ian/555

For the last 5 months I have been suffering from a slipped disc and have found that my own Gp is just a prescribe pain killers sort of guy.
I have done a search on the net and have found a clinic claiming to be able to treat disc problems using the Maitland -Cyriax field of Orthopaedic Medicine which deals exclusively with the vertebral column and related musculo-skeletal trauma.

Can anyone offer me some advice based on experiance of this type of treatment or advice on other forms of treatment, as I am getting severly depressed with the thought of having to put up with this F*(*&£^ pain indefinately.

PhilH

Hi Ian

I'm not a medical Dr but have suffered back problems for years, on and off.

Interestingly a slip disc has nothing to do with the movement of one of your discs its all down to an escape of the fluid from the spine hitting the nerves.

he best treatment I ever had was from a good physio therapist. About 10 courses over a 6 week period moved me from the point I couldn't stand up to a sound back, and provided the knowledge of how to keep it in proper shape.

Personally I'd avoid any of the other types of (quack) practitioners out there and stick to a physio. Take a look in the yellow pages and/or ask the doc for a recommendation.

Phil

ajw

Sorry to hear about your problems.

My advice would be to see a consultant orthopaedic surgeon with a spinal interest. You may have to go private, but your GP probably will not have any qualms about referring you. Even if he cant offer a solution, he will refer you to a good physiotherapist or even chiropracter - the other thing you mentioned Ive never heard of.

Regards Andy.

Neanderthal

iTrader: (6)

I have suffered with a weak back for years (found out its a birth defect - but I'm not in as healthy state as I've been in the past).

I used to get a really uncomfortable pain in my lower back but it usually went after a couple of days taking it easy.

Earlier this year the same pain occured but would not go away. After a couple of weeks I went and saw a Osteopath on the recommendation of the gilfriends mother who was a secretary there.

3 half hour sessions (half hour session a week) I've never had a better feeling back. It cost me £21 per session (friends and family discount) but it was worth it.

The initial session was a bit unnerving when he crunched my spine back in line (he did the same thing the next 2 weeks with hardly any cracking so it must have worked).

He also showed me a few excercises to do which help strengthen muscles to help counter-act the lack of strength in my lower back.

I'd recommend him to anyone with back pain.

Matt
P.S. Sorry for the long post

DavidBrown

Hi Ian,

I feel for you dude.

I slipped a disc a few years ago, at first it was a nagging pain, made worse when trying to raise my right leg.

After a while I couldn't lay flat.. then it hurt to walk.. then I was in constant agonising pain 24/7.

I had no end of chiropractor/GP stuff, all to no avail.

I asked to see a specialist.. I was told the waiting list on the NHS was 9 months. Instead, I paid £70 for a private consultation the next day.

The consultant told me I needed an MRI scan.. waiting list on the NHS around 7 months.. I paid £400 for a private MRI scan within 2 days.

The MRI scan showed I needed an operation sharpish.. the herniated disc was squashing my spinal chord. Privately I would have to wait 10 days, on the NHS just 7 DAYS !..

I went in, had keyhole surgery (microdiscectomy) to remove the protruding disc, which had almost severed my spinal chord.. within 3 hours of that, I was walking and was pain free for the first time in 2 years. Was amazing.

Don't wait. GET IT SORTED.

Want any info, E-mail me.

Luke

Go private,last thing you need is a 3.day wait in a N.H.S hospital,Should you have one................
I had/have back/leg problems. I have a fantastic Orthopaedic doctor in Istanbul that i visit

believe me its worth it.

Stay away from those "Feng shui" type folk!!

ScooBabe

Myself and a friend have both used a chiropracter. Great results, and are keen on stressing the inportance of back exercises to prevent re-occurrence.

Ring them for a chat to see if a sipped disc is something they can help you with. They will do a proper consultation anyway.

They have years of training by the way

john banks

Difficult problem. With the usual disclaimers, I am currently in General Practice. Presumably your doctor checked whether you had bowel/bladder upset as that is a sign of spinal cord compression and an indication for urgent referral. Other than that the current vogue for treatment of back pain is usually keeping mobile and giving analgesia and investigating immediately if there are worry signs, or delayed by six weeks if not as most of it settles spontaneously by then. If you are not happy see your doctor again and raise your concerns - he MAY well not just be blindly pushing you pills but following best current evidence. I know many orthopaedic surgeons now will not operate unless there is spinal cord compression. However, if things have been going on constantly for five months it would certainly be worth getting referred to an orthopaedic surgeon IMHO.

ChrisB

Sorry to hear you're still not sorted mate

I can't remember what he did, but my Dad had some painfull back trouble. Local GP wasn't much help so, like Neanderthal, he went to see a private Osteopath.

A few sessions later, with similar cracking and crunching noises he was pretty much sorted.

He's been back since a couple of times when he's aggravated but it was well worth the money.

ChrisB.

Mungo

Purely my own opinion based on personal experience, but I would highly recommend a chiropractor. I also have many friends who swear by them. As an ex-rower I have a lot of friends with lower back problems. Many have had successful surgery, but this was usually a last resort once they couldn't walk. Chiropractic has sorted both myself and my wife.
Not cheap (about £30 for 15 mins ) but it has worked.

sebastian

I` m a Dr with a slipped disc (L4/L5) have had a combination of physio (good exercises for the muscle spasm) osteopath (Ok but expensive and same old thing every week) and an epidural steroid injection by the specialist rheumatologists (effective- took away 85% symptoms, but likely to recurr)

You must get referred to a hospital specialist so insist your GP does this ( he probably is reluctant to spend the money)as you need proper evaluation, an MRI scan, and treatment.

Im hoping to avoid an operation but if you do I`d get a neurosurgeon in preference to an orthopod, or at least make sure they do a lot of backs!!



[This message has been edited by sebastian (edited 06 September 2001).]

Tim Skerry

It is worth mentioning that all "slipped discs" are not the same. As someone said earlier, it is not the whole intervertebral disc that moves. The disc is best visualised as a doughnut - and the outside (the annulus fibrosus) is attached to the vertebrae above and below. It cannot moved. What is called a slipped disc is a prolapse of the jam in the doughnut (the nucleus pulposus) which is a stiff jelly-like material, containing proteins and other smaller proteinaceous molecules (proteoglycans and others). The severity of the prolapse depends on several things
1 how much material prolapses,
2 what it presses onto, and
3 how quickly this happens.


Obviously the more material that comes out the more there is a chance of pressure onto a vital structure. Unfortunately the annulus is not equally strong all round and if prolapses happened in a ventral direction away from the spinal cord, there would be nothing reallly important for it to press on. What does happen is that it goes dorsally or sideways and that means it preses onto nerve roots leaving the spine or the nerves inside the neural canal (the tube/arch of the vertebra). It is possible to have a partial prolapse, and this might seem to be good as less material pressing on nerves would appear to be good. However, a partial prolapse leaves a weakened tract through the annulus, so another prolapse can happen in the same place.
In humans, fortunately the discs likely to prolapse are lower lumbar (often L5S1), and the good thing about this is that the spinal cord in man is shorter than the length of the vertebral canal by quite a lot, so that there are no bits of the spinal cord (which is central nervous system) there. (Damage to CNS is much more likely to be serious, permanent and generally bad than damage to peripheral nerves) So in man the nerves in the spine at the lower lumbar level are peripheral (known as cauda equina) and have the theoretical capacity to regenerate.
The speed or duration of a prolapse is important. A slow progressive or repetitive minor prolapse will cause chronic pain but because of the progression after prolapse *(see later) is less likely to cause serious motor or sensory deficits. A rapid sudden onset prolapse is bad news - when over a few hours all or nearly all the nucleus spills out and presses hard onto a nerve. This causes problems because the pressure may kill off cells and therefore lead to loss of those nerves altogether. Sudden onset protrusions may need urgent surgery, and microdiscectomy is probably the treatment of choice. (This is surgery through a small hole to remove nucleus material and decompress the nerves)
Where prolapses are slower, what happens is that the mound of material resolves and shrinks quite a lot. this is due to the solubilisation of the smaller molecules in the nuclear material (proteoglycans etc) so that the condition will improve. Unfortunately many sufferers continue to have pain because there is som eresidual pressure on the nerve roots. Surgery in longstanding chronic cases is less likely to be effective than it is in sudden onset cases.
Disc protrusions cause a variety of symptoms from pain through sensory and motor deficits. The nerves in the areas that usually suffer from prolapses also supply the pelvis, so in bad cases incontinence could be an issue. This may be manifested (paradoxically) as an inability to pee - so called retention with overflow but it can resolve very successfully with time, so don't despair if you have bad dusfunction associated with sudden onset protriustion or after surgery, when the pulling about can accentuate things for a day or two. Leg function can also be afected, and muscles in qusestion can include the gastrocnemius (back of the calf, and everters of the foot - the ones on the outside of the calf that twist your foot so the little toe is higher than the big one. Others involved may be the flexors of the toes, especially the deep flexors, so that the toe bends at the "knuckle" joint but not the lower ones.
Sensory dysfunction is interesting in a horrible sort of way. You can map which nerves are involved in a case by seeing which areas of the leg and foot have cutaneous sensation (pain on pricking the skin).

Damaged peripheral nerves are theoretically able to regenerate, but the problem is that the ones commonly affected are in the sciatic nerve, which contains the longest nerve fibres in the body. Even at 1mm a month, that can mean a long time to get sensation back in your toes.

I speak as a sufferer who had surgery(Sudden onset protrustion with microdiscectomy 10 years ago) and a vet who used to do the same surgery on dogs esp dachshunds, and now musculoskeletal research scientist, so I hope this is helpful, and I can try to answer specific questions if others come up.

From a personal point of view, I think that neurosurgeons have a reputation for being a bit less gung ho about exposure - ie they might make a smaller hole when operating, but the most important thing to consider if you are contemplating suyrgery is how often does your surgeon do these operations? Senior registrars may actually do more ops than consultants in some places, so don't be put off if you get one of them, but I don't think it would be unreasonable to ask how many (s)he has done.

Kussimurran

Ian!

I am a chiropractor and acupuncturist, and I have been in practice for eleven years working for the largest multidisciplinary orthopaedic clinic in the UK. I work in a team of surgeons, orthopaedic physicians, chiropractors, osteopaths, physios etc, dealing mainly with musculoskeletal issues.

Unfortunately I no longer work much as I have come down with myeloid leukemia, and I am undergoing treatment for this. However, I have learned a few things about bad backs!

Many of the posts contain some very useful information.

The first thing you need is an accurate diagnosis. If indeed you have a PID( prolapsed intervertebral disc), there are several options. There is no need to rush to a surgeon as your first line of defense, as only a small number of PIDs are actually operated on, and in this case it isusually due to either intractable pain that persists despite conservative treatment, or due to progressive neurological deficit( loss of your reflexes, bowel/bladder dysfunction, weakness etc. ).

So, if you came to see me, I would organize an injection by one of my colleagues( orthopaedic medicine practitioners ), such as a caudal epidural or facet/root blocks, if your pain level is very high. If not, we would sart you on a course of manual therapy, comprising mobilisation, manipulation, soft tissue work and home exercises in order to settle your pain and inflammation.

Finally I normally then refer onto another colleague in the clinic, a physiotherapist, who looks at underlying muscle imbalances and spinal stability issues, and then works with you in the rehab centre.

The prognosis is generally very good, and only a minority of patients need surgery or injections, although I do not know the details of your case.

It does not matter if you see a MAIPULATIVE physio, osteopath or chiropractor to start with, as long as they are all state registered and have a good reputation.

Do not hang around, as prolonged inflammation is damaging and leads to functional and structural changes in your spine.

Best of luck, email me if you have any more queries about anything.

Dr Andreas Hallin, DC MBAcC

ian/555

Thanks for all your opinions and advice, I suppose I had better get back (no pun intended) to my GP and ask for a proper diagnosis.