Bob: Today, Brad, we're going to talk about the big lie that there is about bulging discs and herniated discs. Brad: Right, it's a big misconception, and we need to clear it up.
Bob: That's right. (Singing) Bob and Brad, the two most famous physical therapists on the internet Bob: Hi, I'm Bob Schrupp physical therapist
Brad: Brad Heineck physical therapist Bob: And together we are the most famous physical therapists on the internet.
Brad: In our opinion of course, Bob. Bob: Today, we're going to be talking about the big lie, which actually comes in part from this book called "Paindemic" And this was written by Dr. 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. Brad: Right, it's a good chapter. And if you've got back pain and you're thinking about getting an MRI, you really should read -- Bob: Right, MRI, or if you're going to think about having surgery, you definitely want to. We'll talk more about this book in future videos, but right now, let's talk about the big lie. Alright, 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 a herniated disc. And you're going "oh my God".
Brad: Right, you're all excited. I better get surgery. Bob: I better have surgery. And 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 of studies - is show that most people at a -- well, some people at a certain age have a bulging disc, and they have no pain at all. Brad: Right, exactly
Bob: So let's go right to this chart, and then we'll show this, okay? So if you have a bulging disc what they did is they did MRIs on people... can you see this Lonnie? They did MRIs on people who are having no symptoms whatsoever, they had no signs or symptoms of pain and 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. No symptoms.
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 percent of the people had a bulging disc, but no pain. Brad: And you can see it just gradually goes up with age Bob: So it's a it's a part of aging, it's a deterioration process like getting grey hair, or putting on a few extra pounds. So are you gonna have surgery when you get grey hair, Brad?
Brad: No Bob: The other thing is - and we don't have a chart for this one - was for disc protrusions, which is really a disc herniation. We're going to show this on the model a bit, but on the disc herniation, the same was true, Brad. At age 20, 29 percent of the people had a disc herniation, and had no symptoms. All the way up to 70 - ah I'm sorry, they had one for 80 years old. All the way up to people in their 80s, 43 percent had a disc protrusion or herniation, and no pain. Brad: So if you think about it, you've got back pain, and you may have had that herniation in your discs 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 you -
Both: Still have the pain! Bob: 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. Bob: First off you have the disc itself.
Brad: Well let's look over at our Napoleon here
Bob: Bone apart... Brad: We're going to look at L5 and L4, two lower vertebra. 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 This cup represents one of the vertebra, this is the other. The green ball represents the actual 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. But if you get a bulge - just kind of zoom in here, Lonnie - and, see how, right where my finger is pointing, there's a bulge starting Particularly if it's in the back where most bulges are when you bend forward, it oftentimes 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 actually spills out back. Brad: A disc is just like this. You can see there's material under this, it's liquid, kind of 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 pushes out the back and hits a nerve Brad. Brad: Exactly, 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 here. 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 actually started getting weakness in the foot that's usually a sign that you're getting pressure on the nerve and it's going on to the, you know, it's pushing on the nerve itself. The other th-- so really three instances. One, is it pushing on your spinal cord? And it'll tell on the MRI, you'll be able to see that. Two, was it pushing on one of the spinal nerves? Or three, is there an actual mass there? I mean if you have cancer or some type of mass growing...
Brad: Right sometimes if 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 be even 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 really something you want to consider, that you really want to try some aggressive physical therapy way before you try surgery. It really kind of is the last case scenario. So 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 disk protrusion or disk herniation. Brad: Yeah I think Bob meant to say MRI.
Bob: Did I, what'd I say?
Brad: X-Ray Bob: Oh X-Ray, well X-Rays show some of that stuff too.
Brad: Sure. Bob: Alright, thanks for watching and make sure you subscribe if you haven't already. Or we'll come out and slap ya. Brad: (laughs) oh, Bob, we're not that violent!
Bob: Okay, maybe we won't.
