Trigger Point Injections vs Dry Needling
I was sitting in my office today reading over some articles when I came across this article discussing the resolution of a disc herniation without the use of surgery in the New England Journal of Medicine. I copied the article below with link to journal by Jennifer Hong, M.D. and Perry A. Ball, M.D.
A 29-year-old woman presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. There were no bowel or bladder symptoms. Magnetic resonance imaging (MRI) of the lumbar spine revealed a lumbar disk herniation resulting in substantial spinal stenosis and nerve-root compression (Panel A, arrow). She elected conservative treatment with physical therapy and an epidural injection of glucocorticoids. A second MRI obtained at follow-up 5 months after presentation showed resolution of the herniation (Panel B, arrow). Lumbar disk herniation has an uncertain natural history. Data from clinical trials suggest that patients who have herniated lumbar disks have similar long-term outcomes whether they undergo surgery or elect conservative management. In addition, the risk of subsequent catastrophic worsening without surgery is minimal. This patient reported that she began to have back pain after playing volleyball several years before presentation, whereas the pain and paresthesia in her leg began 6 months earlier and were not associated with a precipitating event. Her clinical symptoms resolved, and she was discharged from the clinic, with follow-up recommended as needed.
Jennifer Hong, M.D.
Perry A. Ball, M.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH
P. Freeman, N. D. Jeffery. . (2017) Re-opening the window on fenestration as a treatment for acute thoracolumbar intervertebral disc herniation in dogs. Journal of Small Animal Practice 58:4, 199-204.
H. S. Füeßl. . (2016) Wie sich ein Bandscheibenvorfall ohne Operation zurückbildet. MMW - Fortschritte der Medizin 158:12, 41-41.
Dr. Corey's two cents
What most MDs and Surgeons believe from prior information is that disc injuries will not heal and can only be treated by surgery. However growing, quality research is showing that disc herniations will actually heal themselves when complimented with activity avoidance and conservative treatment, and the bigger the herniation the more likely it is to reduce. You can read an earlier blog I posted discussing this topic. http://www.centeredspine.com/blog/your-slipped-disc-can-get-better-heres-how
Conservative Chiropractic care has been shown in research to be beneficial in reducing disc herniations in the neck,(Outcomes from Magnetic Resonance Imaging-Confirmed Symptomatic Cervical Disk Herniation Patients Treated with High-Velocity, Low-Amplitude Spinal Manipulative Therapy. Journal of Manipulative and Physiological Therapeutics. October 2013), so it make sense that it can help the lower back as well.
From a biomechanical standpoint, one of the most common joints injured in back are the facet joints. The facet joints allow the spine to bend forward and backward, prevents each bone of the spine from sliding forward, and compliment the disc with movement. However when facet capsule is strained, damaged or arthritic to the point where it cannot handle the load it gets stuck leading to spinal stiffness and lack of proper movement at the disc, making it suceptible to herniation. (See the video below).
Chiropractic adjusments are specific manuevers used on the spine to create proper movement. In conjuction with manual therapy and rehabilitation, this is conservative care to help improve a disc herniation. If you have any further questions, feel free to contact our office or set up a free consultation to talk with me about your issues or concerns.
Dr Corey Idrogo
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Trigger Point Injections vs Dry Needling
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