January 2006 - Posts

What is "Nerve Root Adhesion"?

There is the formation of fibrosed tissue (scar tissue) in the process of a derangement (bulging disc, herniation...) being reduced and healed in our spine.  If there is nerve root involvement in the episode--i.e. radiating or referred symptoms occur, the scar tissue would likely to also involve the nerve, causing nerve root adhesion.  A typical symptom behavior of a nerve root adhesion is that one would consistently experience radiating symptoms (anywhere down from the spine) whenever he reaches the limited end range of a certain movement--i.e. when the scar that is adhered to the nerve is stretched.  Such symptoms is very consistent with repetitive movements reaching certain end range, and it immediately subsides as you return from end range. None of the radiating symptoms would become sustained, unless the range of motion is severely limited. 

The way to eliminate this phenomenon is by stretching the scar tissue, and thus to elongate the fibrosis.  Therefore one would need to stretch progressively and carefully beyond the limited end range once the derangement is completely healed.  The reason why it is important to stretch in this way is that the scar tissue limiting range of motion of that spinal segment causes the neighboring spinal segments to compromise for the restriction.  Therefore those levels become more susceptible to injury or derangement.

Stretching the nerve root adhesion should be done when the derangement is completely healed and with proper precautions.  If it is performed appropriately, re-injury can be prevented and functional abilities can be greatly increased.

posted Monday, January 09, 2006 8:02 PM by admin with 542 Comments

"Should I do hamstrings and piriformis stretches?"

Someone recently raised a question regarding numbness and weakness resulting from a low back pain episode.  He recently had a low back injury from squatting and reaching down to pick up an object.  After performing extension exercises according to the McKenzie principles his back pain has completely resolved within 8 to 9 days, but the numbness and weakness have persisted.  Then he was told to perform hamstring and piriformis stretches...  "Should I do them?" he asked.

It is true that numbness may take sometime to resolve, or it may never resolve if scar tissue is adhered to the nerve (unless you stretch it right). Unlike numbness, weakness however can be an indication that the motor nerve is still being interfered, unless it is from disuse atrophy. His injury occurred when he was squatting down and bending forward, and thus extensions (bending back) may likely be the most effective in resolving the rest of the problems. But if he performs hamstrings and piriformis stretches at this time--note that they are both bending forward movements--his problem may be worsened, or a potential relapse would be underway. This is, sadly, a very common phenomenon: clinicians prescibing exercises indiscriminately and patient's progress becomes very inconsistent.  In order to allow soft tissues to heal and to elimiate relapse, all forward movements should be avoided--e.g. bending over, slouching, etc.  It is crucial to know the directional preference of a mechanical derangement according to the symptom behaviors, and thereby perform the specific targeting reductive exercise.  In this case, it is adviceable for the patient to perform extensions in standing hourly, and also try to perform press up with exhalation in the back extended position (when you come up on your hands) for more reductive pressure. Once he has no more weakness, gained full range in the back, no pain or stiffness for 2 weeks, he can begin stretches that require forward bending in mid-day before and after repeated entensions are performed.

When you do the right thing and proceed carefully, it only takes a couple of weeks to get rid of this kind of problems for good!

 

posted Monday, January 02, 2006 11:58 PM by admin with 176 Comments