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Old 01-14-2006, 12:27 AM   #1
Beth Moscov
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Okay.

Doc just called and told me the results of my MRI. I haven't seen the specialist yet. That will be on Wednesday. But if anyone who has gone through this can tell me what they learned about:

treatment options and successes/failure

maintaining workout health.

I would appreciate what you could tell me.
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Old 01-14-2006, 09:30 AM   #2
William Hunter
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Beth, first of all sorry to hear about your injury.

Secondly, unfortunately there are many different terms used to describe disk injuries (protrusion, bulge, herniation, rupture, fragmentation - hopefully no one professional uses the term "slip" anymore). In my experience I've seen radiologists have some disagreement as when to use which term to describe what they see on film. I generally take rupture to mean that the outer ligamentous structure, the annular fibers, has/have torn, which may mean that the inner nuclear material is on its way out. Not good.

A more important starting point would be to describe your symptoms. Severe pain? Only in the LB or LBP with radiating pain into the leg? Radiating below the knee? Are you antalgic (unable or unwilling to straighten up, possibly tilted to one side like a ship in trouble)? If there are more serious neurological symptoms, such as trouble with bowel or bladder control, then you would already have been sent to the neurosugeon.

If you're basically functional, then, IMO, a proper physical exam would include various loading strategies to determine which movements worsen or lessen the pain. McKenzie protocol is a good place to start, where they determine first whether or not flexion or extension has an effect on your pain.

Hopefully others will chime in, but I'd like to hear what you're feeling currently, plus the mechanism of injury, if there was one.
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Old 01-14-2006, 10:08 AM   #3
Beth Moscov
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William,

You said: I generally take rupture to mean that the outer ligamentous structure, the annular fibers, has/have torn, which may mean that the inner nuclear material is on its way out. Not good.


That is how the doc described it. But it was my family doc. I see an excellent back doc on Wednesday for better diagnosis and treatment options.

Symptoms: Pain in the local region constantly. Also off to the left side. Made worse by staying in any position for any length of time - except sleeping on my tempurpedic mattress. On occasion the pain runs down both the front and back of my left leg. On occasion it goes down both. I also experience occasional numbness and/or tingling.

As a CrossFit trainer, I have already done a bunch of work on my own to figure out what I can do physically. Squats are great, even with weight. Just not max weights. Kettlebell swings seem to be the best. They hurt while doing it but I get the most relief from anything after two or three hours after doing them. The other thing that helps when it is completely flared up is sitting in a squat position - it seems to stretch the area out and feels less "compressed".

History: I was rear ended in a car accident that totalled my car about three years ago. That is when the pain began. The angle of the road made the injury worse on the left. I have done fine with exercise, acupuncture, and physical therapy until about a month ago. I actually think running my half marathon in the end of October is part of what caused the destabilization of the area. That was when I had my first flare up of this intensity but it went away with exercise and antinflammatories (over the counter naproxin).

In December my very large dog had some serious illness issues. I spent a lot of time on the floor with her petting her. In retrospect, I was sitting in a way that strained my back, plus simply sitting for hours didn't help either. This led to the current flare up which was finally triggered after a bunch of yard work (I live on a farm so I was hauling hay and stacking wood).

So, hopefully this will help you help me.

What is the McKenzie protocol?

I am concerned about the average physical therapy as I am so much stronger than most people with this type of injury. If they try and get me to do some of the stuff my friends do, I will have to stifle a laugh. One PT I know told a friend of mine that anyone who can do abmat situps must have incredible abs. The main thing is that they often think I must be just fine because I can do things the average person can't. But I don't want to hurt and I am definately impaired. But with CrossFit, I am starting at a high level of function compared to what most PT's see.

(Message edited by beth_moscov on January 14, 2006)
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Old 01-14-2006, 07:06 PM   #4
James Hall
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Beth,
I'm a CertMDT (McKenzie). Does repeated flexion or extension make you better or worse? Or does side gliding make you better or worse?
The trick is finding the offending direction and going opposite to that.
Does it need to be loaded or unloaded? Many questions. Unfortunately, I've run into several therapists with the credentials who don't do the work (McKenzie...fortunately, we've begun to address that issue). Go to www.mckenziemdt.org and find a therapist in your area. If they do passive modalities, run away like crazy! They have the initials but don't practice what they preach and are being pressured to produce numbers. Call me with any questions, I will be happy to talk to you.
As we say, "If you're not peeing on your drop foot, you don't need surgery!".

James
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Old 01-14-2006, 08:46 PM   #5
joseph elberti
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I have been told by teachers here at Chiro school, one who is even certified McKenzie, that getting flexion-distraction work on a distraction table is the best way to deal with ruptured discs (usually- of course there are exceptions).

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Old 01-15-2006, 09:44 AM   #6
William Hunter
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I agree with James and joseph, there are lots of options to work with prior to surgery.

A key question is whether or not your recent increase in pain is merely an aggravation of the old disk injury, or did some new disk disruption take place. The specialist who looks at your MRI may be able to tell if the rupture is old or looks fresh.

If no new injury has occured, then I would think that it would be your choice to work through the problem the way you have in the past, utilizing a modified CF approach (of course).

I am not McKenzie certified, I merely took two weekend seminars from a qualified instructor. The protocol is sound. I have done some of my best work on acute disk patients utilizing the loading strategies. When it's done right it can lead to almost miraculous turn-arounds, literally within hours.

joseph, the "McKenzoids" are a serious bunch. I think if your teacher was overheard recommending flexion-distraction he would be targeted for assassination by Robin himself LOL. F-D is pretty much the exact opposite approach to McK, however there is no more popular chiro technique for severe disk issues.

The DC who taught me McKenzie hated F-D, and would not even consider adjusting his patients until he had worked through a few daily treatments utilizing McKenzie.

Good luck Beth!
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Old 01-15-2006, 11:18 AM   #7
James Hall
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William,

Whoa, whoa, whoa! I am certainly not trying to pick a fight, but that is the problem with the perception of McKenzie...i.e. that it must be extension only. Even other supposed certified practioners think this. The Institute is trying to fix the problem. Search on Dan John's site, there is a great synopsis of McKenzie and exercise.
I just spent 2 days following someone who basically advertised the letters but didn't practice the method. Irritating, in that it was only positive from a marketing direction, but patients were being deprived of information to fix themselves. It comes back to the old (but true) saying, give a man a fish and feed him for the day, teach him to fish and feed him for a lifetime.
The direction of preference doesn't matter, only the result. Some of the fastest responders are anterior derangements. Flexion is a powerful diagnostic as well as maybe therapeutic direction.
Yes, Joseph, we McKenzoids are robots and are a serious bunch. We obey the commands of the Master. Kidding. We like to think and explore. When I get a patient in the clinic who is not a straight extension responder I get excited! Now I have to think and figure this thing out!

Good luck, Beth!
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Old 01-15-2006, 11:33 AM   #8
William Hunter
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James, sorry about the misrepresentation. I'm sure that in my limited training I was given mostly the highlights. I generalized because I rarely see anterior derangements vs. posterior arrangements, as most people seem to hurt themselves while in some form of flexed posture.

Joseph, see what I mean? I've been targeted for assassination and now I must go into hiding. I'm headed to a plastic surgeon so he can change my fingerprints right now. :-)

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Old 01-15-2006, 04:19 PM   #9
James Hall
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William,
Don't leave dude! I love chiros and MDs and DOs who are willing to discuss things without getting out of sorts. Don't change anything. You're a valuable asset to this community!

Love ya man!

James
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Old 01-22-2006, 02:44 PM   #10
Beth Moscov
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Okay. I saw the back specialist. Very interesting comment:

After a long talk about crossfit and my experience as a trainer, he felt that I don't need any other type of exercise except crossfit - done as I do when I work with injured folks. He felt our combination of exercises, with our strong emphasis on excellent form, was exactly what I needed.

He also prescribed prednisone (which sucks) and an upcoming epidural if the prednisone doesn't cut the pain.

And PT - but she was instructed to let me determine the exercises and only do ultrasound and massage stuff.

He really emphasized that CrossFit was exactly what he would recommend for my ruptured disk.
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