There is the pain of the injured muscle plus the sympathetic pain along the nerve pathways. This appears to conduct itself in stages through a minimum six week cycle followed by a measure of rehabilitation which varies in efficacy. The severity varies widely, and the actual sites of pain vary considerably, but the cycle of stages appears to be a constant in all cases. Actually, the time-period is somewhat deceptive, as an incredibly large number of people reported a sort of "Oh yeah, I DID feel some stiffness about a week ago, but I paid no attention . . .". The thing to keep in mind is that due to the complexity of the structures involved, the injury must be treated as a PROCESS rather than an EVENT.
The process seems to pursue the following steps:
- Initial tweak
- Period of stiffness often ignored for weeks
- Onset of first pain episode
- Minor and temporary reduction in activity
- Temporary lessening of pain
- Second pain episode critical, very severe
- Patient seeks professional medical help
- Gradual lessening of the Parasympathetic symptoms: splinting, stabbing sensation, etc
- Pain spikes -- physical exhaustion, local rigidity, tenderness, high potential for re-injury and/or injury of other body areas. Often psychological changes due to chronic pain appear at this time. Numbness or tingling in the extremities.
- Gradual Rehab - two to three years.
The tweak may or not be remembered by the patient. Notice how far down the list is the usual visit to the doctor or emergency room in some cases. Sometimes the whole prior history is totally forgotten until the common statement "I was just reaching for a pencil and THEN it happened!" Well, no. The condition invariably predates the simple motion, and sometimes builds for years up to the "tweak" that will set the avalanche of pain in motion. In chronic cases caused by a lifetime of, say, wearing six-inch stilleto high-heels for eight hours a day, the actual tweak is incidental to what has been made inevitable over years of poor ergonomics.
Pay Attention Here!
In virtually every case I examined where surgery was performed, the patient ignored not only the initial stiffness, but the first pain episode as well. In other words, the patient told themselves any number of excuses such as "I am not that old, I am needed at work, my children depend on me, this project is absolutely essential, I am a VP for a major corporation and I am certainly not going to let a little pain stop me, I am a professional Marine in the US armed forces and I must continue to do jumps.", etc. Its all the same, people. The human body has changed minutely and will very little variation in over a million years. You are no different. These people were no different and fusing two vertebrae together means pain and limited motility for the rest of your life. Avoid it.
Usually though, the patient takes a couple days off, immediately experiences major relief since this is what the body is asking for anyway but then goes back to the same old grind before real rehab has begun. Trouble in River City is on the way, my friends.
Physiologically, the temporary reduction in activity, combined with a few pain depressors, like tylenol and a few martinis, results in some numbness and some inflammation reduction, without true healing having time to take place. Professional athletes use this all the time to "get through the season." I know of one team in California that establishes as regular procedure a sit in tubs of ice water after every workout to reduce inflammation caused by the extraordinary hard pounding the athletes must take. Ever wonder why most pros are washed up after thirty-two?
By the second episode, it has become clear that a real problem exists and medical help is needed. And then its too late. The universal comment, from emergency room to G.P. office is "They can do nothing but give a one time major pain killer." True enough. A lifetime of poor posture, lack of proper exercise, bad ergonomics, bone-wrecking footwear and whatever else has done its work and the patient is looking at a minimum of six weeks of COMPLETE bedrest. Sometimes pills and alcohol come into the picture here, as the pain is not inconsiderable and depression from being jolted into the status of "disabled" is often quite high. "Disabled? You mean like those dudes in wheelchairs?" they exclaim. Well, if you dont do complete rest, yes, you WILL be bound to a wheelchair and worse.
Often there is radiating pain or spike pain at specific points far from the site of actual injury, as the haywired nervous system continues to try to relay information back to the brain. In my case, the muscles of my inner thigh began "splinting", that is, they all began working simultaneously and at once for hours and days on end, rendering the entire leg useless. Visually, the leg surface looked like it was rippling like the ocean on a breezy day.
Strong muscle-relaxants can alleviate this condition, but side-effects can be unpleasant as well. Eventually, the splinting yields to periods of "spike" pain, that is, burning or stabbing sensations at random.
Recovery is not a flat-line or even an exponential curve of improvement. If you were to graph the pain levels, the line would look more like the stock market. Some days are just going to be bad ones with a fair amount of pain and others will feel like the whole thing was just a nightmare of the past.
Gradual rehab involves doctor supervised exercise, chiropractic "adjustments", and a slow recovery, beginning, as mentioned before about six weeks in the best of circumstances after the tweak. Full recovery can take twenty-four months according to some chiropractors. No joke indeed. This last period cannot be overstated enough, for the common dictum "Bad back is for life" is due largely to people not paying full attention to their bodies and the necessary time required for recovery.
- Severe low back pain
- Radiating pain
- Coughing, straining, laughing produces more pain
- Tingling or numbness in legs or feet
- Muscle weakness
- Groin pain
- Sexual dysfunction
- In some cases, loss of bowel control, incontinence, urination problems, pain during "bearing down"
Diagnostics may include X-rays, MRI, myelogram, EMG, and nerve conduction velocity. The myelogram is indicated where the disk is herniated and the location needs to be pinpointed.
There are a fair number of variations on these symptoms, given that impaired nerve function can respond with wildly unpredictable consequences. Sometimes there is very little pain, but whole muscle systems will "lock-up" in rigidity, especially in those with highly developed muscle groups, such as weight-lifters.
Invasive repair procedures are beyond the scope of this paper, but briefly, the most radical procedure involving removal of the damaged disk followed by fusion of two vertebrae has increased its stats of anticipated success significantly in the last decade. At the beginning of the eighties, fully 15% and more of some 30,000 patients a year experienced no relief. It has always been the case, and to a large extent still is, that a second "cleanup" operation is required in successful cases to remove scar tissue.
Still, there are physicians who evaluate surgery as an option far too often and far too early in the process. The rule for you should be AVOID SURGERY IF AT ALL POSSIBLE.
Surgery is called for only when the consequences of avoiding the procedure will result in severe or total paralysis due to destruction of the spinal cord and/or major nerve roots. I do have anecdotal reports of people walking out of the hospital the following day from spinal fusion. I suspect this is not common, however. Surgery must always be considered the last resort to be confirmed as a necessary procedure by more than one neurologist.
Recent studies have confirmed most of what has been said here. Those patients who underwent physiotherapy in lieu of surgery had no worse recovery rates than those who opted for surgical remediation. The difference in procedure paths is well into the thousands of dollars There are new procedures, such as thermal annuloplasty, whereby an electrode inserted into the damaged intravertebral disk under local anaesthetic cauterizes nerve endings that have worked into the gel plasm of the disk, but this is no resolution for a ruptured or severely bulging disk pressing on the spinal cord.
Advances in surgical technique have marginally improved success rates. Additional surgical therapies remain available only locally where certain techniques have been developed. Radical advances in treatment are not being widely disseminated through the primary care provider networks but remain with those surgeons and practitioners who possess specialized equipment and developed skills.
We had the opportunity to observe another case study of lower lumbar disk degeneration in a former athlete who developed unrelated carcinomas in other areas of the body. Surgery was not advised but the indivdual, wanting prompt resolution, underwent surgery, which followed the usual pattern of two additional surgeries and little improvement in the condition, no improvement in mobility, and rapid deterioration of lifestyle patterns. Clearly, surgery is NOT a "quick fix".
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