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Hello to all our friends,
A 49-year-old man walks into our physical therapy clinic with, what we would call, a dropped foot. He begins to tell me his story. When he first started to have back pain, he thought he needed to strengthen his core. He had had back pain 3 months earlier, and after working out 3 times a week with a trainer to strengthen his core, he developed a weak foot that couldn’t be strengthened, He was happy that he no longer had back pain but was wondering how to improve his foot strength. This story is one we hear often in our physical therapy clinic. We know that if a patient with back pain is given the wrong exercises, the original back pain can later turn into a nightmare for the patient.
In this patient’s case, he, unknowingly, was in a very difficult situation.
Let me explain. This patient’s back pain symptoms had been the beginning of a compromised disc in his back. To simplify this explanation of his disc problem, I’ll describe the disc as the texture of jelly in between two crackers (his vertebrae). When the back portion of the cartilaginous ring surrounding this jelly was compromised, the jelly can seep backwards toward the nerve in the back and press on it causing back pain.
He began having pain from a compromised disc. He thought he needed core exercises to stabilize his back. The trainer started him on some sit ups and planks. He informed me as he was able to perform more sit ups, 3 days a week, his back pain began to decrease, but his leg began to ache. He thought this was good. As he continued his regime of exercises, the back pain slowly moved down into his leg. He eventually had no back or leg pain, only this weakened muscle which was the cause of his dropped foot. He was hoping I could help him strengthen it, because the trainer was unable to solve this “new” problem.
When a person assumes their back pain is a muscle issue but it is a disc issue, they had better be careful because they can make it so much worse. It would be better to be safe than sorry and go to a physical therapist or spine specialist they trust before getting on an exercise program. Why?
The results of an incorrect diagnosis and, thereby, the wrong exercises, often can lead to a back surgery that could have been avoided with proper examination and treatment.
In the case above, what happened to this person was sad. Little did he know, that as he performed more and more sit ups, his disc, which we later confirmed by MRI, was herniated, and was being pushed out onto the nerve, creating the leg pain. If you think of a nerve as a hose and the messages to the muscles in your body as the water. You can imagine. The more pressure from the disc (jelly mentioned above) on the hose, the more the hose can become kinked, and the messages no longer get to the muscle. Then, the muscle becomes dead haven’t not received any impulses. Bending forward or up for sit ups caused the pressure to move the disc backward toward the nerve. Eventually the nerve was insensitive to pain but no longer had any conduction to know it needed to contract and work.
Most of these cases end up in surgery. The neurosurgeon then performs, hopefully, only a discectomy and takes the disc off the nerve and the strength and sensation returns in most cases. In this case, we were fortunate! Instead of doing surgery, this neurosurgeon was open to first letting us treat with daily traction, which after 3 weeks returned most of this patient’s strength and sensation. He eventually had no pain, was able to take part in a proper exercise program tailored to his injury,and has been pain-free for over 5 years.
Please take your back pain seriously! Don’t just assume that it is a muscle issue, and that all you need to do is core exercises. Please, especially when you are 29 years or older, take that extra time to have an extensive examination, (not just X-rays, MRI’s), but from a medical provider who makes you go through, at least, a 30-minute exam, before restarting exercise. There is a good chance it will help you prevent further episodes of back and leg pain. It can also help you learn how to avoid exercises that are detrimental to your particular back. It can, most importantly, help you avoid an undue back surgery in your future.
Enjoy the journey!
Fran McDonald President/CEO
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