Herniated Disc with Wil Seto
Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, multi time, winners of best physiotherapists in Vancouver and in Burnaby. And we're going to talk about herniated disc. How are you doing Wil?
Wil: Hey, Mark I'm doing well. Thanks.
Mark: Herniated discs. That horrible sounding thing. What's this all about?
Wil: Yeah. So a herniated disc, you know, some people may even have a herniated disc and they don't even have pain. That's the thing. There's very different degrees to having a herniated disc. But what it is essentially is, when you look at your spine like the lower back is a really good example because that's where usually is most common. But you have three joints in your spine. So you have the two small ones which are called your facet joints. And then you have the one in the centre, which is basically where your disc sits. And that's the area where, you know, usually when you have a disc herniation.
And so if you actually think about a disc herniation, kind of like a jelly donut, and if you straighten the back in a way where you bend forward too much and you strain the ligaments kind of in the back side of the back. And then what happens is like if you push the jelly donut and the jelly squeezes out, that's kind of what happens when you herniate a disc. And there's, like I said, varying degrees to severity of it too. So can we really mild where you actually don't even have back pain and that herniated disc can start to pinch up on a nerve. Or where it can be very inflamed and it could be like, basically, you know, super, super painful where you can't even like stand up or sit or move and you have to be bed bound.
Mark: So what are the symptoms other than pain?
Wil: Yeah. Well one of the other major things that I should also mention is that if you have a herniated disc that can pinch in on your spinal cord, there's certain symptoms there that, you know, you want to make sure that you're not having issues with your bowel or bladder movements that's important.
And then any major gross motor stuff that happening as well as it pinches in. And if you lose all you know, bowel, bladder function and your motor controls all gone. So that's obviously on the extreme end. And that's when you want to definitely go to the emergency for that kind of stuff.
And there's usually a lot of pain with that as well. And so symptomology wise, like you're looking at things where even sitting is painful and standing is painful. But the worst will be like bending forward because you're putting more strain. So usually if you have like an a mechanism or a way of you can remembering how you possibly did it, where you're oh yeah, you know, it was shovelling snow for a while and it was bent over in a bad posture. And then all of a sudden, like I felt something in my left side of my lower back, but then the third hurting even more later. So that could be sort of how it happens. Or it could just be like even sitting for long periods of time. Now that we're in this kind of time and an era of like working from home and you're ergonomic setup isn't great. And maybe sitting in the bad chair. And that compression, you know, into the disc.
Speaking of compression, I've had snowboarders and skiers that have made jumps and they've landed on their tailbone and it's caused compression fractures into where the disc connects to the vertebrae. And then injuring the disc at the same time. So those are all sort of different ways that you can injure and how the pain that comes on.
I had someone that actually just, they were already set up to have it happen. Where they had all this muscle imbalance and they went to go pick up literally a paperclip on the floor and their back just went out, so to speak. And they had super bad pain and they thought they just pulled a muscle. But it turned out to be what I thought to be a herniated disc.
We also had another person who were at worlds. I was working with this athlete and he had flown to be with the team and to be with us. And then days to the competition, he comes up to me and say, Hey, Wil, I think I have a bit of a problem with my little toe. And I'm like, what do you mean? Oh, it just feels tingly. And then I start to ask him more questions. And oh yeah, and I don't feel strong on this whole right side. And I'm like, really? And then, so I did a thorough assessment and I suspected them afterwards that he had been playing with a herniated disc. And I said to him, I gave him the low down and I said, you can keep playing, but you might injure it more.
He kept playing. And he did have worsening symptoms. In the end, when he finally went home, I recommended him to go see a doctor and because he didn't have healthcare coverage here, and he was able to manage the symptoms while we were traveling at worlds. He didn't want to see the doctor while we were away, which I thought was silly. And then he went home, had a scan done and he had a very severe herniated disc on the right side of his L5 S1. Had surgery the next day. Wow. And then his numbness was gone and full strength back in his foot. It blew my mind away.
So there's varying degrees of the disc issue when you have a disc herniation. And then I had someone that just had mild stuff going on that it just seemed like a back strain. Didn't even have any of the neurological, like weakness or anything like that going on. And he decided to get an MRI on his own accord and it showed that it had some disc herniation at a couple levels. But he was pretty good function. He just had some mild discomfort.
Mark: So is it, when you're diagnosing this now, you know, as it x-rays, is it eventually, as you see more and more indications of severity, you're moving me into, okay. You got to get an x-ray, you got to get an MRI. How do you diagnose this and how what's the difference?
Wil: Yeah aside from the clinical tests that we do, this is more a medical management, where they look at, seeing the doctor and usually they do get an x-ray. But that's not what I would recommend first. You know, you want to really treat it conservatively and really work on, a lot of the times you know, really doing that rehab is the best, best way to treat it.
Like doing your physio is the best way to treat it. Doing things to really address the imbalances that are happening and the weaknesses because things get really tight when you have that disc and you want to do things to influence more decompression in there you know, and traction definitely really helps.
But you want to get things to decompress more naturally, take the load off by like really taking those muscles that are like this, and getting them to be more relaxed. And then engaging the core and then retraining that stability system. That is key. And then really working on a really good extension protocol, things that actually helped to influence that extension motion.
So there's this whole method of really being able to start to get that mobility back into the spine in a really positive way. Because you want to make sure that you do things with a herniated disc where you're addressing mobility deficits and your core stability deficits.
Mark: So when you're outlining a course of treatment, of course, it varies pretty dramatically. I'm sure. Depending on how severe the hernia is, but what can you give us kind of like a range of what the course of treatment might look like?
Wil: Yeah. So typically for, and this is all very dependent too, on the healing process of the disc and you have to really respect that. That's the thing. It's not like a sprained ankle, or even just like a like those little joints in the back, the facet strain. It's more, you have to respect the disc injury because it's bit of a different healing process. And so when I say that, typically a disc injury can heal anywhere from four to six weeks, fully, which is great.
So then that's what you're looking at, but when it gets to be a really bad disc herniation. Those can even last up to well beyond four to six months, even up to maybe a full year, depending on what's going on. And this is where like, if it's that bad and you're looking at okay, well, there's a little bit more going on on a neurological level where, you have a lot of gross, severe stuff going on with muscle strength loss, and neurological issues.
Then that's where I definitely want to refer over to medical management, have a referral to a doctor and really get things going on that way because that's something that's a little bit more than just conservative treatment.
Mark: And that's where you would work in concert with the doctor where the doctor's looking and checking to make sure. And then referring back to you to give, to outline the recovery process, the exercises, the treatment, basically that they're going to go through, is that how that works?
Wil: Yeah, for sure. We definitely work with doctors on that, but usually, the most advised course of treatment is doing the rehab first. And if things aren't working out there, we're definitely all reaching out to the doctors and even, like I said, with pain management, getting some stuff to really hone down the pain because we don't want you to be bedbound for this long. That's not good. We're going to get you going. And then if it's that bad of a herniation, then let's get some more information. Let's see what's going on.
Mark: If you've got a herniated disc or suspect you have a herniated disc, or you got just back pain, the guys to see your Insync Physio in Vancouver and in North Burnaby. You can reach them and book at insyncphysio.com. That's their website. Both locations are on there, or you can call and book. The Cambie location in Vancouver, it's 604-566-9716 or the North Burnaby location, 604-298-4878. Get in there, get some help. Find out what's going on. Get the heck out of bed and get moving again. Thanks Wil.
Wil: Thanks Mark. You bet.