Disk Herniations and Muscle Spasms

[Elena]

I am a new graduate...May 2007, to be exact, and my first gig is at a chiropractor's office. I have two clients that have got me completely stumped. Sadly, I dread being booked with them, because I feel ineffectual and frustrated throughout the session. But I digress....

Both clients have herniations in a lumbar disc. One client has severe inflammation in the ESG's on both sides of the injury and extending upwards and downwards several inches. Both have incredibly hypertonic muscles all up and down the back, in QL's, ESG'S, and rhomboids. The DC has asked me to focus on relaxing the muscles so he can get adjustments out of the rest of the back. However, the client with inflammation can hardly even tolerate my touch, even the lightest, and if I get anywhere near the injury, the muscles begin to jump and spasm. The other client asks me to do deep work, but as I'm applying pressure, his muscles too begin to spasm. I can visually see them moving beneath the skin! I tried O/I work, but that seemed to be more painful than he could handle. I'm stuck! I feel reduced to vascular flush and effleurage, which doesn't seem to be doing anything to reduce the hypertonicity.

Any suggestions?!?

Natasha

 

[Stuart D]

My first thoughts are to try some myofascial work. Not the deep kind like some do, but more on the gentle kind like Barnes. The area is protecting itself as much as possible and you will need to get through those layers very gently. Deep work is contraindicated as it could cause the area to lock up even more.

Some very mild stretching will help to loosen them up also. Perhaps your DC or you have some that you can give to the patients to do at home. Also recommend ice to them, off and on for a few hours every day for a while if possible is a big help. It may be cold, but in the long run it will be their friend more than they know. Explain to them how it will reduce the swelling and inflammation, and under NO CIRCUMSTANCES are they to use heat at this time. This kind of problem takes TIME, lots of time. Be patient, and tell them to do likewise. Keep up with the DC also to see how things are going.

Hope this helps.

 

[kdanley]

I am just recovering from a herniated disk at L4 and I had severe spasming in my back and quad. I tried several different practitioners (including 3 chiropractors, an osteopath, acupuncture, a JB MFR trained PT, and a MT) before I got some relief. Nearly everyone helped when I was ON the table. As soon as I stood up (well, sort of stood up, lol), the spasms would return.

The most help was from the third chiropractor, who also said NO HEAT under any circumstances (I was using heating pads as it felt good.), and apply ice several times a day. He does other stuff besides chiropractic but the most help seemed to be a lot like JB MFR, only much deeper. He got me mobile again in one appointment. Oh boy, when he stripped those quad muscles, the pain was something else, but it worked to loosen them.

If you are going to do JB-type MFR, don't just look at where the pain is. You have to look for the restrictions and release those first. They might not be where the pain is at all.

 

[BLAH BLAH BLAH]

I agree with the two previous people, ICE ICE ICE, as often as they can and for as long as they can. You might even suggest that they bring some ice packs and put them in a cooler in the car. That way when they leave your office they can ice up immediately.

It does not mater what the issue is there will often be pain during the initial treatments on your table. I find I have to work VERY light initially. This is to make sure that I am not You mentioned a great deal of spasm when you worked certain areas. Muscles often will spasm as they unwind or release guarding that has been around for a long time. Many of my clients have commented that the initial spasm was very painful, but after it worked its self out the pain was almost gone, and they felt much better when they stood. I want to be clear though, when the spasm started I DID NOT STAY AT THE SAME PRESSURE LEVEL, I backed out to a very light touch and just sort of rode out the spasm. I am sure you will get more comfortable once you have worked on a few more bodies, but for now just work in within your comfort level, and trust your skills.

 

[ShortcutHerbal Goody]

I've had this condition a couple of times and tried everything, nothing really worked except ice and four or five days of bedrest then the pain would go away. It's ridiculously delibitating but it usually does go away in time. I had a buddy get it on Christmas Day, went to a famous chiro out here the next day and wound up in the hospital for a week. Adjusting someone with a herniation can be tricky and can often make it worse.

The advice I can give you is don't be too hard on yourself if you can't "fix" someone in this condition. The best you can usually do is attempt to make it not quite as bad and often that means directing you energy to other parts of them to quell the stress this causes. At least that's been my experience.

 

[snowball45830]

Thank you for all the replies!

Yikes, I wish I had checked the replies before I left for work today. I have been using heat as it seemed to be the only thing that would stop the muscle spasms. I was using ice packs before, but it seemed like the spasming was worse. Then I was doing contrast, (3 min ice, 1 min heat x3, end with ice) but that didn't seem to be doing anything. So today I tried just heat. He said he felt better when he got up, but I hope it did not make things worse for him later in the day!

I meet with him again Wednesday, and will go back to ice only, and try the MFR. I have not been doing a lot of work around the herniation site, as he can barely tolerate much touch there at all. The herniation is at L5, but even his rhomboids are super tight and prone to spasms. He is a construction worker by trade (and that's where he was hurt, as well) so I think his body probably needed a lot of work BEFORE the injury.

The DC keeps pushing Biofreeze. Is it okay to use biofreeze AND ice?

Again, thanks so much for the replies! There's just only so much you can learn in school. Nothing beats real world experience!

Natasha

 

[Irish Girl]

from the Biofreeze website: ( http://www.biofreeze.com/faqs_healthcare.php#faq_16 )

Q: Can Biofreeze be used with ice, heating pads, tape or wraps?

A: Biofreeze should not be used with external heating pads as it may cause blistering. You can use Biofreeze with ice to extend the benefits of cryotherapy. Only breathable wraps are recommended for using with Biofreeze.

I don't have any personal experience doing this, however, so I can't vouch for any effects, improved or otherwise.

 

[asian babe]

Thanks, frenchwoman! I feel slightly sheepish that I didn't think to look there myself...

 

[rachel c]

Again thank you for all the replies. I wrote your suggestions and tips down in my notebook, and will review it before my clients on Wednesday. It is very difficult for me to do work I know is causing my clients pain and spasm, but I know, and they have said as much, that they are willing to do what they have to to see some improvement.

Also, thanks for the anecdotal advice...both clients are very frustrated at their slow progress levels, and I haven't really had enough (okay, any experience) with this issue to assure them in any way. I'm fairly sure that at least for one, the frustration with the injury is contributing negatively to the state of the rest of his muscles. The slower the progress, the more frustrated, the more frustrated, the more he tenses and stresses about it, which causes more pain, more frustration, slower healing...!

Any of you who've experienced this condition first hand try acupuncture to any relief? Or anyone have any experience with anyone who has?

 

[Thom]

I agree with Elsewhere, Not really a chiro fan in this instance. If the nerve is impinged more damage can be done. Most massage, physio and ice/heat application can just be a placebo effect! Can people just get better over time as long as no further treatment aggravates the condition?

 

[eelfins]

Eh, no worries, Selkie. Besides, one look at your avatar and you'd be forgiven of just about anything.. t055

 

[summer is almost over]

I agree with dodab, Marion, and others. Chiros have a great track record when it comes to herniations within a certain range. If the herniation is past that range, a DC can still help, and I would still give it my best shot, it's just that the odds are a bit slimmer. I would also do some biofeedback. My husband and I have a hand-held machine (it's not a TENS unit, it's different) that has a specific mode designed to take away pain and another mode designed to heal the tissues on a cellular level to decrease inflammation MUCH faster than it would on its own. My husband actually has a herniated disc and he does chiro and biofeedback for it. I do not work the area directly, as ppl are right, that's contraindicated, but I do help to loosen up the fascia, and also the surrounding muscles so that they don't start compensating too much and adding to the problem (not to mention generating even more pain, soreness, and trigger points!)

And please please don't feel bad if you can't help this person. I went through this same thing for several years, and it took me a long time to realize that I was simply not going to help everyone. For some people, the cause of their problem is something different than we've been trained to deal with. For others, they might actually be subconsciously attached to their pain because it gets them some other benefit from surrounding family members or an excuse not to work or something. And yet others might be something completely different. It's really hard for us to know. We just have to give each person our best during the time we have, with the skills we have, and let whatever divine energy or force you believe in do the rest. If the client doesn't get better, please don't assume it's something you should've known or should've done or whatever

Hugs,
~Jyoti

 

[Superior Jeans]

Just by coincidence I just got done working on a lovely lady with this problem which is weird because I usually only see guys with this problem (okay some ladies addicted to high heels but generally guys.) Anyway, I could sense she had some real emotional stuff just under the surface beyond her obvious furstration with the pain. She dialogued throughout our session and since a good deal of my training was in body/mind therapy I encouraged it. I worked around the area, located ground zero and charted it's trajectory and did some of the stuff I have found effective in treating this including side postures. But the focus seemed to keep coming back to what she was saying about the pressures in her life and her fears.

I ended with still point manuevers and unwindings and it triggered a huge wave of emotional release. She sobbed and sobbed. She really needed to do that. It was a huge relief for her and she said she felt amazingly better. She sure looked different when she left.

You never really know what's going to work but treating the whole person beyond the symptoms can often bring interesting results.

 

[Haruhi-X]

Wow, elsewhere, thanks for sharing that story!

That is SO TRUE how our minds, bodies, souls, spirits, histories, memories, etc, are all so intertwined! I don't want to hijack the thread out of the disc herniation realm, but I wanted to share this along the same line as elsewhere's story: I remember some throbbing headache that just would NOT go away, no matter how much gentle trigger point work, deep tissue, static friction, etc we did. It was only when we did some myofascial release that I *emotionally* released, and poof--headache gone...after about an hour of unsuccessful (but usually very effective) clinical work

Hugs,
~Jyoti

 

[motherofgradn04]

I am huge into essential oils and liniments for situations wherre you can't work much (due to irratation). BUT they need to be reapplied countless times for a few days so the client must take some home.

Not an ice user..... ice will seforum.xxxnant the qi and complicate things later. That's a whole other post though.

 

[Silver Bear]

softhearted:

Not an ice user..... ice will seforum.xxxnant the qi and complicate things later.

I am so glad you mentioned this! I have shied away from ice because I thought I remembered hearing something like this from one of my instructors. I couldn't find a reference for it anywhere, and the chiro I work with is an ice nut (ice for E-V-E-R-Y thing, argh!) I know that ice reduces nerve pain and inflammation (which reduces overall inflammation) but moist heat brings in the local circulation and facilitates healing. I usually opt for heat because of this, or at least compromise with a vascular flush. I am guessing in this instance (disc herniation) keeping inflammation down (and thus further nerve impingement) is of highest priority? (This may be a whole new post, as you said...in which case, I'm totally willing to make it one!)

The chiropractor is treating both of these clients very aggressively...traction and exercise...one of the clients has started seeing a PT who told him he would have to "aggravate the condition a little in order to test spinal ROM." :?: These treatment efforts don't feel right to me, but what do I know? The DC has pushed me to do PIR/AIS on one of the clients....I have not, because my gut screams at me that this is not the appropriate action AT ALL. Actually, the DC has stopped referring one of the clients for massage as of this week, because he believes she is "faking it." Gah! Now I'm just venting, but I KNOW this woman isn't faking it. She may be holding onto her pain for one reason or another, but there is not a piece of me which believes she is faking it! I think the DC is just frustrated and trying to blame her because he hasn't made any progress with her. In her last few sessions with me, she has spent the first 15 or so minutes just wanting to talk to me, to share about her injury and frustration with lack of progress, and to try and explain things to me after which she asks me to try and explain it to the DC.

elsewhere, yes, thank you for sharing that story. I think repressed emotion has a huge amount to do with one of my client's pains, as I mentioned above. Sadly, the environment I'm working in is really the last place I'd want to work towards that with a client. I think it's time to put in my notice...

Natasha