Degenerative Disc Disease

The aging process brings about degenerative changes to our ligaments, tendons, and cartilage through the desiccation (the drying out) of collagen. Degenerative Disc Disease (DDD) refers to this process occurring in the vertebral discs. It just so happens that the vertebral discs suffers through the most dramatic of age-related changes of all connective tissue related to this process. In DDD, the discs will shrink and collapse bringing the vertebrae closer together and causing greater risk of disc herniation and assorted pain problems.

The typical treatment for Degenerative Disc Disease is heat, rest, physical therapy, and of course, medications—pain relievers and anti-inflammatories. These treatments can not solve the problem of ligament laxity as we have seen Prolotherapy do. Injections to the ligament area, can help restore, tighten, and thicken the ligaments that will stabilize the spine in Degenerative Disc Disease.

The Problem With The Diagnosis
We typically have patients come into our office with big stacks of MRIs, CT Scans and x-rays to confirm the label of Degenerative Disc Disease placed on them by other medical professionals. For example, a woman once came into our office. She had in essence become the living, breathing “embodiment,” of the problem that showed up on her film. When she came in, all she could do was talk about her degenerative disc disease at the L-5, S-1 discs.

This woman had pain in her groin and her back. When we told her we were going to examine her to determine if this was indeed her problem, she had a lot of difficulty comprehending that her pain may not come from her Degenerative Disc Disease at L-5, S-1 because she had already been diagnosed as needing surgery on these two discs. There have been many studies and papers written on the accuracy or correctness of diagnosis based on an MRI reading.

We know from studies that half the people after a certain age show disc problems on film but they reported they had no pain.

So if someone has a diagnosis from an MRI the first thing we do is see if that is REALLY where the pain from your spinal cord injury is coming from. To practice good medicine you need to rely on MRI and X-Rays and scans but you also need to use your hands to find out where the pain is coming from, being careful to gently press on the suspect area causing pain. When the physician’s touch elicits an intense pain spot, known as a trigger point or tender point, then we know this is the spot (to do Prolotherapy). In a future article we will discuss Prolotherapy Injections and the benefits of prolotherapy injections treatment in greater detail.

Disc Herniation
As Degenerative Disc Disease progresses, the pressure exerted on the discs by the squeezing together of the vertebrae can cause the disc’s inner fluid the “nucleus pulposis” to bulge (or herniate) out and through the disc’s outer layer (the annulus fibrosus) and press down on the nerve.

It is estimated that nearly 90% of disc herniations occur in the lower back and in connection with the L5-vertabrae, either between L4 and L5, or, L5 and S1. Read about Dr. Darrow’s back pain

Questions about this article? Contact Doctor Darrow.

Ligament Sprain or Herniated Disc?

Damage to ligaments is estimated to be responsible for up to 70% of all cases of lower back pain. In my clinic, I would estimate these causes to be even higher.

Many people, over the age of 50, have disc problems but don’t even know they have a disc problem because the disc has not been causing them any pain.

But if someone tweaks a ligament in their lower back, usually the iliolumbar ligament, which connects the pelvis to the spine and they have an MRI done and it shows a herniated disc, their doctor is going to want to operate when it is not needed in the many cases I see. That disc may have been herniated for years and had not been causing any pain.

If we palpitated the area above the pelvis, where the iliolumbar ligament is, and it is pretty sore, Prolotherapy could help heal that injury without surgery.

So what does the Prolotherapy do? It strengthens the ligaments, and gets rid of the pain by stabilizing the spine. We also use the MedX exercise machine. The MedX works by strengthening the musculature of the back and increasing its range of motion, both of which have been found to decrease back pain. We would also align the spine with applied kineology. Combined, these treatments usually put us in very good shape.  So if you were in a Los Angeles car accident, or a collision in some other city, and want to try pain relief therapy that can heal the damaged joint, insurance may not cover it.  But if you can prove it was reasonable and necessary expense, your car accident lawyer may be able to recover you money damages to pay for the therapy.

In Excruciating New Cure for Back Pain, Doctors Tell Patients to Hit the Weights

WALL STREET JOURNAL
Tara Parker Pope
November 12, 2002

For people with back pain, the advice has long been simple: Take it easy. Now, some doctors have a radically different suggestion: Make it hurt even more.

The new treatment, called aggressive rehabilitation, goes well beyond traditional physical therapy, taking the “no gain, no pain,” approach to an excruciating level. After years of tentatively guarding their backs for fear of injury, back-pain sufferers who can barely walk or stand are subjected to grueling exercise, using their back muscles to stretch and push weight.

Those who can soldier through the treatment call it a miracle cure. A number of recent studies show back-pain sufferers who use aggressive exercise are far more likely to return to work, have less pain and are less likely to seek additional back treatment than those who use more traditional treatments.

“We say, ‘Let’s not guard it and protect it anymore,” says Carol Hartigan, a physical-medicine and rehabilitation physician at the Spine Center at New England Baptist Hospital in Boston. “It’s the opposite of what they have been told. If you have a bad back, it should be strong and flexible and fit.”

Intensive exercise has been slow to catch on. The therapy is far less lucrative than pain pills, injections and surgical treatments that are the cornerstone of the back-pain industry. And patients, too, are reluctant to pursue the treatment, which takes more time and effort than passive therapies. But now with growing evidence that spinal-fusion surgery doesn’t work for most people, more patients are looking for nonsurgical options.

David Shorr of Chicago is a believer. A few years ago, he was ready to under go spinal-fusion surgery for three degenerating disks. Mr. Shorr, a 38-year-old partner in (a) Chicago trading firm, was barely able to walk.

In a last-ditch effort to avoid surgery, he flew to the Physicians Neck and Back Clinic in Minneapolis, where doctors prescribed intensive exercise that focused on building up muscles. Before treatment, he could use his back to push 42 pounds; after 3-1/2 months, he could push 178 pounds–his body weight. He and his business partner invested $25,000 to buy the MedX exercise equipment used by his doctors.

“The first night I was crawling around, that is how much pain I was in from my first treatment,” says Mr. Shorr. “Now, 38, I’m as strong as I have ever been. When you’re living with back pain, you are willing to experience worse pain to get past it.”

The treatment runs counter to what most back-pain sufferers have been told. Often, physical therapists tell patients to ease up if they start to hurt. But proponents of intensive exercise say it only does more damage when people stop using their backs. The patient becomes “deconditioned,” and the back becomes weaker, making it more likely to be injured again. Whether the problem stems from an injured sick or degenerative disease, proponents say strengthening the muscles will help.

“The more inactive they are, the lower their chances of recovery are,” say Charles Keley, a founder of the Physicians Neck and Back Pain Clinic.

Still, he says, getting better often is “dependant on whether they have the chutzpah to go through an initial increase in symptoms.” Patients face a huge psychological hurdle in believing that they can start using their backs. As many as a third of patients drop out of the intense exercise programs.

“I was very afraid and very concerned,” says Elizabeth Prouty, a 56-year-old Boston resident who had suffered years of back and disk problems. She underwent aggressive rehabilitation twice a week for 10 weeks, and now regularly does the back stretched and weight-lifting that keep her pain in check.

Of course, patients shouldn’t just rub off to the gym on their own. Proponents say that at least initially, such treatment should always be monitored by a physician. Meanwhile, finding a spine specialist who recommends aggressive rehabilitation rather than just traditional physical therapy can be tough. Some doctors use MedX exercise equipment, which uses computers to monitor a patient’s progress.

Dr. Hartigan says her center uses the Cybex back extension machine and other weight machines commonly found in health clubs, Most centers recommend a maintenance program using an inclined “Roman chair” that a patient can lean on while lifting and stretching the back.

(The key to the program) is that (it) doesn’t focus on pain relief but on restoring back function. “Rarely do they say they have no pain,” says Tom Mayer, an orthopedic surgeon and medical director of Pride Rehab (in Dallas). “But these people who were previously thought to never be able to work again…who do go back to the same kind of jobs they had before.”

St. Paul, Minn., lawyer Tim Malchow, 60, could barely walk, drive, or even sleep in a bed because of paralyzing back pain. After aggressive rehabilitation treatment, he continues to exercise on his own and is now able to drive, swim and go hunting. “I was not at all intimidated by the fact that they said, ‘You’re going to have to exercise and you’re going to hurt’,” says Mr. Malchow. “I know what pain is all about.”

References
Brian Nelson, MD; David Carpenter, MS. Can Spinal Surgery Be Prevented by Aggressive Strengthening Exercises? A Prospective Study of Cervical and Lumbar Patients. Archives of Physical Medicine and Rehabilitation 80 (Jan 1999): 20-25.

Identifying Different Types of Back Pain

To review, there are many structures in the lower back that can cause severe pain. These include muscles, ligaments, tendons, bones, joints and discs. The outer rim of the disc can be a source of significant back pain due to its rich nerve supply and tendency towards injury.

During our development, there is a great deal of overlap of nerve supply to all of these structures. This makes it nearly impossible for the brain to distinguish between injury to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury. This is where an examination into the cause of the pain is important; each of these different structures may need a different type of treatment to resolve your pain.

Back pain can be divided into three large classifications. The most common condition is known as axial, or mechanical back pain. This pain can run the gamut from a very sharp to a dull ache. It may occur all the time, or it may come and go. It also varies in intensity from very mild to extremely severe. One patient may report that his/ her lower back is only sore when having been seated for a long time, or after working in the garden. Another patient may report severe, debilitating pain and need assistance to walk or stand, or even to get up from a sitting position. While one patient is perfectly straight, the other is bent over and locked in a crooked posture. The one thing that is common in these conditions is that the pain is restricted to the lower back area.

This most common type of problem, mechanical back pain, is completely non-specific with regards to the injured structure or structures. Generally, the pain gets worse with certain activities or positions. It is usually relieved by rest or changing positions. Note, extended bed rest may aggravate this type of problem.

This condition responds extremely well to conservative care. At times, spinal manipulation alone is the “miracle” affording immediate relief. More often, the injury involves more than just a misalignment of a vertebrae or of your pelvis. nerves, muscles, tendons, ligaments and skin can all have an influence on the degree of discomfort. And each of these may need to be addressed to attain relief.

Back pain can be divided into three large classifications – axial pain, referred pain and radicular pain.

If you have multiple episodes of this type of pain, you will want to engage yourself in a rehabilitation program to help resolve the underlying causes of the problem. Here, the diagnosis goes farther than just finding out what is causing the pain, but additionally centers on what weakness or restriction you have that ultimately causes you to have an episode. Here again, we function much like a “coach”, finding the cause(s) and helping to direct you towards ways of avoiding and limiting future bouts with pain.

The most common type of back pain is known as referred pain. Here, patients complain of having an achy, dull type of pain that seems to move around. The discomfort comes and goes and varies in intensity. This achy pain starts in the low back area and commonly spreads into the groin, buttocks and upper thighs.

The treatment options here are similar to those used in treating axial pain. Diagnostic and therapeutic measures are aimed at correcting abnormalities in the muscles, ligaments and small joints of the spine.

The last type of back pain is known as radicular pain. In this case, the pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.

The most common example of this type of problem is the sciatic pain that radiates along that sciatic nerve – down the back of the thigh and calf into the foot. This type of pain is caused by injury to a spinal nerve. Some of the possible causes of this are a disc protrusion or bulge, arthritic changes or a narrowing of the opening through which the nerve exits.

While a few of these cases will require surgery, most respond to conservative care. Here the care will consist of multiple therapies, all designed to reduce inflammation, balance your posture, strengthen supporting structures, attain normal motion and improve the health of the nerve that is involved.

In all types of back pain, your health habits play an important role. For example, there are certain foods that are high in the fats that cause more inflammation. Limiting intake of these animal fats and increasing your intake of the good fats that reduce inflammation may play an important role in your healing. Smoking is another health concern. Statistically, smokers are slow healers with respect to back pain.

An important part in prevention is keeping these back muscles active and in good tone.

One of the most important areas in chronic back pain management is the strength of your abdominal wall and your pelvic floor. There are three major abdominal muscles, each with small subdivisions. Any weakness in one of these sections can be the root cause of a chronic back problem. Weakness in these structures causes your back muscles to tighten and shorten. This adversely affects the lower back on the small joints and discs.

If you are interested in helping to prevent or at least limit your chances of having any of these types of back pain, talk to us about testing and setting up an exercise program for maintaining good support for your back.

Back Pain Forum

From Your Questions On Our Radio Program:

“Most of the surgeries that are done, in my opinion, is to cure the MRI than to cure the person. Our clinic is filled with these people who had the surgeries that have failed.”

Low Back Pain
Caller: I have had low back problems for a number of years, and I would say that once or twice a year my back will go out. My back will go out at the strangest times, I could be sitting in a chair and when I get up, it can go out. I am at the end of my wits with this. I have been trying to do everything I can to strengthen it.

Dr. Darrow: Your situation is very common; most of the people who have back pain, and that is about 80% of the population at some point or another who have recurrent back pain like you do, have what we call lax or loose ligaments that connect the pelvis to the vertebrae. (Ligaments attach the bones to the bones).

So what happens is you can get in certain position where you lift something or there is some activity that you do, the ligaments, because they are loose, will allow the bones to move out of position causing inflammation and pain.

You have to strengthen the abdominal muscles. We have at our clinic, a machine that is called MedX which is very specific for getting those muscles right around the vertebrae tightened up and strengthened up and then Prolotherapy is absolutely perfect for that because it grows back these ligaments and when I say grow back I mean it increases the density by about 50% and the tensile strength by 200-400%

Lower Back Pain
Question: I have back pain, lower back pain, diagnosed as a degenerative disc in the 5th lumbar, I am actually going in for another MRI, then I am scheduled to go into pain management with my doctor. I have constant pain.

Low Back Pain
Caller: I have been suffering with lower back pain due to playing football for such a long time. The pain runs from my lower back down into the right side of my leg. Chiropractors worked on me for years but they say that basically there is nothing they can do for me with the discs as compressed as they are.

Dr. Darrow: There are two things that run through my mind immediately when someone has leg pain…

Herniated Discs – Sciatica
Caller: I am having a lot of problems with my lower back L5 (Lumbar 5) disc. Every now and then, and for no reason, I get a tremendous pain in that area, my back freezes up and I can’t do anything or straighten up. I wind up bent over in half, it goes on for several days…

Lumbar Stenosis
CALLER: I am neurologist, I have a lot of patients that have lumbar stenosis with a lot of pain, weakness, and loss of balance. For various reasons, medical problems, they are not good surgical candidates or they do not want surgery…

 

 

NSAIDs
Caller: I suffer from chronic pain from a number of sports injuries, lower back and shoulder, I currently take a number of non-steroidal anti-inflammatory drugs (NSAIDS), I have tried the ones that are suppose to be strong, but maybe they are bad for you heart. Any suggestions for those of us with these ongoing problems?

Dr. Darrow: In my opinion, the best suggestion is to try to get off the NSAIDs, get to the root of the problem and get that fixed. Have you had any surgeries already?

Caller: I have had three lower back surgeries.

Dr. Darrow: We can examine the low back and see if there is something we can do with Prolotherapy. Do you have any pain down your leg?

Caller: Occasionally down the left leg, but the pain is mostly in the back.

Dr. Darrow: Well that is good news because that sounds like it is “mechanical low back pain,” which means that the ligaments are probably just sprained and you can have hope.

Failed Back Surgery Syndrome
Researchers writing in the medical journal Cirugia y cirujanos examined main causes of failed back surgery syndrome (mistaken diagnoses, transoperative error, technique error, poor application, poor indication).

Rosales-Olivares LM, Miramontes-Martínez V, Alpízar-Aguirre A, Reyes-Sánchez A. (Failed back surgery syndrome.) Cir Cir. 2007 Jan-Feb;75(1):37-41

The reseachers results: “There were 16 females and 4 males with an average age of 53.2 years. Eight patients had 1 prior surgery, 8 patients had 2 prior surgeries, 3 patients had 3 prior surgeries, and 1 patient had 4 prior surgeries. According to the Oswestry preoperative scale, 12 patients had scores higher than 60% and at 2-year follow-up, 11 patients had scores lower than 20%. Despite the persistent symptomatology and complications, in almost all patients the satisfaction index was 100%.

According to the evaluation, the main cause was poor indication in three patients, poor indication + technique error in 10, and technique error in 7 patients.

Conclusions: The most reported initial etiology was lumbar disc hernia with minimally invasive treatment with questionable surgical indication.”

Complicated Disc Problems
What you have been discussing really directly effects my life. I am in my 30′s, and for at least the last three to 4 years I have had significant back pain and recently it has gotten worse and to make that more complicated recently I have had a couple of car accidents that have inflamed my lower back pain. I have been told that I have a herniation, I guess a bulge in my lower back and my concern is I don’t want to have surgery, what I do want to do is have some semblance of a normal life and I love to play golf which is hard to do with lower back pain. When you go and play you wind up with an aching back that practically knocks you off your feet for a couple of days. How can Prolotherapy help?

L3-L4 Herniation
Caller: I have slight herniation between the L3 and L4 vertebrae from playing sports. What is the suggestion for stabilizing the area short of surgery?

Dr. Darrow: What we do is stabilize the vertebrae and the ligaments around them with Prolotherapy so if there is a herniated disc, it doesn’t cause any havoc by rubbing against the nerves that come out the spine and go down the leg.

There are several ways we stabilize the area, one is with MedX back exercise equipment. MedX machines exercise your back by taking your lower body or pelvis out of the picture so when you exercise (which is just a forward extension and a backwards extension), it strengthens the muscle right around the vertebrae, those little paraspinal muscles that are weak in everyone.

The muscles around the L3-L4 area do not have very good strength, with this MedX equipment, we can strengthen up every area of the back. It has a computer hooked up that shows us exactly where your muscles are weak.

Sciatica
Question: I have had back pain for some time, the pain radiates down my legs, I have had three epidurals and cortisone shots but without any relief, where do I go from here?

Iliolumbar Ligament Sprain or Herniated Disc?
Damage to ligaments is estimated to be responsible for up to 70% of all cases of lower back pain. In my clinic, I would estimate these causes to be even higher.

Do I Need An MRI?

In our office we find many times that the MRI reading of the knee, hip, shoulder, ankle, neck, and spine has nothing to do with what is causing the patient’s pain. We also find that these MRI readings prompted surgeries that “repaired” something that was not causing the pain. This is why we see so many failed surgery patients.

You just can’t read an MRI to decide what is going on with a patient, you have to use your hands and do an examination.

From Quest Diagnostics Patient Health Library

Low back pain: Should I have an MRI?

Key points to remember
* An MRI is not a standard test for finding the cause of low back pain. A physical exam that includes questions about your medical history is enough to diagnose and treat most cases.

* Since most low back pain gets better on its own, it’s often best to wait and see if you get better with time.

* An MRI is helpful if your doctor suspects that disease or nerve damage is causing your pain.

* MRIs are expensive. Health insurance may cover only part of the cost.

* An MRI may find other problems that have nothing to do with your low back pain. This can lead to more tests.

“For every 100 cases of low back pain, only 5 are caused by serious disease or nerve-related problems. Imaging, including MRI, is helpful for diagnosing and planning treatment for these types of conditions. That means MRIs are not helpful in 95 out of 100 cases.”

Prolotherapy and Back Pain Articles

Prolotherapy helped me personally after numerous chronic injuries and a failed surgery. It is a valuable weapon that can help people with chronic pain.

It’s not my herniated disc?
Many people come in with what they are calling a herniated disc problem because they have pain in their back and pain in their leg and they think the disc is responsible.

MRIs and Back Pain
We typically have patients come into our office with stacks of MRIs, CT Scans and x-rays to confirm the label of Degenerative Disc Disease placed on them by other medical professionals. For example, a woman once came into our office. She had in essence become the living, breathing “embodiment,” of the problem that showed up on her film. When she came in, all she could do was talk about her degenerative disc disease.

Sacroiliac Joint
One of the most common causes of low back pain that we see in our office is the pain caused by the sacroiliac joint (SI).

Degenerative Disc Disease
The aging process brings about degenerative changes to our ligaments, tendons, and cartilage through the desiccation (the drying out) of collagen. Degenerative Disc Disease (DDD) refers to this process occurring in the vertebral discs. It just so happens that the vertebral discs suffers through the most dramatic of age-related changes of all connective tissue related to this process.

MedX for back pain
A MedX workout twice a week for several weeks can alleviate back pain and prevent back injuries, and a recent study indicates that the MedX might even prevent back surgery.

Failed Back Surgery
Perhaps the most distressing is “failed back syndrome” — an official-sounding term to describe the pain of those poor patients whose surgical attempts have failed to correct their problem.

Genetic Back Pain?
When you ask me what is the best way to prevent these back pain episodes that you have, the triad of healing in my office is chiropractic to align the spine and then MedX treatment which are big frame machines that were established by Arthur Jones who built Nautilus equipment.

Lower Back Pain
Because the structures of the lower back are very complicated, and the specific symptoms of lower back pain are highly varied, lower back pain is one of the most difficult to diagnose and treat.

Lumbar Stenosis
From Dr. Darrow’s radio show: The caller is a neurologist. “I am a neurologist, I have a lot of patients that have lumbar stenosis with a lot of pain, weakness, and loss of balance. For various reasons, medical problems, they are not good surgical candidates or they do not want surgery.

MedX-Wall Street Journal
An article about the MedX machine that appeared in the Wall Street Journal.

Myths About Back Pain
While sometimes easy to diagnose and treat, back pain can also be very complex. The source of the pain can be due to a single, or multiple causes. Consequently, it can be difficult to diagnose the cause of the pain. Each pain source has a wide variety of treatment options that must be considered, and your treatment may be completely unique from someone else.

Bulging Discs
A caller into the Dr. Marc Darrow Radio Show has aggravated a baseball injury and his herniated discs, Dr. Darrow discusses the spraining of the iliolumbar ligament and the examination and potential use of Prolotherapy.

Radiculopathy Blog
Radicular pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.

Radiculopathy
Often I find that the radiating pain is not because of radiculopathy or pinched nerve but because of a ligament that is loose or injured because ligaments refer pain the same way.

Surgical Alternatives
Can Prolotherapy really fix a back problem where surgery cannot?

Types of Back Pain
There are many structures in the lower back that can cause severe pain. These include muscles, ligaments, tendons, bones, joints and discs. The outer rim of the disc can be a source of significant back pain due to its rich nerve supply and tendency towards injury.

During our development, there is a great deal of overlap of nerve supply to all of these structures. This makes it nearly impossible for the brain to distinguish between injury to one structure versus another.

Psychological Factors in Back Pain
There is much to be said for reducing the stress load in one’s life when trying to deal with chronic back pain.

Sciatica
I am having a lot of problems with my L5 disc. Every now and then, and for no reason, I get a tremendous pain in that area, my back freezes up and I can’t do anything or straighten up. I wind up bent over in half, it goes on for several days.

The Role of Psychological Factors in Back Pain

There is much to be said for reducing the stress load in one’s life when trying to deal with chronic back pain.

Stanford University researchers studied 96 people with high-risk factors for disc degeneration, to measure the psychological factors on back pain. Surprisingly they found that people at high-risk for disc degeneration were only slightly more likely to experience back pain during normal activity than people without obvious disc problems. In fact, 25 percent of the high-risk group had no corresponding symptoms of low back pain!

This meant to the Stanford researchers that doctors should know that damaged discs do not automatically mean that the patient is experiencing pain, and also if pain is present, surgery will not necessarily eliminate it because of the stress factors in the patient’s life.

A better predictor of pain, they found, is an abnormal result on psychometric testing. Basically, that the amount of discomfort that people have is related to their ability to handle stress. Said lead Stanford researcher Dr. Eugene Carragee, “People with poor coping skills…are more likely to perceive discography as painful and to have symptoms of low back pain during their daily activities.”

The results suggest that physicians must be acutely aware of the emotional or psychological factors that may be affecting how patients perceive their back pain.

Pain is Not Just Physical

Our philosophy on healthcare is to assist our patients in their healing process on many levels beyond just the physical.

Although our training teaches us to focus on the physical body as the cause of pain and disease, we have found that many of our physical problems stem from and are modulated by emotional, mental, psychological, and spiritual issues.

Not all people heal on the same schedule or in the same way. We provide a healing model with a loving environment. We don’t deal in disease; we deal in healing, which is an active process. Our patients are taught to create the concept and feeling of health. We often have to remove a person’s diagnosis that he or she has been branded with by other doctors.

Pain does not mean that a person is broken. X-rays and MRI scans frequently do not tell the truth. A common response from patients is “I can’t believe this is a medical office. You are all so understanding and supportive.” Many of our patients have been to a multitude of other doctors. We need to be different to make the difference.

● Read about Dr. Darrow’s back pain

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Radiculopathy Pain

Sciatica-Radicular Pain-MRI

Radicular pain or “radiculopathy” (sometimes also referred to as a “pinched nerve”) is often described by patients as a deep pain that travels down the leg. This pain is often accompanied by numbness or tingling, and muscle weakness in the limb.

The most common example of this type of problem is sciatica. This radiates down the leg along the sciatic nerve. Sciatica follows the path down the back of the thigh, into the calf and then into the foot via branches of the nerve.

Radicular pain may be caused by an injury to the spine. It may be from impact injuries that cause compression in the vertebrae, such as those in sports related injuries or motor vehicle accidents, i.e., disc herniation. Or it may be caused by a degenerative process discussed above such as stenosis or Degenerative Disc Disease.

It is essential to perform a physical examination in cases of referred pain to isolate the problem.

It may actually be a ligament injury that appears to be a nerve impingement and ligament trigger points may refer pain in a manner similar to radiculopathy.

This is why relying on an MRI as the sole diagnostic tool could lead to unnecessary surgery. An MRI may show a pre-existing condition that never caused pain. If surgery was performed to correct this condition and pain was actually generated by a ligament sprain, the surgery would fail.

A physical examination and conservative treatment will help determine if this is a ligament injury or a nerve problem.

It is important for the patient to know in cases of radiating pain that an MRI that indicates slippage of the vertebrae (Spondylolisthesis), an arthritic condition, or a bulging disc is NOT necessarily an indication that surgery is needed.

More radiculopathy articles

Radiculopathy Part 3

Caller: I was in a car accident, a roll over car accident on the freeway that resulted in Bulging Discs in my spine and a herniated disc in my neck. They cause me a great deal of pain.

Dr. Darrow: Do you have any pain that goes down your arms or legs?

Caller: Down my arms especially on one side, the left side

Dr. Darrow: (If it is a nerve problem) One of the first things I would try (even before Prolotherapy) is spinal decompression therapy. Spinal decompression therapy is like traction except it pulls you in different directions. What it does is pull on the spine and open up the foramen which are the holes in the spinal cord which the nerves pass through that go down the arm and very often with a series of decompressions, you can aleviate the problem by in essence, giving the nerve more room to breath.

The other thing is that there are trigger points often that can cause these radiating pains down the limbs and even though you say you a herniated disc, that doesn’t mean that that is causing your pain or the pain radiation, because there are trigger points that can create the referral pain patterns just as well as what we call radiculopathy or pinched nerve, so you need to go to someone who understands these different mechanisms and just doesn’t follow the allopathic medical model of “herniated disc – go to surgery.”

We find that most of the people that have these problems with radiating pain is that the radiating pain actually goes away by itself, even without doctors over a period of time, now it can be cyclical thing and come back but often times I have had patients who have fought me and gone to surgery and not only winding up with pain in one limb, but pain going down the other limb as well probably because of scar tissue that forms. Return to Radiculopathy main page

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