This article is a transcribed edited summary of a video Bob and Brad recorded in January of 2016. For the original video go to https://www.youtube.com/watch?v=ClylSTLubvY&t=1s
Bob: Today we’re going to be taking about the big lie, which comes in part from this book called Paindemic. This was written by Doctor Melissa Cady. She’s a doctor of osteopathy and she wrote a chapter in this book called The Disc, I believe it is, and that chapter alone might be worthwhile getting this book.
Brad: It’s a good chapter. If you have back pain and you’re thinking about getting an MRI, you should read it.
Bob: Right, MRI, or if you’re thinking about having surgery, you want to. We’ll talk more about this book in the future, but right now, let’s talk about the big lie. First off, let’s say you’re having back pain. You go in and you have an MRI, and they found out you have a bulging disc or herniated disc. You’re going “oh my God.”
Brad: Right, you’re all excited. I better get surgery.
Bob: The thing is that’s probably the last thing you want to do because the problem is, what you’ll find out, this study – we’re going to show a couple studies – is shown that some people at a certain age have a bulging disc, and they have no pain at all. So, let’s go to the chart. So, if you have a bulging disc, what they did is they did MRIs on people. They did MRIs on people who were having no symptoms whatsoever, they had no signs or symptoms of pain. They did it on people in their 20s, 30s, 40s, 50s, 60s, and 70s. What they found out is that 30% of the people in their 20s had a bulging disc.
Brad: No symptoms. Active people.
Bob: 40% in their 30s – no symptoms, had a bulging disc. All the way up to when you’re in your 70s, 77% of people had a bulging disc, but no pain.
Brad: And you can see it gradually goes up with age.
Bob: It’s a part of aging, it’s a deterioration process.
Brad: It’s like getting grey hair.
Bob: Or putting on a few extra pounds. So, are you going to get surgery when you get grey hair brad?
Brad: No.
Bob: The other thing was disc protrusions, which is a disc herniation. On the disc herniation, the same was true, Brad. At age 20, 29% of the people had a disc herniation and had no symptoms. All the way up to 80, 43% had a disc protrusion or herniation and no pain.
Brad: So, if you think about it, you have back pain, and you may have had that herniation in your disc for 10 or 15 years prior without any symptoms. Then you get back pain, and it may be from a different cause, you get an MRI, and they see the herniation or the protrusion and point the finger at that. You have the surgery, get it taken care of, and still have the pain.
Bob: Yes, because it wasn’t from the herniation. So, we’ll talk a little more about that, but right now Brad is going to show what a bulging disc would be like. First off you have the disc itself.
Brad: We’re going to look at L5 and L4, two lower vertebra.
Brad: This red bulge here represents a bulging disc or herniated disc and now if we look at these two vertebrae, and we’re going to take it out and show a model of those.
Brad: This cup represents one of the vertebrae, this is the other. The green ball represents the disc itself. This is a healthy disc. It moves, it has some mobility in it, so that you can move your spine as we all do.
Brad: Particularly if the bugle is in the back where most bulges are, when you bend forward, it often makes it worse. Or when you lift weights with poor body mechanics and seated with poor posture and that bulge can eventually turn into a herniation.
Bob: A herniation is when some of the inner material of the disc spills out back.
Brad: A disc is just like this. You can see there’s material under this, it’s a thicker liquid, but it can come out and cause that bulge and that’s a problem that you do not want to have.
Bob: It’s a problem that is not really a problem unless it pushed out the back and hits a nerve, Brad.
Brad: Right. I guess what I meant to say was when it gets this far out, and it’s extreme, and creating pain and whatnot.
Bob: So when should you have surgery? There are times you should. One is if this bulge or herniation is pushing against your spinal cord, which is running right down in this hole of the back of the vertebra. The other one is if it’s hitting one of the nerves coming off on the sides. If it hits that nerve, it could give you some pain down your leg and if it’s causing you “foot drop”, where you start getting weakness in the foot, that’s usually a sign that you’re getting pressure on the nerve and it’s pushing on the nerve itself. There are three instances. One, is it pushing on your spinal cord. It will tell on the MRI, you’ll see that. Two, was it pushing on one of the spinal nerves. Or three, is there a mass in there. I mean if you have cancer or some type of mass growing.
Brad: Right, sometimes it’s benign and they get in there to remove it and it takes care of the problem quickly.
Bob: Or a blood clot. There could even be a blood clot growing on the spinal cord. Dr. Cady, she said she knew plenty of physicians and surgeons who would avoid back surgery like the plague, that was one of her quotes. So, it’s something you want to consider, that you want to try some aggressive physical therapy way before you try surgery. It kind of is the last case scenario. Again, don’t get distraught if you’re seeing a lot of things on your X-Ray which is just showing general aging which is conveying a disc protrusion or disc herniation.
Brad: Yeah, I think Bob meant to say MRI.
Bob: Did I? What did I say?
Brad: X-Ray.
Bob: Oh X-Ray, well X-Rays show some of that stuff too.
Brad: Sure.
Bob: Alright, thanks!
If you are having pain associated with a bulging or herniated disc you may want to check out our Sciatica Program for more information.
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