(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 282 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.

To 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?

An 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.

In 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 injuries 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 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.