Question
I am a 42 year old female and i hurt my back trying to catch a heavy box i was putting on a shelf that almost fell. I had an MRI done which shows i have a bulging disk on L4 and L5-S1 with a tear. I have been going to physical therapy for 2 months and also have had 3 epidural shots which did not help. I have constant pain in my low back and buttocks and down the right leg. What is the next step for treatment in getting better? I take vicodin but only dulls the pain also i still take roboxin and celebrex. I don't sleep well and am very limited to what i can do. I only way i feel better is laying on my side. Do not want to live the rest of my life laying down. What do you suggest i do now? Also what is the next step in treating this? Thank-You

Answer
Dear Tina,

Rehabilitation times for a herniated or bulging disk will vary from patient to patient.  The first thing I will say is please be patient and do not expect quick relief.  Epidural shots are often ineffective at reducing pain transmission and will do nothing to heal the injury.  Physical therapy is a good step, but if you have not improved after two months of care, you need to go somewhere else.  They are either not teaching you the correct application of exercises to help stabilize the area, or it is just not going to be effective in your case.

Have you tried chiropractic care?  I treat disc bulges and herniations all the time with good results.  More than 75% of the cases I see improve to be pain free, and less than 5% have to be referred for surgery.  Look for a chiropractic physician who has Cox Flexion/distraction tables in their office or intervertebral disc decompression...these are highly effective in working on the disk and helping to form proper scar tissue while maintaining fluid content on the inside of the disc.  

At night, I would encourage you to try placing two pillows under the legs when sleeping on your back to reduce pressure on the disk.  This effectively places you in a seated position while on your back...flexing the hips 90 degrees and the knees 90 degrees so that the disk space can be open, and that gravity is along the line of the femur shaft (leg bone) which allows a gentle stretch of the lower back musculature.  Do not sleep on your stomach, this compresses the joint spaces by placing your spine in hyperflexion and this will make the disk bulge worse.

Stability of the low back is key and the multifidus muscle is the most prominent muscle that you need to be concerned with stabilizing.  There are exercises that specifically target this muscle which attaches to the back side of the disc and slightly crosses the fact joints..it is extremely important.  Please do some extra research online about the multifidus, and bird dog exercises.

And lastly, there is a great author by the name of Pete Egoscue who has written a few great books on effective self rehab techniques...some of which I actually utilize in my clinic.  I would suggest that you buy a few of his books.  His working knowledge of the anatomy is better than most doctors and physical therapists.  You can learn a lot to help in stabilization of the entire spine, which will help to control pain and future injury.

Good luck Tina, hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net