Two steps forward, one step back!
I feel so sorry for Amy as she has been doing everything possible to strengthen her core muscles to help support and stabilise her spine. All was going well but a period of stress one morning was enough to tip the balance and lead to a relapse. The thing with pain and particularly back injuries is that they tend to be multi-factorial; in that it only takes a certain combination of seemingly everyday factors to take you over the edge and into the possibility of injury. This could be something simple like a lack of sleep, feeling slightly under the weather, a prolonged period of breastfeeding in a slightly strained position, a poor lift or prolonged sitting.
The back mechanism is complex with muscles, ligaments and nerves as well as the disc all having the potential to be injured. The back is also a classic for visceral referral (more Gayle’s area of expertise than mine) where problems with the stomach, bladder, kidneys or bowel can be felt in and across the lower back.
In this case with Amy, although it did not seem as severe or as truely suggestive of a disc injury as last time, I was not keen to manipulate within a few minutes of her re-injuring it. I would liken this to Russian roulette. Manipulation is great for dysfunctions concerning the facet joints of the back, or even muscles and ligaments, as it can restore function and release muscle spasm, but with discs it can make it better, or it can make it worse. Amy did not have all of the classic disc signs such as referred pain down the leg, positive straight leg raise, weakness of the leg muscles or altered sensation or altered reflexes, but she did have a positive slump which does indicate some degree of neural irritation or entrapment. It is always a difficult decision to make as manipulation can have such a profound effect on pain. I often self-manipulate or ask Nick to manipulate my back if I feel it becoming problematic – but this is easy as I know my own body and can be fairly confident that it will be fine. With patients it is often a case of performing a very thorough examination, even then many dysfunctions can present similarly, and then following and trusting your instinct – after 20 years of doing this job I have learnt to listen to it. Manipulation can be useful after the acute phase has settled to help restore function as long as it done with consideration to the patients current state.
Unfortunately disc mechanics are very complex and it also does not have a great blood supply, so they can take time to heal. It is very common to have speed-bumps along the recovery journey, but as with Amy this time, it did not seem as severe. Hopefully this episode will continue to settle, she will be able to advance her exercises again, and so continue to strengthen her spine. It takes around 2-3 months to do so and frustratingly, like walking up snow, each time you re-injure it, you lose a bit of what you have worked so hard to gain, so the time required pushes out to 3-4 months.
Keep it up Amy.
Grant
Posted by Grant Plumbley on 7th January, 2012 | Comments | Trackbacks
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