Recommend running in conjunction with ultrasound, nutrition, and orthotics for your patients with degenerative discs

Many runners are told to stop running when diagnosed with a degenerative disc in the back. Not only is this inappropriate in many cases, but often, running is part of the solution for someone in this situation.

Case History
Gina B is a 33-year-old hairstylist, whose job involves standing all day. She came into my office in late 2000 with low back pain that was getting worse. When I took an x-ray of her low back (see page 62, Figure 1), I found Gina had an extremely degenerated disc at the L5 level of her low back (arrow C). This is a condition more commonly seen in a 60-year-old. Disc spaces D, E, and F were full and healthy. Gravity line A should be going through line B, and the fact that it was not only added to the stress on the joint.

Discs typically degenerate with age or trauma. Trauma to an area of the spine without rehabilitation will produce a tightness of the supportive muscles, a fixation of the joint, and an ultimate reduction of the normal blood flow to the disc. This is similar to a tourniquet around the arm. Eventually, whatever is on the other side of that reduction of blood flow will die. It will gradually wear down until symptoms begin to occur. Symptoms can come in the form of localized pain, restriction of normal motion, or pinching of the nerve that exits the spine at that level. Symptoms typically will worsen over time without corrective care.

Figure 1: X-ray of Gina B’s low back. The degenerated disc is located at L5 (arrow C). Disc spaces D, E, and F are full and healthy. Gravity line A should be going through line B.

Appropriate Treatment
In most cases, the disc will never grow back. The next best thing is to restore motion back to the joint. This will promote the influx of a rich blood flow back to a withered disc, and time will allow that portion of the disc to resume function to whatever level is possible. To get motion back to this injured joint requires work and patience.

When a disc degenerates, adhesions form around the joint as the body tries to lock up this injured area. As long as that is allowed, there will be an inability to do many things. The goal is to go against what the body is attempting to do and work to dissolve as much of the adhesion formation as possible. This is done with ultrasound therapy, which prepares the joint for rehabilitative exercises to restore motion back to the joint and increase the blood flow back to the remainder of the disc.

Patience is the key. Three to five visits will not do the trick. It may take 30 to 40 or 60 to 80 treatments. Patients must be willing to put in some time and effort to get results and maintain some level of treatment to keep the results. The ultimate ceiling of potential may be reduced to some degree, but it can certainly be raised from where it is, especially if patients have only been told to stop running without receiving corrective care.

Running offers multiple benefits in a case such as this. The key to any degenerating joint is to increase mobility as much as possible. To stop activity and ignore the degenerative joint is not proactive care. Restore mobility in both the joint and the individual will improve both mental and physical wellness, and this should happen only if a patient actively manages their condition. This is done with ice, adjustments, and other beneficial adjuncts.

The next most important thing to do is to fit the patient with flexible, custom orthotics that can provide protection from damaging heel-strike shock. The injury and lack of normal motion in the low back are clear examples of an instability in that area. The need for orthotics increases even more if there are any imbalances, pronations, or supinations in the medial arches of the feet.

In addition to ultrasound treatment and orthotics, frequent spinal manipulation greatly helps to restore motion back to the locked joint. This will encourage a better blood flow and a reduced likelihood of future injury.

Combine this with some nutritional support such as glucosamine with a ligament-strengthening supplement (minerals) to begin the healing process. There are also many all-natural anti-inflammatories recommended, such as proteolytic enzymes. A daily routine will contribute and support the physical treatments that are being given.

Gina was not a runner when she entered my office in late 2000. Once the process of rehabilitation began to show improvements, Gina wanted to know what more she could do to help herself. When that question is asked in my office, there is usually only one answer: Begin running. She has now completed four races and is well on her way to running a half marathon this year.

The importance of orthotics for Gina was learned the hard way, long after she had enjoyed being pain-free for almost 1 year. There was an irritation on one of her orthotics, and I decided to send it back to the laboratory for modification. Within 2 days, Gina suffered with severe, debilitating psoas spasm bilaterally. She was unable to work, let alone run. I requested that the lab send the new pair back to us overnight. After several days of sheer agony, Gina replaced the orthotics and was back to herself within 48 hours.

Today, Gina is preparing for her first Vermont City Marathon this Memorial Day. CP

Timothy J. Maggs, DC, specializes in sports and industrial medicine and is a graduate of the National College of Chiropractic. He writes and produces a talk radio show on sports medicine and speaks at numerous engagements. Maggs can be reached via email: runningdr@aol.com.