.ibackrelief.com or 1-800-596-7788. Do check all of them if you have the time. Prices for similar items and shipping charges seem to vary quite a bit.

I am 38 and have spondylothesis which has been manageable until recently. I do specific exercises for my back. Any recommendations to reduce pain?

Spondylothesis occurs in about six percent of the population. Surgical treatment usually requires fusing together several vertebra. However, most patients tolerate spondylothesis throughout their life and maintain function and good quality of life. Some do, however, go on to have surgery. Things a doctor and patient would take into consideration before surgery are: is there progression of the spondylothesis, is there intractable pain and how much is the patient functionally impaired? Other issues like neurologic deficits may play a roll and should also be evaluated.

Certainly a trunk stabilization program is directed toward mimicking the goals of surgery. That is, providing muscular fusion that helps to stabilize motion in the segment involved. Stabilizing the spine with stronger muscles can help reduce pain. Considering that your pain has been manageable up until now, it would be worthwhile to have an office visit and get some X-rays to make sure that your slip is stable and the condition has not worsened. This would be important information and help you with your decision making.

I have had a desk job for 28 years. I've had bouts of sciatica pain over the years, what type of exercises can I do to ease my situation?

The answer would really depend on the outcome of an exam and a full diagnostic study by a back pain specialist. Some patients with symptoms like those you describe have spinal stenosis, a narrowing of the lumbar or cervical spinal canal, which causes compression on nerve roots. That particular problem isn’t helped much by exercise. A much more common problem is degenerative disc disorder. That simply means spinal discs are aging along with the patient. Degenerative disc disorder can be greatly helped by various exercise programs that a doctor chooses based on a patient’s exam.

You also mentioned dealing with bouts of sciatica. Sometimes doctors will choose to treat patients suffering from recurring sciatica with selective nerve root injection and/or epidurals–again depending on diagnosis and the severity of the problem.

A recent X-ray shows some loss of height at T-12 and some calcification of the distal aorta. Should I take calcium supplements, and what can I do for my back pain?

Back pain is probably the single most common complaint for middle-aged people. The loss of height in the disc space that you mentioned often happens as people age. People also tend to be less active and not exercise as much once they reach middle age. The combination of decreased muscle tone, combined with less activity and aging of the disc, sets one up to experience back pain. Why has this happened? Because the spine is a carefully balanced column of vertebrae held in balance by muscles.

Most spine physicians do not suggest calcium supplements for back pain as you have described. Instead, they often suggest that patients look at their diets – determining how much calcium intake they have now and making sure they get the appropriate amounts for their age group.

If your pain continues, you should see a back specialist to make sure it’s simply disc degeneration due to aging. This would also help rule out other problems that are far less likely. Your doctor’s evaluation would probably include things like bone scans, MRIs etc.

Finding an appropriate aerobic exercise program is sometimes a good place to start. Beyond that, your doctor may recommend some physical therapy.

Whenever I overexert my back or stand for prolonged periods of time, my lower back pain increases significantly. Can something be done to correct this condition or is it just a matter of exercise and pain management?

Many things can be done for patients with chronic lower back problems. They range from simple exercise programs at home to surgical intervention. If surgical intervention is required, there is a wide range of possibilities, depending on the specific situation.

Doctors use diagnostic studies like X-rays and MRIs to develop a therapeutic intervention for a patient. Certainly exercise programs are the mainstay of treatment. For patients who have chronic, intractable pain with no other solutions, sometimes pain management clinics can help. It may be a good idea to consult a back specialist for an exact diagnosis of your problem and develop a treatment plan from there.

I have scoliosis and chronic low back pain. I am no longer able to do what I once could as far as duration and difficulty of an activity. What can I do?

Scoliosis may or may not be a factor in your pain problem. Individuals often live with a reasonably pronounced curvature without significant symptoms. Often patients manage pain through a program of stretching and strengthening the available muscles. Individuals without scoliosis usually deal with pain in the same way.
You may decide to visit a physiatrist (medical specialist in physical medicine) who could provide a comprehensive exam. The results of that exam could be reviewed to provide specific medical and physical treatment options for you. Maintaining a wellness approach to your back programs can yield great dividends as you grow older with scoliosis.

Is there a certain way that I should lay in bed so that I won't wake up with a sore back?

Sleeping positions are often lifelong habits that may be hard to break. Most spine physicians suggest to patients that they should lie on their side with a pillow between the thighs, and no more than one pillow underneath the head. It’s perfectly alright to alternate sides. Sleeping on the back is okay with the patient keeping one pillow under the head and one beneath the calves. Belly sleeping is not for adults, and we advise against reading or working in bed.

Last fall I hurt my back golfing. There still seems to be some discomfort after returning to the game. What can I do?

Before returning to the game, do a serious warm up. A stretching program should include exercises for your hamstrings, lower back and quadriceps. In addition, return to the game allowing for a slight drop in your competitive edge as you get back into the “swing” of things. If your pain persists, consider seeing a physician who specializes in back problems.

Is there any help for tail bone injuries?

There is help available for tail bone injuries. However, the exact treatment would depend on the type and extent of the injury. Tail bone injuries are often helped by injection therapy, or if necessary by surgery. If you feel your injury should be evaluated, consult an orthopaedic back specialist.

I have been on Darvocet, and then Vioxx to relieve severe back pain caused by scoliosis. My doctor recently took me off the Vioxx telling me it is not a good idea to take it on a permanent basis. I am once again in severe pain, any suggestions?

It’s important for you to know that a doctor providing information via the internet should not detract from your relationship with your own physician. That aside, it appears your pain is responsive to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). Vioxx is a newer NSAID which has been marketed as safer than older NASIDs like Naprosyn or Motrin. However, there has been some concern expressed about taking more than 25 mg daily. This may be a more sensitive issue for individuals with known liver disease or multiple medical problems. Fortunately, there are several medications in this class that are equally effective and safe.

Darvocet is a mild narcotic analgesic that although quite useful, does have potential for creating a dependency in patients. This must always be considered by a medical professional who has taken the time to know your medical history and the viable options that may or may not be open to you.

Standing for any period of time is very painful. Medications and physical therapy have not helped. This has been going on for six months, what can I do?

Pain similar to what you are describing can be caused by back problems. Diagnosing the exact cause would require a full evaluation at a pain management center, like the one here at Albert Einstein Medical Center, or by a spine specialist. That evaluation could possibly include a back MRI. The exact treatment of your pain would depend upon the findings of the examination and the MRI.

My back pain leaves me unable to sit for long periods of time. Should I be using heat or ice for relief, and is exercise a good idea?

Back pain is a symptom that can come from many different sources, but usually it is caused by one specific problem. For instance, sitting or standing for a long period of time can stress back muscles or cause the vertebral joints to ache. The pain generally lessens when a person starts to move around and the muscle tissue loosens up.

Ice is usually recommended at the onset of back pain, followed by moist heat. Ultimately, ice and heat do about the same thing and the patient can choose whichever offers the most relief. It’s a good idea to take frequent standing or walking breaks if one tends to sit for long periods of time.

Many patients take up walking to help relieve pain. It’s great exercise and can be incorporated with a gentle stretching program.

I suffer from lower back pain which travels to the groin. What can I do?

Back pain traveling to the groin can be related to problems from the lower back and may even indicate problems in the hip joint itself. There are many different causes of groin pain. Generally a doctor narrows down the diagnoses by taking a basic history of the patient, then performing a physical as well as basic diagnostic tests, such as a plain X-ray. Usually going through this process will give the doctor a good idea of what could be causing the problem. In cases like yours, follow up with an orthopaedic spine surgeon for an evaluation if symptoms persist.

My daughter is suffering from neuromas and high blood pressure. So far nothing has helped, where can I turn?

Neuromas are benign tumors of the nerves. By your question, and because this is a back pain Internet forum, we're assuming that this is a neuroma of the spine. Since your daughter is 15 years old, and if she does have neuromas of the spine, she should visit a pediatric orthopaedic hospital. If he or she hasn’t done so already, your pediatrician may choose to do more tests to find out what is causing your daughter’s high blood pressure. Certain spine diagnoses are associated with neuromas of the spine, and doctors can best evaluate these problems in a pediatric environment.

Answers provided by John Handal, MD, Chairman, Department of Orthopaedic Surgery; Leonard Kamen, DO, Clinical Director of MossRehab Outpatient Centers; Mark Kotapka, MD, Chairman, Department of Neurosurgery; and Sanjay Gupta, MD, Director, Pain Management Center.