Question

Clinical information: low back pain. Technique: sagittal t1, t2 and stir images. T2 axial and stir coronal images. Findings: spastic straightening of the lumbar spine with spondylo-degenerative changes. L4-5 disc show degenerative changes is a posterior central annular tear, broad-based disc bulge with a central focal component indenting the thecal sac mildly encroaching upon both lateral recesses with no significant foramina compromise, there is also bilateral mild facet joint arthropathy. L3-4 disc show mild early broad-based disc bulge effacing the thecal sac without thecal sac compression, nor foramina compromise. Rest of scanned discs are unremarkable. Unremarkable alignment. Normal Mr. appearance of the spinal cord and bone marrow signal intensity. No other significant abnormality seen. Impression: l4-5 degenerative disc protrusion as well as bilateral facet joint arthropathy.
Please suggest treatment.

Dr.Julie Mercy J David · Accepted Answer

1.lie on your back with your legs extended and your feet flexed upward.
2.bend your right leg and clasp your hands around the knee.
3.gently pull your right leg ac
4.ross your body toward your left shoulder. Hold it there for 30 seconds. Remember to pull your knee only as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain.
5.push your knee so your leg returns to its starting position.
6.repeat for a total of 3 reps, and then switch legs.
1. Reclining pigeon pose pigeon pose is a common yoga pose. It works to open the hips. There are multiple versions of this stretch. The first is a starting version known as the reclining pigeon pose. If you are just starting your treatment, you should try the reclining pose first.
1.while on your back, bring your right leg up to a right angle. Clasp both hands behind the thigh, locking your fingers.
2.lift your left leg and place your right on top of the left knee.
3.hold the position for a moment. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve, causing pain.
4.do the same exercise with the other leg.
Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions of pigeon pose.
2. Sitting pigeon pose
1.sit on the floor with your legs stretched out straight in front of you.
2.bend your right leg, putting your right ankle on top of the left knee.
3.lean forward and allow your upper body to reach toward your thigh.
4.hold for 15 to 30 seconds. This stretches the glutes and lower back.
5.repeat on the other side.
3. Forward pigeon pose
1.kneel on the floor on all fours.
2.pick up your right leg and move it forward on the ground in front of your body. Your lower leg should be on the ground, horizontal to the body. Your right foot should be in front of your right knee while your right knee stays to the right.
3.stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back.
4.shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs.
5.take a deep breath. While exhaling, lean your upper body forward over your front leg. Support your weight with your arms as much as possible.
6.repeat on the other side.
7. Knee to opposite shoulder.
Back pain due to muscular pain
it looks like a muscle pain kindly do some exercises that may help you to get rid of your pain and regular stretch may help you to relax the muscles of your back and lower limbs the exercises I personally recommend are listed below in the order I use with my patients.
Exercise #1 in the early stages of a disc bulge, your body’s natural response is to tighten up and protect the spine and buttocks area. Because of this, one of the the simplest things you can do yourself to relieve radiating back pain caused my a disc bulge is stretching piriformis muscle.
How to perform it:
● begin lying on your back with your knees bent and feet positioned flat on the floor
● place your right ankle over your left knee
● use your hands or a band to pull the left thigh towards your chest, and hold for 20 to 30 seconds
● repeat on the other leg
● aim for 3 repetitions on each side
exercise #2: prone alternating leg raisesthe prone leg lift creates spinal extension helping push the jelly-like material back towards the center and reduce bulging disc.
How to do it:
● lay face down with your palms on the floor under your forehead.
● straighten one leg then lift it a few inches off the ground with your toe pointed.
● lower your leg to the floor with your knee remaining straight.
● switch legs
● repeat 3 x 15 reps each side
● 3 x a day
exercise #3: half cobra pose
the half cobra pose creates spinal extension helping push the nucleus (jelly) back towards the center and reduce bulging disc.
How to do it:
● begin this exercise by lying on your stomach (prone position) and slowly prop yourself up on your elbows while keeping your hips in contact with the floor.
● hold the prop-up position for 10-15 seconds before returning to the prone position (lying face down).
● gradually increase to holding the end position for 30 seconds. Aim for 10 repetitions of this stretch.
** initially, you may not be able to tolerate this position very well, so make sure you start slowly and carefully.
Recommended: half cobra pose exercise video demo
exercise #4: full cobra pose
the full cobra pose creates even more spinal extension than half cobra helping push the nucleus (jelly) back towards the center and reduce bulging disc.
How to do it:
● begin lying on the ground with your hands flat on the floor at the level of your shoulders
● slowly push your hands to raise your shoulder off of the ground until you feel a slight stretch
● increase your range of motion by exhaling as you push further into lumbar extension
● aim for 5 repetitions
exercise #5: abdominal drawing maneuver
a solid core foundation helps provide stability which in turn prevents re-injury and further injury from occurring. This will help reset the spine into neutral position.
How to do it:
● lie on your back
● bend your knees
● contract your stomach muscle (abdominals)
● hold for 5 seconds
● release
● perform 3 x 20 sets daily.

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