Lumbar spine disorders are a common accompaniment to aging. I have recently had a couple of different lumbar problems and seem to have been able to improve them without medical intervention. This is a story of my research and interventions.
As shown above, as an intervertebral disc deteriorates, it impinges upon the associated nerve root. The result is pain, numbness, and/or weakness in the area served by that nerve. In the case of the lumbar spine that is the leg. The resulting symptoms are commonly referred to as "sciatica", although other nerves, such as the femoral, may be involved. The medical term for this type of problem is radiculopathy.
Here is what is known as a dermatome map, showing where the different nerves map on the skin:
Click to embiggen. The label assigned to the nerve refers to the vertebra below the nerve. So the nerve L2 issues from the junction between vertebrae L1 and L2.
Here are excerpts from a review article covering the treatment possibilities for intervertebral disc degeneration:
Current Treatment Options for Intervertebral Disc Pathologies
Most patients’ conditions are managed conservatively but a small proportion progress to having surgery... if the pain is not intrusive, analgesia will likely improve capability and quality of life until the pain passes. If pain persists, then exercise, heat, cold, corsetry, acupuncture, radio frequency/shock waves, and varying intensities of massage may make the pain better for a while in some individuals, but, as ever, could make it worse in others. Beyond that we are looking at degrees of invasion such as local infiltration of trigger points with local anesthetic and steroid, or beyond that again to surgery, if distress, weakness, disability, and the passage of time justify it... This may be decompression (to remove tissue such as the disc, bone, or hypertrophic ligaments impinging on nerves) or fusion of the normally mobile intervertebral joint to immobilize it and so reduce pain.
Anti-inflammatory medication can also be helpful. Exercises should be done carefully to avoid aggravating symptoms. Here is a good list of exercises, with illustrations.
Fish Oil
I was surprised to discover that fish oil may also be of benefit. According to this animal study, Omega-3 Fatty Acid Supplementation Reduces Intervertebral Disc Degeneration, fish oil improves the health of injured intervertebral discs. In the test arm they fed rats the human equivalent of 4 grams per day of fish oil, daily. The result:
This study is the first to demonstrate that a n-3 FA [fatty acid] diet of EPA and DHA[the key fish oils] attenuates IVD degeneration in a rat lumbar disc degeneration model. Daily oral supplementation of pharmaceutical grade n-3 FA for 2 months decreased injury-induced dehydration of intervertebral discs and reduced histological signs of IVD degeneration.
This was just an animal study, but this is the only nutritional intervention I am aware of that benefits intervertebral discs. Per my previous diary salmon is the best source of fish oil.
I did several interventions - anti-inflammatories, stretches as part of my yoga routine, and plenty of salmon. My sciatica is currently in remission. Hopefully that will continue.
Disc degeneration is not the only potential source of back problems. The vertebrae are linked together by…
Facet joints
en.wikipedia.org/...
The biomechanical function of each pair of facet joints is to guide and limit movement of the spinal motion segment...
The facet joints, both superior and inferior, are aligned in a way to allow flexion and extension, and to limit rotation. This is especially true in the lumbar spine.
I found an exact description of my facet joint symptoms here:
Why Do You Have Lower Back Pain when Standing up from a Sitting Position?
When you’re seated, the facet joints in your lower back are in an open and slightly flexed position. When you stand up, these joints compress. If they are painful or have arthritis, you’ll have pain as you stand up because this puts pressure on the painful joints. In addition, if there is any type of movement of one vertebra forward on another (called spondylolisthesis), then this shift will have occurred as you sit. This is called degenerative spondylolisthesis (2). When you get back up, the vertebrae will come back into position after a few seconds, leading to that awkward “walk it out period” that starts out painful and ends up more normal.
A typical list of facet joint symptoms can be found here. Excerpts from that list:
- Referred pain. The pain may be referred to the buttocks, hips, thighs, or knees, rarely extending below the knee.1,2 Pain may also be referred to the abdomen and/or pelvis.3 This type of pain is usually caused by facet arthritis and is experienced as a distinct discomfort, typically characterized by a dull ache.
- Effect of posture and activity. The pain is usually worse in the morning, after long periods of inactivity, after heavy exercise, and/or while rotating or bending the spine backward. Prolonged sitting, such as driving a car, may also worsen the pain. The pain may be relieved while bending forward.1,2
- Stiffness. If the lumbar facet pain is due to arthritic conditions, stiffness may be present in the joint, typically felt more in the mornings or after a period of long rest, and is usually relieved after resuming physical activity.
For a map of referred pain due to facet joint dysfunction, see the image here.
A comprehensive list of facet joint disorder treatments can be found here. Among the nonsurgical options are heat, cold, anti-inflammatories, avoiding extended sitting, exercise, and physical therapy. It is difficult for me to avoid extended sitting because I spend a lot of time on the computer, and standing is not always easy for me. Nonetheless, I am getting up and moving around more frequently, which helps. I continue to do my yoga stretches, both forward and backward bending poses. I believe this helps and in any event is not hurting. I am also being more attentive to my sitting posture – spending more time sitting erect with my lower back curving forwards instead of lazily backwards.
Another thing that I am doing that seems to be making a big difference is nutritional. I cooked a turkey, saved the meat for later, took all the bones and joints and boiled them down to a quart of thick gelatin. I used to do this with beef knuckles but red meat contains an inflammatory factor. I consumed this over the period of about a week. Next I took the dark meat and the gravy and simmered that for a few hours. I am in the process of consuming that. I am quite a bit better and I believe this has played a big part in my improvement.
Regenerative medicine – Platelet rich plasma and stem cells
Last but not least, there are some providers offering platelet rich plasma and stem cell treatments for these disorders. The current consensus seems to be that these treatments might help but that more study needs be done for them to be proven. For those interested, a comprehensive review of the use of stem cells in spinal disorders can be found here. A comprehensive review of platelet rich plasma can be found here and a case study of platelet rich plasma injected into facet joints of 5 patients can be found here.
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