Most people undergoing back surgery are doing so because they have a herniated disc. We have treated hundreds of herniated disc patients in the past few years and we have had less than 2% of our disc patients go on to have surgery.

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Herniated Disc treatment

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Herniated Disc

Herniated Disc Treatment Protocol and Options

Herniated discs are never easy to treat. Most people undergoing back surgery are doing so because they have a herniated disc. If they were simple to fix, there wouldn’t be so many people making the decision to undergo spinal surgery. Spinal fusion has a positive Subjective outcome in only about 10% of cases. According to JAMA statistics 50% of surgical fusions are considered successful objectively…”successful” as defined in these cases means ‘not requiring a second surgery’.

We have treated hundreds of herniated disc patients in the past few years and we have had less than 2% of our disc patients go on to have surgery. Approximately 90% of our herniated disc patients are pleased with their results. About 5% are satisfied with their results and the last 5% of our herniated disc patients are those that we are not able to help substantially.
We are not able to make the determination for certain whether decompression will be successful until 12-15 treatments have been rendered. Herniated discs are sensitive, and the decompression we use to treat them needs to start out at a very low level. We then gradually incrementally increase that poundage at each subsequent visit.

We will typically increase the force by 5-10 pounds for the lumbar spine and 1-2 pounds for the cervical spine at each visit. If the patient is not experiencing an increase in discomfort from their previous treatment, we typically increase the force by 10 pounds in the lumbar and 2 pounds in the cervical region. I often have patients that don’t experience any significant relief until reaching a force that approaches 75% of their total body weight. It can take up to 20 visits to reach that force especially if the patient is sensitive and in significant pain. Typically we will have signs such as sleeping through the night, or less frequent and/or less severe episodes of pain that helps to confirm the patient is receiving the proper treatment.
Another important aspect regarding our herniated disc protocol is that I strongly recommend spinal adjustments, spinal decompression, electrotherapy, cold laser therapy and in-office rehab/work hardening and strengthening. All of these treatments work synergistically, and the overall treatment and outcome is improved when we combine these treatments rather than cut corners in an effort to reduce costs. Cost is often a significant factor when it comes to treating herniated discs. Still, with all the aforementioned procedures, we have not had a herniated disc treatment plan ever exceed $10,000. We transitioned our practice from an insurance-based practice to a fee-for-service practice back in January of 2007. Our treatment plans range from $2,500 to $7,500. This may sound expensive…until you consider the cost not only of surgery, but of the continued care and follow-up required following surgery. Often that first year following surgery costs can reach well over $100,000, especially when you consider the likelihood of continued care in the name of medications, rehab, follow-up appointments and missed time at work.

Treatment plan

Comprehensive Treatment Plans are typically not derived until about visit 8 once spinal decompression therapy has commenced. The purpose for this is that musculoskeletal conditions vary greatly in the way that they respond. One patient may respond much faster than the next…others may be very sensitive where treatment will have to commence at a slower pace. I personally make out each patient’s treatment plan. I base it on several factors including their exams, MRI’s, X-Rays, and response to treatment thus far. The treatment we prescribe here is individualized. I make every effort to accurately prescribe the number of visits that are required for a full recovery. Herniated discs are complex…the treatment plans cannot accurately be predicted within the first few visits.

Subluxation Degeneration

Chiropractic care may include Interferential therapy for 15 minutes at a sweeping frequency of 1-150 applied to the areas of complaint in an effort to reduce muscle spasm, sensitivity and inflammation, and to increase blood flow to the tissues to promote healing. Reducing pain and spasm are vital to herniated disc treatment. When the muscles are in a relaxed state, the spinal adjustments will be more effective in reducing joint fixation. If the joints in the spine are free of facet joint fixation then the spine and discs will decompress more effectively. In contrast, a spine that is hypertonic and fixated will likely be irritated following decompression therapy. The subluxated/fixated joints can become irritated and possibly injured if they are subjected to the forces required to decompress a herniated disc and therefore should be adjusted/released prior to decompression. Relaxing the muscles of the spine is also important. Hypertonic muscles that are stretched during decompression often times respond afterwards with spasm. The muscles are likely already tight and prone to spasm, and if irritated or ‘stretched’ they become more irritated and possibly inflamed leading to more spasm. In other words, electrotherapy is essential to proper decompression of a herniated disc. Infrared heat and/or cold packs (complimentary) will be applied along with the Interferential therapy to promote further pain/inflammation reduction. The patient will have the treatment applied on an intersegmental traction table to continue improving the patient’s level of pain, mobility and tenderness. No patients or 3rd party payers are ever charged for intersegmental traction…This is complimentary as well.

  • Chiropractic Manipulative Treatment (CMT)

    The patient will often receive (if deemed necessary during the patient’s initial exam and subsequent response to treatment) Chiropractic Manipulative Treatment (CMT) to the areas of the spine that are subluxated/fixated following electrotherapy in order to facilitate proper segmental function and proper biomechanics. Fixated joints are often inflamed and will eventually become degenerative. It is also vital to adjust the regions of the spine surrounding a disc herniation. I firmly believe that it is best to adjust the entire spine, as everything is connected…we are a living organism however in workman’s compensation or personal injury cases I will only treat areas of the spine that are directly related to the injury in question. If the spine is fixated, then decompression may lead to exacerbation. A spinal disc will not effectively be decompressed if the joints surrounding it are fixated as this will limit the ability for that vertebral segment to be ‘decompressed’. These joints become fixated from the associated conditions common with herniated discs, such as prolonged muscle spasm and inflammation. If the joints are freely moving, the decompression will be effective. Joints can (especially in an arthritic spine) remain and/or return to a fixated state through much of the treatment plan as they typically need to be adjusted numerous times before they become freely moveable without readily becoming fixated again. When the joints are free from fixations, we will reduce frequency of adjustments to once per week, until the end of the plan. With all the rehab in the later phases of our protocol, it is important to continue weekly adjustments to prevent exacerbation and injury.

  • Manual Therapy

    Manual Therapy is to be performed to the soft tissues (muscle and connective tissue) related to the area of complaint. This procedure is done to reduce muscle tension by freeing up adhesions within the muscles as well as relaxing and reducing muscle hypertonicity. Manual therapy will consist of Active Release Technique, Myofascial Release Technique, and/or Trigger Point Therapy. This is usually only done in the first week or two of treatment and it is also complimentary in most cases.

  • Mechanical Axial Traction (Spinal Decompression Therapy)

    Mechanical Axial Traction (Spinal Decompression Therapy) will be applied to the patient’s spine to reduce/reverse the compressive forces on the discs. Applying a negative pressure to a herniated disc essentially draws the herniated portion of the disc off of the impinged nerve root. With repeated decompression treatments, the patient’s symptoms typically gradually subside until there is no more pain or paresthesia. Axial traction is also helpful in facilitating imbibition of nutrients and hydration into the intervertebral discs as well as reducing impingement on surrounding nerve roots and adjacent structures. This process of imbibition benefits any discs in the lumbar spine that may be undergoing desiccation as a result of spinal fixation. This procedure will be performed for 15 minutes at a force deemed appropriate in relation to the patient’s weight. The force will be intermittent with a hold time of 45 seconds and a relaxation time of 15 seconds with a ramp up and ramp down time of 30 seconds. Decompression Therapy is the most important component of our herniated disc treatment protocol.

  • Laser/Infrared Therapy

    Laser/Infrared Therapy is essential in helping to heal the disc following spinal decompression. Once a disc has been decompressed it needs time to heal while remaining decompressed. The healing process can be improved significantly with the application of laser therapy. Laser therapy helps to reduce inflammation and muscle spasm as well. The tissue of the body in which laser therapy is applied, absorbs the energy of this high-intensity light-wave, and in turn uses it to ‘hyper-metabolize’ those tissues so that they may heal more readily. The frequency of the light wave is ‘tuned’ to the energy frequencies of living tissue. The body then harnesses this energy and uses it to promote healing, inflammation reduction and muscle relaxation. Basically the tissues can use this energy to improve the overall metabolic function of the cells in the region of the applied light energy. Most patients notice an improvement after just 2 or 3 treatments. We use light therapy in the middle throughout the second half of the treatment protocol. This is the most beneficial time to promote the healing process.

  • Ultrasound

    Ultrasound is used (when necessary) to promote inflammation reduction as well as reduction of scar tissue. This modality is used on certain patients that have issues with adhesion formation and myofascial conditions. Ultrasound therapy is used in cases where the patient is not responding to our typical herniated disc protocols. This therapy is usually added along the way and is not generally prescribed in advance for patients. If a patient is not responding favorably to our typical protocol, then they will be treated with ultrasound for 2-3 weeks to assess effectiveness of this modality. If the patient responds favorably, then the treatment will continue through the rest of that particular phase of care. If the patient does not respond favorably to ultrasound, then treatment with this modality will not be continued.

  • In-Office Rehab

    In-Office Rehab will commence as soon as the patient is in a stable state. We will be working on improving the range of motion, strength and durability of the affected spinal region as well as the core. We begin by instructing the patient on specific home stretching exercises. Eventually, as the patient progresses, they will be given home exercise routines that are more aggressive and that incorporate strengthening exercises. At that time they will also begin specific in-office supervised work hardening exercises. We also have a core strengthening program utilizing unique core-strengthening machines in our clinic that are vital for thorough recovery from disc injuries. The rehab program prescribed for this patient is personalized and each exercise is specifically chosen to help the patient with their specific condition. In-office rehab will typically commence in the 4th or 5th phase of the treatment plan. The Rehab will be performed at each visit. Treatment and rehab frequency will continue at 3 treatments per week. Rehabilitation is similar to a workout routine in that you would benefit most by working out at least 3x per week.

  • Neuromuscular re-education

    Neuromuscular re-education: (only if/when necessary) We have in our office a machine designed to eliminate pain associated with movement of the affected body region. These are specifically termed “movement impairments”. A “movement impairment” is basically pain associated with movement. If the patient still has pain towards the end of their treatment plan specifically associated with a certain motion or position, we will use our Active Therapeutic Movement Machine (ATM2) to re-educate or re-order the firing pattern of the associated muscles. Often times pain associated with movement is due to the muscles firing out of the ideal firing pattern/order. With only a few treatments this machine ‘resets’ the firing order so that the body can activate the muscles in the proper order thereby eliminating the pain that’s likely due to improper firing order of the muscles involved. Results are typically seen with the first treatment if this machine is indicated, and often times this device is only needed to be used a handful of times before the pain is relieved. If the patient is progressing as expected and there is no remaining pain in the rehab phases of care (the last two phases) then this machine will not need to be used, however it is included in the proposed treatment plan because it is impossible for us to determine if it will be necessary early on in treatment.

  • Home Inversion Therapy

    In all cases of disc herniation it is imperative that the patient continues with some sort of decompression therapy at home for a period of at least 1 year. This will allow the patient to maintain the level of health they achieved here at the practice. It is essential to continue the decompression (inversion) therapy so that the discs can continue to benefit from imbibition so that nutrient exchange can continue at optimal levels. Without a means to continue decompression at home the disc will soon begin to degenerate and the condition will likely return. We have experienced great success with those patients who are able to implement an inversion table for home usage. This is an essential component of herniated disc recovery…yet it is even more important to ensure that the condition does not return.

Re-exams are performed at the end of each phase of care. Each phase of care is outlined on the “Recommended Action Plan” (treatment plan) and phases change at different intervals throughout the plan. These re-exams will be performed by reassessing the orthopedic tests that were positive in the previous exam.