This episode is entitled “Prolapsed lumbar disc” and it covers:
I used to go cycling and wake them up. You couldn’t cycle. It was just too painful sweep, not to eat, but I didn’t. Somebody Sharpie, something paid so much GP and he prescribed aerosol consultation. Eventually I called him back to see me for five minutes. There you come to waiting a coach. And they, I was like, Dan, just ask patients. And that was it. He didn’t change the killers. I didn’t really go walk in on Danny. He tried me on how much up to you. And then there are signals that I was working with and they try to walk in and it’s going to get washed. When I’m just laying there, I’m getting quite a bit of being on your NPDR is still vaguely Tate. And can’t feel sensations down here. They tell you as well, buying awake and I feel then it gives you a shock. And when, so if you miss a step and you get that shot thing, where is that? And the shin Pandia upper muscle condition.
We’ll circle back some of that stuff. And if so, pre-Christmas was that when it was at its worst and it was at its worst, it was going to go to [inaudible] and I stumbled. I like that between then and recently [inaudible] six weeks is marginally better medications. Given how painful it’s been, how have you been spending your time? What does it look like and will call me at home, but I try and keep up as far as possible. I find shops. The way I seems to use it just Sany that you are sitting, as you talking to me the length of time you’ve been sitting while we’ve been talking, is the pin building up and I, you start feeling that. Stand up, move around.
Is there a daily part of it? How does it feel when you wake up in the morning?
Once I stand up and I do feel though the sound on this way, there’s not a sharp pain that in the ankle up here. And then I, the morning, the most painful time, or does it depend on what you’re doing to the day? I think it depends on what I’m doing. Um, I am spending on laptops again. I have to stand up just to walk around. I can sit there and again, I tried jog and like often laying I was doing, I quit that patient this week. When you walk or are you aware of, or you can have some that work. It’s that lifting the foot top or is it pushing down on the ground? It’s pushing down. Right. Sure. If you had to stand on one foot and push yourself up on your toes, that would be a problem. That was one of the things I did with the physical therapist. It was an issue.
Right. Do you mind just standing up and we’ll just check a couple of things. As you’re standing, is there something around you you can grab a hold of if you lose your balance or is there a chair you can drive across? I love it. And then there’s a cat in the background and at least it’s not a screaming child. Just if you need it, it’s there. First thing is if you’re standing evenly on both feet, there’s the right leg. That’s the problem. Isn’t it. So with your left foot, can you pull your toes up towards you? So keep the foot on the green, but just lift the toes up off the floor. Easy enough to do yep. Now do the same thing on the right foot.
Often painful to do, but is there any weakness when you’re trying to lift those up? No thanks or no. Next one, all the weight on the left foot and go up on your tools. Go off and then three or four times. Easy enough. And then the right foot. I can do that. So getting your up off the floor is difficult. Good enough. Next little test. Maybe if you turn signed on, so your backs to that chair. If you slide your left foot in front of you a little bit, the straight leg to up towards you. If you don’t have any problems lifting the two off the floor, swap rate, slide the right for the tape and pull that to up towards you.
Any problems? Does that move them and seem to increase the pain in the ship? We’re not being too accurate with the kind of reach solution here at school regard as a positive, straight leg raise test. So you’ve obviously got a weakness in your ability to lift your heel up off the floor. And they’re specific to a specific nerve you’ve heard of the cyanotic nerve nerve is actually a peripheral nerve. You can think of it like the Amazon river. It’s a big nerve, but it has tributaries much like the Amazon river. And those are called spinal nerve roots. And there income from lumber for five S one S two, which is the nerve that specifically enables you to often push your heel up off the floor control. Next one. So it is likely that you have an S one nerve root impingement as a broad description. And the most likely explanation for that is a disc problem. And again, the most common one for an S one nerve root problem is the L five S one disc in terms of assessing the cause of your pain, that’s probably as close as we can come. Just one of these virtual consultations and knowing you all, certainly from many years ago, I think that fits with what you had in the past as well.
This is not a definitive diagnosis because to some extent, diagnoses are not awfully helpful. And of course, we’re there examining you or possibly even sending you for an MRI. We can’t be absolutely certain that’s what’s going on based on my experience and the information available to us, all the evidence that’s causing your pain. You mentioned the doctor asked you, and I know our onboarding form and our bot asks or problems with coming to the toilet and all sorts of red flag questions. And you answered no to all those, which is great. The reason we ask those is that your S one nerve root is close to a whole bunch of nurses who took bowel bladder as well. You can have irritation to those nerves, as well as the irritation to your spinal nerves. The doc probably said that, but it’s worth reiterating is if you do develop any problems with the most common one, the waterworks difficulty starting or stopping when you pee or you think particularly first thing in the morning, if you don’t need to urinate first thing in the morning, and that’s very unusual for you, then just crawl NHS 1, 1, 1, it’s not an emergency, but you definitely want to get that investigated quickly because you don’t want your bladder understanding.
What can happen is you just don’t feel it that actually you’ve got full bladder and that’s not healthy, that would need to be dealt with in any. I’ve only seen it twice in 30 years of practice. It’s pretty rare, but it’s definitely worth people on the plus side. You’re a bit better than you were a few weeks ago. And I would certainly expect that because discs can heal. And so can that nerve, that the nerve takes time to settle once your nerve has been inflamed irritated, it can take weeks, sometimes months to settle back there. As you say, when you catch your foot, you get as kind of some shooting pain. That’s not surprising just because the nerve is raw, just react. And that’s what will cause your numbness, lack of sensation. There’s a needles and pain. If we take that as a given, how do you speed up the return?
How do you stop this from getting worse again?
You’re keen for relief and prevention, but I would say initially let’s focus on the relief stage. Some of the advice I give you is relevant to a long-term prevention as well, but we’ll definitely circle back in future to focus on the preventative messages for the session today.
How can you get better quickly? It seems like a good four years so that this campus do the right thing. It just showed us that resource stumble and must’ve wait. This is an important point in terms of, what’s actually the background contributing factors to this, so that the stumble clearly as the trigger, that’s obviously ticked you off the edge of the cliff pin, but how did you get to be on the edge of the frescoes? Because you’re up to be able to have a return and a stock with a developing a disc prolapse. Obviously we’re in the middle of a global pandemic with the Coronavirus.
How has life changed for you prior to this previous six months in terms of lifestyle?
I was on huddle from star for March last year. What were you doing that you wouldn’t normally be doing when you were working?
I was walking, equal time, either sitting down in the office, on conjecture or [inaudible] coffee bars. I’d be on the train, walking around in the store, doing stores of like, I was sitting down, I never saw her walking and doing things, bending, stretching. [inaudible] I’m not doing that walking road, perhaps doing more, eventually a task anyway. That’s probably be a major change, I think. Where are you still doing your, as it were a formal exercise at the same level? I was walking, I tended to go three or four times a week quicker, slightly more, but that was counterbalanced with the fact of weaker at home.
I wasn’t doing nearly as much constant activity. In balance you are almost certainly sitting more than you’re used to. I think so. Normally I’m a chair sometimes and on the chair. And if we use that chair you’re leaning on at the moment as an example into shot, even though it’s not turn it sideways. Sit on it and see if you can get in a kind of posture that you think you would normally be in on a chair. Is that because you’re working on a laptop and you’re sitting on it. Stand up or whatever is least uncomfortable.
I’ve got a hypothesis that applies to an awful lot of people, and that is probably it’s pushed you closer and closer to that. When you sit, you’ve got a sustained load on, on everything it’s different to standing is different to walking around, certainly the position you were sitting in there as well, call relative flection. You’re bent forward that we all ought to be able to do that without any grip problem. But I suspect the problem for you as being in the significant some transition that you’ve suddenly doing a lot more of it. Your back isn’t conditioned to that. And so it fatigues and eventually the stream in essence is going to be felt on one of these tissues. And for you, if you think about it, your lumber disc. The discs in between the vertebrae, they’re essentially fighting infrastructures. People often when they hear the term slipped disc, they think it was Robert thing that slips in and out of place.
But it’s very much a normal actually the majority of that disc is fibrous structure. And the center of all of those fibers is this kind of gelatinous material called nucleus Paul process. And what happens when you sit this, there is a compressive building on the desk, but if you imagine that the back and that’s the front and then forwards or the camera’s confusing. I said, that was the back. If that’s the back, you work out, when you sit that happens, you stretch the back of the desk. You’re going up the back of the desk. I’m stretching now, as I say, you want to be able to do that, but if you do it for prolonged periods and actually do it repeatedly, and your back isn’t used to that level of activity, that type of activity, then it will fatigue. And you get these little micro tears in the fibrous part of the disc. And then eventually, if you are unlucky, as you were, and you got some stretch on it, you get a bigger tear. Then some of the jelly squirt. Three, the fact that’s a prolapsed disc and Newstart prolapse material that jelly has impacted on your S one nerve root irritated it, and that’s what causes your static pit.
If we take that as a given, and as I say, that’s a hypothesis, feel free to walk around, Sandy. We have your hips from side to side, gently our tobacco, it’s, all that kind of stuff. The key thing is to avoid stretching the back of your disqualify, trying to heal, because it will heal that or that defect, that tear, it needs to be healed by the formation of scar tissue. And that takes time. The disc has no direct blood supply. It’s a great tool to heal much more than a broad pre-proposal four to six weeks. Discs will take considerably longer because they don’t have an arterial blood supply. You need to give it the time while that’s happening. You need to try and avoid much stretching off the back of your desk. Now in the longterm, we definitely want to get you back to being able to move in all different directions, including men forests, but in the short term, it’s best not to stretch it.
And as I said, when you sit, especially the way you sit, you tend to stretch the back of the desk. And as such, you may be picking the scar airing that scar tissue before it has fully formed.You mean team this chronic inflammation in the spine or in that desk. And so long as it stays inflamed, you know, it’s going to be irritated by inflammation. And so you’re just stuck in this continuing loop and remember inflammation initially as your friend is the first stage of healing. You have to go through information before you can start building scar tissue, but if you keep retaining scar tissue, you’ll keep reinflating it. And you never really get anywhere. And you can end up with this chronic one plastic pig. There will have been a degree of healing occurred in your desk, but I’m concerned that it may be, could have been faster and it could have been further on the road by.
In order for that to happen, I think you’d very much in a short term need to minimize how much or bending you do in your lower back. If you’re going to sit that you maintain the natural arch in the small of your back, when you sit. The easiest way to do that is to sit high up. You sit with your hips higher after the session pass, send you a report and I’ll send you some weeks with video clips showing you how to do all of this stuff. And some exercises that I think you’ll find helpful. Let’s carry on where we were at. It’s very important that you don’t bend your lower back forwards, particularly when you’re sitting and standing. If you’re on all fours where the spine is suspended and there’s no great load on it, then you might get away with a little bit of forward bending of your wall.
We definitely need to avoid doing it with looked on it. Also I was walking the office. The, obviously you have that giving us cheer Swisher design [inaudible] underneath the chair that they can then escort you back. Like when it was, he walks up, made you sit, as you see. Some of the links I’ll send you two videos to hang to it down to chair to get that support. Things like a rolled up towel in the smaller group. Certainly when I sit and I don’t actually don’t use a back support, I just set nice and tall all myself. But again, it’s what you’re used to. And if you’re not used to that, your muscles will fatigue quite quickly. Then they will get a bit achy and sore. If you’re used to have support, I suggest you get extra support from this ruling tip in all. And you can show that in a smaller, natural rock.
Use it or lose it, the abuser, and be quite good for that. I’ve known you for many years ago, so you try to stay active and that’s good. You, if it doesn’t hurt to walk that walk or walking good for, or at least it doesn’t aggravate them. Any movement that you can do that doesn’t aggravate it, it’s a good thing, but anything that you do, that those seem to aggravate it your best to avoid. You already told me right in the beginning, sitting, sitting aggravated it. Don’t sit or sit with your hips higher than your knees in natural options, and only do it for a brief period. Don’t wait until your leg gets more uncomfortable before you get up. Because by the time that happens, you’ve aggravated it. I’ve got these little pithy and use or lose it, but don’t abuse it, that don’t pick the scarf
And another one is if you want to get better, stop doing things that make it so that I think in terms of relief, the most important thing is don’t do things that make it worse. And I think you’ve identified the bending your back forwards as being a worse. Don’t do that in the short term, there was a bunch of relieving exercises. And these are not stretches people very frequently get hung up and many resources will tell you how to stretch your back. But actually, especially with this problems, stretching is pretty unhelpful, but you’re better to move it. When you’re naturally doing that, just swinging your hips from side to side, gently arching backwards. That can be helpful too, but it’s really any movement that doesn’t increase your pit.
However, when it comes to this particularly desks, there can be a delayed effect. What you do today, you might well feel tomorrow. The disc itself and the majority of us, particularly the perimeter of the disc or the tiering B has no nerve supply. You can irritate the disc. You can actually damage the disc and not feel anything at the time. It’s only once the inflammation is built up and you’re irritating the adjacent nerve that you get more sciatic appear right now, you obviously got instant pain when you tripped. Was obviously significant prolapse because instantly, however, now that we’re seven, eight weeks in, there is a good chance that you could be irritating the desk, but not feel it at the time. You’re aware of that even though something might feel okay, that doesn’t mean it is. You really looking for a pattern too, if I do a bit more. Let’s use a really obvious one, a bit more bending in a day having the next day.
I was by cards. The bullying is a shelter for my which banging over or can’t retain it wasn’t until the next day. I see what you’re saying while you do today. Sandy has that provided some useful insight up to this point, same thing to stop doing them. I will, as I say, will be quite an information packet, follow up email to the session, certainly with a bunch of videos for you to follow along in terms of different exercises that I think would be helpful, how to set, how to band while preserving your spine in that kind of neutral alignment and legacy. I can’t stress enough. The importance of things that you do will get more uncomfortable either. Don’t do them or cut down the length of time. You know that you can’t stand still for more than a couple of minutes, so don’t do it, but it’s absolutely been one of the links I’ll send you as the podcast. How much should I rest with science trying to get that balance right. Is really important because when you get it, you rehabilitate much faster than if you get it wrong.
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