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herniated disc treatment options

buck

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In general when its so many levels you certainly want to try conservative measures first. Ive seen so many train wreck spines where people are fused L1-S1 with lamis and anterior fusion as well and you still get post op issues such a scarring cause issues and osteophytes projecting into neural foramen... and its just a wreck.

For situations like you mentioned with multilevel disc issues id try epidurals and anti inflam meds and if surgery is needed try to pinpoint which level is causing you the most issues.


ohhhh and something i didnt mention! One of the reasons i use selective cox2 inhib is becuase of muscle growth. Many studies point to cox1 as being the primary muscle inflammatory mediator needed for post exercise muscle growth. Early studies were done looking at muscle trauma ( like cutting it) and it showed cox2 and we thought it was cox2...but turns out in physiologic muscle growth post exercise its mostly cox1.


So wtf does that mean....that means if you were to take large doses of say advil before working out...your muscle protein synthesis is probably gonna be blunted to the degree of over 80-90%. ( sorry no studies of guys on AAS). There seems to be less effect if advil or other cox1 inhibs are taken like the next day but if its in your system prior to exercise its mostly likely going to decrease your gains.


If you look at some studies on older people it showed that they made better muscle growth when taking advil...but you have to read the study to see that advil increased there functionality due to decreased pain so they were more active then there counterparts.

So thats one of the reasons i take a selective cox2 inhib when im in pain.
I started avoiding anti-inflammatories back in the early 90's as the studies I saw didn't really show anything positive and just masked symptoms. You can add Stenosis, Spondylolisthesis to my spine issues as well. I have never used pain meds of any sort on a regular basis. I take 1 cyclobenzaprine 3-4 times a year and that does about all I need. Some great info you have posted for all to read!
 

Dave Perez

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2 rounds of prednisone and rest along with stretching helped with 2 herniated discs in my neck...it took about 6 months for the numbness to stop...chiropractor and sports massage made it worse...
 

finephysique

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How bad would it be to have to use anti inflammatory meds like ibuprofen and naproxen every day long term? I am not at that stage yet but the days I do use them I feel so much more mobile. I would rarely use over 400 mg ibuprofen or 500 mg naproxen in a day.
 

buck

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How bad would it be to have to use anti inflammatory meds like ibuprofen and naproxen every day long term? I am not at that stage yet but the days I do use them I feel so much more mobile. I would rarely use over 400 mg ibuprofen or 500 mg naproxen in a day.
NSAIDs Tylenol Naproxen have been show to possibly have adverse effects on internal organs, leading to possible stroke, heart attack etc. If you are going to use them i suggest looking to see it you are willing to take the risk. I know many people that have used them long term with no side effects(so far) and others the ended up in the hospital in a short time.
 

gotgame

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How bad would it be to have to use anti inflammatory meds like ibuprofen and naproxen every day long term? I am not at that stage yet but the days I do use them I feel so much more mobile. I would rarely use over 400 mg ibuprofen or 500 mg naproxen in a day.


Well id first see what was wrong and see if you are gonna have to really take them long term to treat your symptoms. lets say you have severe stenosis and taking 500mg naproxen daily helps. Well thats great that a lower dosage like that helped but truthfully its still concerning to be taking that for many months to years on end.

ALL nsaids work on cox2 and prostaglandins. so when you start doing that you are restricting blood flow to the kidneys and tubules ( i think cox 2 is in the macula densa as well). So long term you are increasing your risk for kidney damage.

If you look back at the vioxx studies.. now there was a TON wrong with the way the conclusions were made...but there is truth in the fact that if you limit prostaglandins long term that there can be an increased risk for heart issues but i believe this is for ALL nsaids that decrease cox2. Just so happend vioxx did it really good and time taking it wasnt limited as much as day advil when you get a stomach ulcer and stop.

If however you get imaging and its an annular tear and its not a severe narrowing then taking nsaids for a few months while it heals then that would be ok in many patients.
 

gotgame

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Have to ask about it since i see it everywhere...McGill Method. Before i go any further, understand that McGill Method in my experience was good for practicing abdominal bracing and conditioning one's core (i've tried it, was coached in it by someone trained by McGill himself and yet i still have pain) but what i never understood is this: they claim McGill Method will heal your spine and cure your pain. Ummm...how? How will getting a stronger core cure things like a herniated disc? No one ever answers this when i've asked it before to the people who just claim McGill for any and all back pain. "Just do McGill and the pain will go away. You watch!" and if it didn't, "Well, you didn't do the exercises long enough".


Not trying to hate on McGill but i'd like to know if I'm off here. It's a good practice to train and re-educate your core muscles (if they were poorly trained to begin with), but it won't solve the issue of physiological changes in the spine that are the causes of pain. Is that last statement incorrect Gotgame (because that was the conclusion i came to)?

Gotgame, I'd love to hear what you have to say about the McGill Method.

Right... its not. But having a strong core can possibly help in preventing making it worse or having other levels herniate. Its ofcourse not full proof but by having a strong core it allows for better stability across the board on things other then axial loading
 

gotgame

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2 rounds of prednisone and rest along with stretching helped with 2 herniated discs in my neck...it took about 6 months for the numbness to stop...chiropractor and sports massage made it worse...

Oral prednisone is a good option for people who have nerve root irritation and dont have severe stenosis. If one can knock down the inflammation as the disc dessicates a bit then often times symptoms will resolve longer term.

For my neck i have taken pretty nice dose of prednisone and it knocked down the pain but given my degree of stenosis it came back and i didnt wanna risk taking too many rounds of prednisone so i switched to selective cox2 inhib and epidural once in a while. I will eventually get an ACDF and be done with it. ACDF is a straight forward procedures and ive done many of them on my ortho spine rotations back in the days but it still has its risk and id want to put it off until ive exhausted all reasonable non op treatments.
 

cage99

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The RFA treatment was my last option I tried... Unfortunately it did not work. Fusion is what’s left on the table. I’ll just avoid the excercises that make the pain worse. Utilize ibuprofen for some tiny relief. Focus of core excercises and lots of stretching...

Lots of great information here! For those of you who do not have severe trauma to there spine count yourself lucky. And make sure you take all precautions to prevent a back injury.

Cage
 

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