Bulging disc and sciatica

[KnottedYet]

I just checked, and the PT who read my MRI (and thinks PT could fix the leg pain) is listed on the McKenzie web site -- unfortunately, she lives 100 miles away, and the one I've been referred to is a DPT but isn't McKenzie-certified.

Can you call the McKenzie PT who read your MRI and thinks PT is viable, and ask her if she can recommend someone near you? McKenzie Certs and DIPs are *months* of further study after graduating PT school.

Someone who hasn't done the advanced study isn't going to have a clue. Having them treat you and asking the McKenzie PT to check their work isn't feasible for a couple reasons: For one, the general PT doesn't know MDT in the first place. For two, asking a non-treating PT to check the work of the treating PT is ethically and legally a complete and total no-no!

[berkeley]

Herniated disc here. We should start a club.

In addition to McKenzie, also check out the work of Stuart McGill.

http://www.backfitpro.com/

In the end, you have to find something that works for you - everyone is so entirely different when it comes to this. I know people who have done the discectomy will great results, I know some who ended up back in surgery again a few years later.

I've been religiously doing the McKenzie exercises without only short term relief (but at least some relief) but so far no change day in and day out. I just had a cortisone epidural - I'm one of the lucky ones that gets some real relief from that, so I'm hoping it works this time around again.

It does curtail biking at least in the short term - the flexion on the spine is really not what you need right now.

I'm at my year anniversary in dealing with this, so I know how frustrating it is. And whoever said you'll start to feel crazy is totally right. Chronic pain is mentally defeating.

[KnottedYet]

Herniated disc here. We should start a club.

It does curtail biking at least in the short term - the flexion on the spine is really not what you need right now.

Flexion is only bad if someone has a posterior disc bulge, and only 60% of back pain is caused by posterior disc bulges.

There is no such thing as "McKenzie exercises" because there is no one single "McKenzie" approach to joint derangement.

One person's corrective motion is another person's re-derangement motion.

Berkeley - if you've been doing something for months with no lasting results, then it is the wrong thing. Whoever gave you those "McKenzie exercises" either didn't know what they were doing, or hasn't heard from you how they are working and been able to modify them to get you the correct motion to push your unique and particular bulge back into place. (I'm assuming you are doing the motion 10 times every 2 hours, avoiding your deranging direction, correcting your posture, engaging your core at all times, and have not progressed)

People aren't cookie-cutter xerox copies of each other, and neither are painful backs, and neither are corrective motions.

[berkeley]

Flexion is only bad if someone has a posterior disc bulge, and only 60% of back pain is caused by posterior disc bulges.

There is no such thing as "McKenzie exercises" because there is no one single "McKenzie" approach to joint derangement.

One person's corrective motion is another person's re-derangement motion.

Berkeley - if you've been doing something for months with no lasting results, then it is the wrong thing. Whoever gave you those "McKenzie exercises" either didn't know what they were doing, or hasn't heard from you how they are working and been able to modify them to get you the correct motion to push your unique and particular bulge back into place. (I'm assuming you are doing the motion 10 times every 2 hours, avoiding your deranging direction, correcting your posture, engaging your core at all times, and have not progressed)

People aren't cookie-cutter xerox copies of each other, and neither are painful backs, and neither are corrective motions.

I absolutely agree - which is why I said following the McKenzie method has not helped me - it is quite possible that it won't work for all who experience back pain. And the people I've seen have been instrumental in getting me from being completely unable to do anything to at least functional - so I do trust that they know what the're doing. I loved my PT - it's a teaching facility at the local university and I've seen them several times for other issues.

If she has nerve root impingement, I still don't think riding a bike is a good idea. She did say it was lateral and impinging a nerve root to me would mean biking riding would be difficult until she can get it worked out. Not to mention, flexion itself can be very hard on the back - bulging disc or not. Just my two cents there. YMMV.

I have a ruptured/herniated disc - there is no "pushing it back in". Perhaps this is true in the case where the disc is "just" bulging. Following good body mechanics will make it not continue to ooze the good stuff out of the disc, and critical in order to stop the degeneration.

As an aside, probably the most frustrating thing for me in dealing with this has been when people think it's just a matter of doing X and then everything will be all better - if only it was that easy. Eight months of physical therapy, seeing multiple people in the practice (one who is McKenzie certified), and every other alternative method short of surgery.... I'm much better, but not anywhere near 100%. It is a hard thing to deal with, mentally.

I do appreciate the insight everyone has given me over the year, but just because yoga/inversion table/acupunture/this exercise/that exercise/surgery helped someone, doesn't mean that it will help everyone. It's a very difficult thing in all of this - knowing what advice to follow, what to do, who to listen to, etc..... even beyond the should I have surgery or not? big question, there are a lot of little questions that bog you down.

[KnottedYet]

A herniation (which is a bulge) can be pushed back into place.

A rupture (torn annulus) cannot. A rupture with fragmentation is a surgical candidate. A rupture with leakage is painful as all heck because the disc goo is caustic. Those leaking discs are obvious to the clinician, and they also respond mechanically. If you move one way, it leaks more. If you move another way, the tear is pinched shut and the leak stops.

Folks with tears don't have much fun because they have to spend about 3 days pretty much in one position (the one that pinches the tear shut). It's not a matter of just repeating a motion over and over agan, it's more like holding a cut shut and waiting for it to clot. They have to take 3 days off work and have help at home for 3 days.

Flexion is not inherently bad. McKenzie MDT uses flexion all the time. Some bulges require some flexion to go back into place. (anteriors and often laterals) Some posterior bulges with lateral components get WORSE with any extension. There are no blanket rules because every herniation is unique and the forces every person's body experience are unique.

After the derangement is resolved for a week, the back needs to return to full range of motion in both flexion and extension every day or the repair will never remodel into something tough and elastic, and will likely bust loose again. Flexion is important, and not inherently evil.

Berkeley, I'm sorry you've had such a rough time. Is it possible for you to go back to PT and see only one therapist for continuity of care? I would (of course) recommend you see the cert. MDT. Did the cert. get to see you often enough that they could tell if you had a responding direction? Did you try the 3 days in the responding position? Of course, if it's already been 8 months you've only got about 4 more before it spontaneously resolves anyway. (ruptures have a natural history of about a year)

Ered - I'm sorry to have hijacked your thread. When I was talking about flexion not necessarily being a bad thing I was NOT suggesting you leap onto your bike and go for a ride, I was only talking about the direction of spinal motion and its effect on disc pressures. I was also not suggesting you bend over and do potato-pickers...

[Ered_Lithui]

For two, asking a non-treating PT to check the work of the treating PT is ethically and legally a complete and total no-no!

Duly noted! I'll see if she can recommend someone here.

And Berkeley--a year! Augh! I'm so sorry.