The Trainer’s Room: Joe Crede and Herniated Discs in the Lumbar Spine

Herniated Discs - Lumbar Spine | Denver(The Trainer’s Room is a regular column at Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy, the pain and rehabilitation experts at the Mountain View Pain Center in Denver, CO. All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described. You should always consult your doctor before beginning any pain management or rehab program.)

This week the injury we will be covering is the very common and often debilitating herniated disc. The athlete we will be using as an example will be Joe Crede. A new member of the Minnesota Twins, Crede has had a successful career, and has even appeared in an All-Star game. Unfortunately for Mr. Crede, the last two seasons have been haunted by back pain caused by a herniated disc in the lumbar spine.

History of Joe Crede’s Battle with a Herniated Disc in the Lumbar Spine

Crede’s battle with a herniated disc in the lumbar spine dates back to 2004, a season during which he played in 144 of the White Sox 162 games. White Sox fans know that Joe Crede’s back problems were an on-again, off-again topic through 2005 and 2006, two seasons in which Crede was generally healthy and played in 282Joe Crede - Herniated Disc in Lumbar Spine out of 324 games total. Obviously Crede was able to manage the lingering problems from the original injury as he turned in his two best seasons in 2005 and 2006, hitting 52 home runs combined.

In 2007, however, Crede played in only 47 games. After trying epidurals for the pain, he eventually had surgery, a microdisectomy, after being unable to manage the pain any longer. Despite a great first half to 2008, after which Crede played in the All-Star game, the back problems produced by the herniated disc came back in earnest. He again had a microdisectomy, after fluid from the same disc was pinching a nerve.

As mentioned, Joe Crede has tried both epidural shots and surgery to treat his back problems. The following is the opinion of the Mountain View Pain Center, and these are some of the options we offer our patients. It is important to start conservatively and measure the improvements before heading into the surgery. This means working with the body to begin the healing process, before using drugs, or removing something through surgery. Of course, there are several different ways this injury can affect someone, and surgery maybe the only option, but the philosophy of the Mountain View Pain Center is to explore natural ways to heal the body, using surgery as a last option.

Typical Causes of Herniated Discs

Now let us backtrack to the original injury suffered by Joe Crede: the herniated disc in the lumbar spince. The most common cause of disc injury is poor biomechanics (moving improperly, which we are all guilty of doing). Discs are most commonly torn by lifting a weight while twisting; getting something heavy out of the backseat of your car is an example. As we all know in the game of baseball, especially at the plate, the body goes through some twisting and contouring with a driving force.

Typical Symptoms and Non-Surgical Treatments for Herniated Discs

The first step is to determine what symptoms we have and address them accordingly. The most common types of pain from a disc injury are low back pain and/or radiating pain into an extremity. We are using low back pain as our example, but radiating pain into the leg is often experienced with this type of injury. In many cases you can just have leg pain and no back pain. The reason the pain is referred to as “radiating” is because the disc material will bulge out causing inflammation and put pressure on a nerve, and the pain will follow that specific nerve’s pattern. For example, a herniation of the L3 disc will put pressure on the L4 nerve, causing pain to radiate down the posterior (back) of a leg.

Back Injuries: Herniated Discs in Lumbar SpineTo determine if a herniated disc is causing you pain, your doctor will perform an examination and orthopedic tests. If your doctor determines that a disc is the problem, the next step is to take a simple X-ray to rule out any underlying problem with the bones or joints. The next step is an MRI; from here you will be able to see the level and severity of the herniation. It is also important to know that the size of the herniation does not necessarily correspond to the severity of pain. In fact, some people can have a large herniation with no symptoms at all, and some can have a very small lesion and experience immense pain. From the results, the doctor will be able to determine if your herniated disc can be treated with natural therapy or if surgery is required.

The initial phase of such an injury is often described as a patient saying, “I heard a pop and then all of a sudden I was in incredible pain.” The pop they heard is the tearing of the annular fibers of the disc. In the acute stage, or a few days after the injury, a patient can be in a lot of pain, and experience some inflammation and swelling. The patient comes in saying, “Doctor, just get me out of pain, please!” To immediately address the pain, the first step is to reduce swelling by cooling the area with ice, being careful not to put the ice directly on the skin. (Yes, you can get a burn from ice!) You can alternate ice on and off twenty minutes at a time. DO NOT use heat; it will increase swelling and you will regret it. At the Mountain View Pain Center, in this situation we like to use a therapy called Hi Volt, which is an electronic modality. The purpose of this modality is to decrease pain and move that edema (swelling) out of the affected area.

Once the initial pain is relieved, we can begin treatment of the injury. A treatment we often choose to begin with at the Mountain View Pain Center is a method called flexion distraction treatment, coupled with other therapies to reduce swelling. The flexion distraction treatment works by widening the disc space and causing the herniation to essentially get “sucked back into the disc”. This treatment can be done by utilizing chiropractic techniques to relieve pressure on the herniated disc.

Another technique we use is called traction therapy, otherwise known as long axis distraction. Here the doctor will use a DTS machine (decompression therapy) set to specific settings unique to each patient. The machine will gradually begin to pull and will slowly separate the two vertebrae pushing on the disc. The purpose here again is to relieve the pressure on the disc. Many patients have found that treatment with a DTS machine is a safe and cost-effective treatment, and have found relief without the need for surgery.

Once the patient is out of pain, the rehabilitation can begin. It is important to remember that just because the pain is no longer there, it does not mean the disc is back to normal. A full disc recovery can take up to 3 months. The purpose now switches to restoring the body back to its normal function. This is done by low back exercise and simple core exercises. A set of very popular exercises used for disc treatment are called Mackenzie exercise (extension exercises). Your physician will be able to instruct you on the proper way to perform these.

Another preventative step that can be taken is supplementation to strengthen the discs or joints, or supplements that help with inflammation. Check with your doctor or physician before taking any supplements to see what is right for you and make sure there are no risks to taking these vitamins.

Some supplements for simple joint care are:

  • Glucosamine sulfate (500mg) with MSM (methylsulfonylmethane) (250mg): Glucosamine sulfate helps to stimulate specific components of your cartilage. MSM helps with pain and has been shown to be an anti-inflammatory
  • Omega fatty acids: Many are known as fish oils, they have multiple benefits besides anti-inflammatory, they also build cell membranes, and help improve neurologic and cardiovascular function. Omega fatty acids are not just good for your discs, they are essential to life.
  • Quercetin/Bromelain: Also have anti-inflammation effects. These can be found naturally in vitamins, but not usually in the amounts useful to aid in inflammation.

These come in several brands, and we are not here to recommend specific brands of vitamins or supplements, just to inform the sports fans on injuries they see in themselves or many of their favorite athletes. If you decide you would like to know more about a specific vitamin or advice on the supplements we use, feel free to call, and we can point you in the right direction.

At Mountain View Pain Center we have seen and experienced that for the most effective pain recovery, conservative treatments should be utilized first before epidural injections and back surgery. However it is important for your doctor to acknowledge the importance of co-treating patients in their best interest for recovery. At Mountain View Pain Center our primary care is chiropractic and physical therapy, however if we determine a patient can benefit from another provider’s care we will refer them with no questions asked. The goal is to get the patient pain-free and restore them to healthy function in the manner that is most suitable to the patient.

Epidural Injections for Treating Pain Caused by a Herniated Disc

Joe Crede had the option to get an epidural injection, what is that?

using epidural injections to manage pain of herniated disc in lumbar spineAn epidural injection is the administration of medication that can cause both a loss of sensation (anesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disc and radiculopathy (radiating pain).

The injections themselves can be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed. Simply put, epidural injections do not produce long term results hence the patient has to keep getting them to reduce the symptoms they are having. Possible side effects of epidural shots can be increased pain, loss of sensation, infection, and nerve damage. Follow the link to learn more about the side effects of using epidural injections to treat pain.

Herniated Disc Surgery

When it became clear the injury would not heal on its own, or that natural methods would be unsuccessful in correcting the problem, the choices Joe Crede faced were epidural shots or surgery. Prior to 2007, Crede had been able to manage the pain through at least four epidural treatments. However, in 2007, Crede determined that the temporary relief provided by the epidurals was not enough. At that point he opted for the microdisectomy, and then unfortunately experienced a re-herniation of the same area. Thus, the microdisectomy had to be repeated again a year after the first surgery.

surgery for herniated disc in lumbar spineIn some circumstances it may be determined that back surgery is the best option. However, surgery is not always needed, and unfortunately many surgeries are unnecessary and cause further complications. Studies have shown that more than half of lower disc surgeries do not successfully relieve symptoms. As mentioned above, at the Mountain View Pain Center we believe that surgery should always be a last-resort option. For Joe Crede, surgery finally came three years after the initial onset of the injury. Despite the relative lack of success Crede experienced with the first surgery for his herniated disc, both he and the Minnesota Twins are hoping that the second microdisectomy will allow him to move forward and have a healthy, productive season.

According to Crede, the early prognosis is that the second surgery appears to have been more successful. His first microdisectomy was performed in L.A., and he says that for 10 days he had to stay in L.A. and had trouble even walking. His second microdisectomy was performed in Dallas, and he says that he was able to go home in two days. Before signing his new contract with the Twins, Crede’s back was examined thoroughly by their medical staff, and “passed with flying colors.” Upon arriving at Twins Spring Training camp in Fort Myers, FL, Crede declared himself “pretty close” to full health

Joe Crede’s Recovery from a Herniated Disc

As for Crede’s recovery, it is hard to tell as we have not treated him, or monitored his progress or rehab program. As mentioned before not all surgeries are successful; however, many surgeries are. As an elite athlete I am sure he has the opportunity to see top-notch doctors, and receive many options of rehab techniques. Of course any fan wishes him a speedy recovery, and hopes to see him out on the field all season long.

Once again, the information and recommendations presented in this article are the professional opinion of the Mountain View Pain Center, and represent some options that we offer to properly treat you and your symptoms. Please contact your primary care physician for more information and what is best for you, and please do not try these treatment recommendations on your own; doctor supervision is required.

______________________________

The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports iDr. Niall McNally - Pain and Rehabilitation, Denvernjuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition. He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX.

A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy - Pain and Rehabilitation, DenverDr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.



About Mountain View Pain Center

At Mountain View Pain Center we are committed to relieving your pain and restoring you to good health and wellness. We are able to do this by combining expert advice, the highest quality chiropractic care currently available, advanced soft tissue work and state-of-the-art rehabilitation programs. At our office you will experience the benefits of a dynamic team approach and receive a level of care which is virtually unmatched elsewhere. With this powerful combination our chiropractors can dramatically improve your life and the lives of your friends and family. The Mountain View Pain Center is located in Centennial, CO which allows us to provide convenient chiropractic care and rehabilitation treatment to Aurora, Centennial, Denver, Lakewood, Parker, Littleton, Highlands Ranch, Cherry Hills, Lone Tree, and Green Wood Village.

Comments

  1. Dick Butkis says:

    I recently herniated my disc. My groin hurts, how should I go about fixing this problem? Do you have spinal decompression?

    • Thanks, Butkis for your post

      Disc heriations can cause pain radiating pain to the groin but there are a number of things that can also cause pain in the groin. First, I would advise you to see a doctor to give you an exam to make sure that the cause of your groin pain is from the herniation. Don’t forget to see a herniation your doctor may need a MRI preformed then he will have a better idea if the pain is coming from your herniation or elsewhere. If you do have a heriation spinal decompression or DTS have been shown to greatly help reduce the pain cause by the heriation. Along with DTS we would also recommend core exercises this way your muscles will help stabilize your heriation. Please let me know where you are from and I will recommend a doctor near you.

      Thanks

      Dr. Erhuy, DC

      • @Dr. Ihsan Erhuy, McAllen, TX. Very far from where your office is located (aren’t you in the Denver area?). Can you recommend a doctor of chiropractor here with DTS?

        • Dr. Erhuy, DC says:

          Hey, Eric there is a doctor that Dr. McNally and I both trust and feel that he will be able to help you get out of pain. His name is Dr. Dirk Martin this office is located in McAllen feel free to call him at any time.

          Dr. Dirk Martin
          956-682-7351
          http://www.martinchiroclinic.com

          Thanks and good luck

  2. Quoc Nguyen says:

    Wow! Very interesting Dr. Mcnally and Erhuy. I have had many problems with my back from lifting from time to time and this article was great. Last yr was the first year I did something about it. Like many, I also had an epidural and it was a total failure. I recently checked in with a chiropractor in my area in Dallas and he is also doing the DTS machine on me. I never was informed of how it would benifit me but all i knew was that it worked. I wish my Dr. informed me like this article did. What else should i ask my doctor about my care and how can i further my treatment?

    Quoc

    • Hey Quoc, thanks for the post

      We are glad that you are seeking help for you back pain and we are happy that it’s going well for you. Don’t forget that disc herniations take time to heal. What we would recommend is talk with your doctor and ask him if you are ready to start doing core exercises. He will be able to show you how to perform them properly. Good luck and keep us posted on how you are doing.

      Thanks

      Dr. Erhuy, DC

  3. H I am a 22 year old college student in
    south florida. I am contacting you because I need some advise/help on
    my back. I play basketball everyday and sometimes I would hurt my lower
    back and be out for a couple days. I always figured it was due to not
    enough stretching. However 15 days the same ting happened except this
    time it is a million times worse. The next 2 days I could not stand up.
    My back was killing me in every position I tried to lay in. By the
    weekend I was able to walk around however I have not made any progress
    since then.

    In the morning I cannot stand up straight and I have constant pains
    going down the outside of my left leg. I am a very active person( my
    job involves teaching sports to the youth in my community) and this is
    holding me back. Not to mention the horrible pain I am in.

    I do not have any health insurance at the moment and am on a strict
    college budget therefore I cannot go see a doctor but I am assuming it
    is a herniated disc.

    I just want to get better so I can continue my studies and get back to
    work. Is there anything you can reccommend?

    • Dr. McNally, D.C. says:

      @Vince,
      Sorry I have taken so long to respond. First off it does sound like you have a herniated disc. Obviously without doing an exam,I can not be certain of that. Do you have more pain sitting than standing? Do you have increased pain when having a bowel movement, sneezing, or coughing? Try raising your legs off the bed while laying on your back, is there increased pain there or down the leg? If yes to any of these then it would definately be pointing us in the direction of a disc herniation. Traction therapy would be best for you and will help heal the disc. In many cases insurance does not cover this anyway so that may not matter to much. If you are a student see if the school offers insurance for students generally this is very cheap, and the deductible is low and has decent coverage. If not you could try something called care credit where they basically cover your costs and you pay them off over time. I believe you can get up to 18 months with no interest. Let me know if there is anything else we can do or if you need me to find a doctor in the area for you.
      Dr. McNally

  4. I have herniated disk on both places on my neck and back. I have been taking drugs and injection to ease the pain, but then it will come back. I decided to stop those medication because I feel like vomiting. My question I have to do surgery on my neck, I am a bit hesitant to perform the surgery because of the risks. This will not guaranteed me 100% that it will rectify the situation. My doctor said if I don’t perform the surgery later on I will walk with a stick because it is in a worst stage. Please advice me if I should consider the surgery and what percentage of getting better. Also I have osteoporasis arthritis, dorsol spondolysis and capal tunnel. I and only 48 years and I can’t believe my body is like an old person.

    • Dr. McNally says:

      @Seemoi,
      I apologize about the late response. As for your question without seeing you there is no way to tell if you should think about surgery. It also sounds like you have a lot of other conditions that are causing you problems. My first piece of advise is to see another specialist and ask for there opinion. There are many cases where herniated discs can be treated conservatively, but there are those that need surgery. A neurosurgeon who works closely with physical therapists or chiropractors would be the best person to ask on this. As for the other conditions my advice would be to start focusing on living a healthy life in all other aspects. This means eat right, take vitamins, and workout. All of these things will help you feel better all over and increase your body’s immune system.
      Dr. McNally

  5. I have l2,l3 disc herniation,.. why does my hip hurt so bad?

    • Have you seen a doctor or been through a physical examination yet for this problem. The L2 and L3 nerves can cause pain going from the back to around the front of the leg. There can be an increase of inflammation caused by a disc herniation which can cause muscular pain in the area. There can also be a spasm of the Piriformis muscle which attaches to the hip. Read into our article on Piriformis muscle in juries and see if this helps point you in the right direction.

  6. Hello I am Pottstown Pa 38 yr female and I can just cry reading these emails. For the past year I have been suffering with severe pain in my lower abdomin and groin area. I've had just about every type of test you can imagine but all were gyn related and to no avail. I was beginning to think all of the Dr's thought I was crazy until now. You see this pain I have come in the middle of the night and interrups my sleep. I scream because it hurts so bad but it only last for 5-10 minutes. I now have an appointment to take some of the same test like MRI and Xray but of the lower back. During my most recent visit the doctor did a back exam and found a very tender spot (l-3 and l4). It seems as thought she got an aha moment after a year of sever pain. I hope we can finally say that this is the culprit…I will keep you posted. Any other feedback would be greatly appreciated as I am really suffering and too young to just sit down.

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