Spinal Decompression

Hello,

A 4cm bulge is relatively large, but is still usually treatable with self-care methods. Frequent use of the McKenzie exercise that best centralizes symptoms (as explained in the videos and ebook) combined with applying cold packs to the low back for about 15 minutes every few hours will usually start to reduce symptoms within a week or so. Adding in the acupressure methods and other self-treatments from the members area will further help to reduce symptoms.

The important thing to remember is that sciatica, especially when it is due to a bulging disc, is a condition that really requires ongoing management even after the symptoms are gone. Continued use of the exercises and being careful to avoid improper bending and lifting and long periods of sitting (particularly in a slouched position) are necessary to prevent the symptoms from returning and getting worse over time.

If you have questions, please feel free to contact me.

Good luck!

Dr. Best

Hello Harry,

Inversion tables can be helpful but I have also seen cases where they cause increased symptoms during the acute symptom stage. Because the results are a bit unpredictable, I recommend them more as a preventive measure than as a treatment during times of major symptoms. In any event, it is good that it has helped you and I recommend you continue to use it at least a few minutes each day for prevention.

Dr. Best

Hello Harry,

Home traction devices including the Saunders equipment can be very effective in some cases, but for most people it is most effective as a preventive measure after symptoms are gone rather than as a treatment during pain episodes. Such devices just don’t create enough decompressive effect in the discs to reduce disc bulging in most cases. High-end decompression machines used in the clinical setting get a much greater decompressive effect and much better results in relieving symptoms.

With any kind of home treatment, be it the McKenzie exercises, acupressure, home traction, or anything else, using the treatment(s) frequently is often the key to getting symptom relief as quickly as possible. For example, someone who does the McKenzie exercise once or twice per day may not get any results, but that same person may get good results doing it for a minute or so at a time 3 to 4 times every hour they are awake. Once the worst of the symptoms are gone, then they can reduce the frequency and just do it a few times per day for prevention, but “intensive care” may be needed to get things headed the right direction. For the best results with traction, again the secret is to do it frequently, not just before or after exercise, but both before and after exercise. A few minutes of traction at a time as often as 6 to 8 times per day will do a lot more than once or twice per day. Some people get some back soreness with this much treatment, but as long as the sciatica symptoms are improving, then you are on the right track.

Good luck!

Dr. Best

Hi Frank,

Inversion tables are fine for relief of mild symptoms and as a preventive measure in people with disc bulges and/or degeneration. It’s best to start with a mild decline on the table for the first few times and gradually increase towards more inversion with subsequent sessions to avoid triggering reactive muscle spasm and also to get used to the circulatory changes (increased blood flow to the head). I recommend the tables that strap you in at the waist/hips, rather than ones where you are simply hanging from your ankles. The one other caution I advise is to invest in a good quality inversion table that is rated for your body weight – the last thing you want is to have the table buckle on you and drop you on your head!

Dr. Best

Hello Alvin,

I was not able to locate any providers with the DRX9000 in London. I did find the following Vax-D provider:

VAX-D Back Pain Centre
Address: Golders Hill Health Centre, 151, North End RdPostcode: NW11 7HT City/Town: London (London) Main phone: 020 8458 6400

You may be able to find additional spinal decompression providers by contacting chiropractors in your area.

Dr. Best

Hello Sandra,

It sounds like you’re on the right track with the exercises you’ve been doing. You may get some benefit from stretching the piriformis (pulling the knee toward the opposite shoulder) and gluteus minimus (the “figure 4” stretch) if you are not already doing that. It is possible that you’re getting some general increase in inflammation from the back issue that is causing some irritation around the hernia repair too. I suggest you try putting cold packs on the groin area when it is hurting and see if that helps. Finally, dysfunction in the sacroiliac joint and possibly the pubic symphysis (the joint between the two pubic bones) could be causing some of your resdual symptoms as well. If the previous suggestions don’t solve the problem, I’d suggest seeing a chiropractor to have that possibility checked out.

If you have further questions, let me know.

Good luck!

Dr. Best

Hello Jerome,

Inversion can be very helpful. It can sometimes irritate symptoms when things are acutely inflamed and in spasm, so some caution needs to be used in those circumstances. Once the major symptoms have subsided though, inversion usually does help alleviate residual symptoms and works well as a preventive measure along with the exercises. Interestingly, for many people, a relatively shallow angle works better than maximum inversion. 45 to 60 degrees down from horizontal seems to be the range where most people get the greatest benefit. When first starting with inversion, I recommend starting at the minimum angle your machine allows and just do a minute or so to start. Then you can gradually increase time and angle as you go along (just increase time or angle for a given session, not both at the same time). Different people have different levels of tolerance to inversion, so listen to your body. If you have increased pain or symptoms of lightheadedness or nausea, it’s best to reduce the time and/or angle to what works best for you.

Good luck!

Dr. Best

Inversion can be very helpful and Teeter is the brand I recommend. During major acute symptoms, inversion can increase symptoms, so I primarily recommend it as a preventive treatment, but some people do get relief of symptoms with it as well. I recommend proceeding cautiously for anyone who is trying to use it as a treatment when they do have major symptoms and start with the minimum angle for short periods of time to see how things respond to it. For preventive use, many people get the best results when they do a moderate angle rather than full inversion, but everyone is different and I suggest testing different angles to see what works best for you.

Dr. Best

Hello Bonnie,

It’s unlikely for spondylolisthesis to progress much at your age even over several years, especially if it is a degenerative spondylo caused by facet joint hypertrophy (extra bone formation on the joint surfaces) pushing the vertebra forward as opposed to what’s called a pars defect (which is a separation/fracture where the vertebral arch joins the body of the vertebra). The two most likely scenarios in my mind are that either the radiologist on the inital imaging report greatly minimized the extent of the slippage (this happens more often than you might think), or the surgery removed enough bone from around the facet joints that it dramatically altered the stability ad/or alignment of that level of the spine. It’s even possible that there was an undiagnosed pars defect that was being hidden and stabilized by the degenerative bone and when they removed the degenerative bone, the segment became much more mobile and even unstable.

This brings up the question of whether the surgery was improperly done, and while the outcome may have been bad, I can’t say that the surgery was necessarily improperly done. The surgeon does the procedure with the information available from the scan, and it’s possible he did what any other surgeon would have done and unfortunately things just turned out badly.

My guess is that you probably have some ongoing inflammation related to the surgery (it’s not unusual for the inflammatory response following a surgery to last for a few months). Also, if there is instability in the spine, that will provoke ongoing inflammation and muscle spasm. When you lie still, there is a tendency for inflammatory swelling to build up, and this creates additional pressure on the nerves. In addition, if there is muscle spasm, the muscles tend to get tighter with less movement. Once you get up and move around a bit, the swelling gets “pumped” out of the area and the muscles gradually loosen up to accomodate the movement.

In acute cases, traction/inversion commonly does increase symptoms. In some cases, traction will temporarily increase disc bulging because it causes the discs to take in fluid. While this is often good in the long run because it also pulls in nutrients that the disc needs for healing, it often does temporarily increase symptoms because more fluid = more bulging. As long as the increased symptoms following traction subside within several hours, it’s usually all right to continue it and it may prove to be helpful in the long run.

Given the relative severity and chronic nature of your condition, and the fact that you had surgery in June, I’d say there’s still a reasonable chance that things will improve gradually over the next few months as things heal and the inflammatory response settles down. Use the things that seem to help on a frequent basis and try to be patient with it. I would suggest trying to get a hold of the original imaging and have your chiropractor or another physician compare the actual images to see what has transpired with the spondylolisthesis. If in fact it went from minimal to a Grade II, I’d recommend having flexion/extension X-rays to evaluate for spinal instability. If there is significant instability, you’re probably looking at another surgery, but hopefully that is not the case. If there’s no instability, then I think you’ve got a chance to get things to a manageable level over the next few months, but there will may be some ups and downs for quite some time.

If you have further questions, let me know.

Good luck!

Dr. Best

Hello Marilyn,

Spinal decompression can exacerbate symptoms temporarily even when it’s doing good in some cases because the body may react to the sudden thickening of the disc due to re-hydration. But when that’s the case, the symptoms improve dramatically within a few days. In your case, there were two issues. First, as the other chiropractor told you, 75 pounds on the first session for someone your size was too much. The other issue, and possibly the bigger factor is that you have a grade II spondylolisthesis. While spinal decompression is fine in cases of degenerative spondlyo ( a stable situation in which the displacement of the vertebra is due to thickening of the joint surfaces), decompression is contraindicated in cases of unstable “isthmic” spondylo which is due to a non-union of the vertebral body from the vertebral arch (thought to be either congenital or due to trauma to the spine in chidlhood or early adulthood). Degenerative spondylos are usually Grade I. Isthmic spondylos range from Grade I to IV and anything above Grade I is usually at least somewhat unstable. With an unstable spondylo, decompression can cause shifting and/or increased instability, thereby triggering muscle spasm and inflammation which can take quite some time to settle down.

If you are not already doing some type of abdominal exercises, I would highly recommend you start, as this helps to stabilize the spondylo and minimizes symptoms from any shifting that may be occurring. Regular crunches are good for this purpose, as is the pelvic tilt exercise if you’re just starting out. As your abs get stronger, planks do an excellent job. In my experience, the stronger the core muscles are, the fewer problems people with spondylos have.

In addition, when there is a spondylo, patients often find that they need to alternate flexion and extension positions for the McKenzie exercises. Unfortunately, the extension positions that work best for disc protrusions can irritate the spondylo, while flexion positions for the spondylo may irritate the disc. Finding the right combination of flexion to extension is an individual thing and requires some experimentation to get it right, and it’s subject to change over time. It can be a bit frustrating to manage, but it can be done and if you’re exercising the core muscles well, you probably won’t need to do as much with flexion.

I hope this is helpful for you.

Good luck,

Dr. Best

Hello Anne,

First, I apologize for not getting back to you sooner. I usually get an email notification of new question posts, but I didn’t get one on yours and only saw it when I received notice of someone else’s question.

Kenalog is one of several corticosteroids that are used in treating back pain and sciatica. As with all steroids, it’s mode of action is to reduce inflammation. They don’t directly address the underlying problem and when they do work, the results are usually temporary (lasting anywhere from a few days to several months before symptoms return). Steroid injections can dramatically reduce symptoms when inflammatory swelling is a significant contributing factor to nerve compression. When there is significant narrowing of the nerve canals from structural issues such as disc protrusions and/or degenerative bone and/or ligament thickening, they usually don’t help much, at least not for very long. In my opinion, they really are only useful as a temporary symptom reliever to allow the patient to undergo other non-surgical treatment (such as physical therapy, chiropractic, etc.) more comfortably, or as a means of controlling symptoms until surgery (if indicated) can be performed. It’s one of my pet peeves that some doctors will prescribe them without explaining the nature of the treatment, nor recommending other concurrent treatment that actually directly addresses the underlying problem. There are cases where other treatment options have been exhausted and periodic injections are helpful in maintaining the symptoms at a tolerable level, but those are unusual, and from what a number of patients have told me, there are some doctors who present such injections as a “fix” for the problem when it is nothing of the sort.

I hope this is helpful for you.

Dr. Best

I’m not sure what you mean by me requesting a response again. You are on my email list and are receiving my email newsletter that goes out automatically, so I assume that’s what you are talking about. The amount of pain is not an indicator of the nature nor severity of the problem, nor what to do about it. The best guide for what to do is the testing procedures in my free ebook. In case you do not already have it, you may download it from the link on the right sidebar of this page: . If those methods don’t significantly improve things within a week or two, I’d strongly recommend you see a doctor for further evaluation.

Good luck!

Dr. Best

My free ebook covers the McKenzie method in detail. You may download it from the link on the right sidebar of this page:

Scoliosis in and of itself usually does not produce sciatica, although back pain is relatively common due to muscular contraction around the spine. Your leg pain is most likely a result of either muscle referral pain from the hip and buttock area or there may a disc protrusion or some type of degenerative change in the spine that is causing compression of one or more of the spinal nerves. The McKenzie method is primarily useful for nerve compression issues, whereas stretching and massage typically is more helpful for symptoms related to muscle contraction (one muscle, the piriformis, that commonly produces leg symptoms is also covered in the ebook). Self-treatment can be very effective, but I’d also suggest you consider seeing a massage therapist and/or a chiropractor for treatment of the joint and muscle issues that are typical with scoliosis cases.

Good luck!

Dr. Best

It’s certainly possible to over-do any form of treatment, but as long as there are no contraindications present, such as spinal ligament instability, and the treatment is done within established protocols, there’s not a significant risk of overusing spinal decompression.