Dr. Tyler Ideus
January 30, 2020
Amy, 29, came into the office with an acute onset of lower back pain. Her issues stemmed from a likely disc bulge, which created an antalgic posture — the body shifts the hips one direction and the other direction to try and unload the spine making one look crooked.
This type of situation can be very debilitating and painful, which is why I often recommend an oral steroid such as a Medrol dose pack to shorten the term of intense pain. I have no problems with taking this medication as long as we are also addressing the root of why the problem occurred and then taking the appropriate measures to help the patient rehab to minimize the risk of having it happen again.
However, in this particular case, due to the patient’s current medication list and hormone replacement due to fertility treatments, I recommended that she stay away from taking additional medications. This is a common situation and there are people who also prefer to avoid taking medications. When that is the case, there is still a lot we can do to help relatively quickly.
For Amy, we were able to find a comfortable position on her side, so I performed a modified, very gentle type of dry needling for pain management, which is extremely effective in these cases. Next, we used Active Release Technique (ART) to stimulate receptors in the muscles and surrounding tissue for an inhibitory effect of the pain. Lastly, I provide instructions for home care, which included:
- Positions of relief to be used throughout the day
- Minor activity such as walking and two stretches called side glides and press-ups, which have a therapeutic effect on the bulging disc.
Amy’s symptoms were reduced by 30% after the first visit and after four visits in a two week period, she experienced 90% relief.
If we compare this to a case where an oral steroid was used, it has been my experience that pain relief after the first 24 hours is somewhere between 50-70%, and after two weeks we are still around 90% give or take 10%.
In conclusion, I am fine with using medication to decrease as much pain as possible as soon as possible in order to go on with day-to-day life. However, there are situations where medications may not be an option and, while one may have to struggle with the pain a bit more in the initial days after the injury, with the right rehab — unfortunately, there is a lot of bad rehab and advice out there for lower back pain — recovery can be efficient.