6 Step Treatment For L4 L5 Disc Bulge L4 L5 Bulging Disc Treatment by Dr. Walter Salubro Chiropractor in Vaughan
Chiropractor in Vaughan Explains 6 Step Treatment Protocol for 6 Step Treatment For L4 L5 Disc Bulge L4 L5 Bulging Disc Treatment
Vaughan, ON – In this video, I’m going to show you my six step protocol that I have used to help many people in my office that had been diagnosed with L4 L5 disc bulge and L5 S1 disc bulge. Stay tuned to the end to get through all these six steps.
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Hi, my name is Dr Walter Salubro. I’m a chiropractor and Vaughan, Ontario, Canada, and welcome to this video. And in this video I’m going to walk you through my six step protocol that I’ve been able to use to help many people get through their discomfort and relieve their chronic pain and get their life back, essentially, that have suffered with disc bulges in their low back. Now, the first thing I want you to really get is not to give up. I’ve received the many, like hundreds of comments and questions in my videos below, in my other disc bulge videos, which you can check up here and people are looking for solutions and they’re looking for hope. And my whole objective with this video is to lead you in the right direction, to be able to ask the right questions with your therapist or doctor, to make sure that you’re getting the right protocol in place for, not only just the diagnosis of the disc bulge, which most people get, but also some protocols to help you begin the corrective process and the healing process to get the chronic pain subsided, and get your life back to full function.
And for many people, one of their big objectives is to eliminate the need for using drugs or depending on drugs and for many, many people it’s to eliminate the need for surgery. Now the next thing I want you to get before I go over the six steps is that there’s not one specific way to successfully help someone with this bulges or treat someone with disc bulges. There’s a multitude of different ways. There’s different protocols, there’s different things that can be done, but the key thing is that something must be done in and it must be done correctly.
So this protocol is just the one that I’ve been able to successfully use with a lot of people that have had disc bulge complaints and symptoms associated with disc bulges, but there may be other successful ways out there. So it’s your objective to really seek the exact precise therapy that you need based on your circumstances, based on your case results, based on your clinical presentation, because not one specific way is unique to everybody.
That’s a very key distinction that I want you to get. Now, the last key thing I want to say that’s a very important, before I get into the six step protocol here that I have for you, is that when you’re working with the spine, especially the lumbar spine, the lower lumbar spine, but the same is true for the rest of the spine, but we’re going to focus on here because that’s where most of these disc bulges occur, L4 L5, L5 S1, the lower area of the spine. Well, the spine is very intricate. There are vertebrae, there are nerves that come out from the side of the spine. There’s a nerve on the inside of the lower lumbar spine here in the spinal canal called the cauda equina and the spinal cord ends here. There are ligamentous structures, there are muscles, there are tendons, there is a ton of structure that’s feeding a ton of information to the brain.
Essentially, what that means is that this is a very complex structural entity that goes, that we have, that we’re dealing, so correcting the problems associated with disc bulges and getting the healing process to to kick start is a very intricate, multifaceted approach. It requires a multifaceted approach because the spine itself is very, very intricate, so it’s not one specific thing that you got to do. There’s, there’s a multitude of different things that have to be done and in some cases they need to be done in a certain order. So that’s what I want to say before I get into the six steps. Now let’s get into this six step protocol with number one. Okay, so in my six step protocol that I’ve used with many of our patients, there are certain things that need to be done in a certain order, but sometimes I’ll jump around from one order to another.
The whole point is that this whole, all six steps are required at some point in person’s care plan. Some will typically come in with a lot of pain, a lot of discomfort in their lower back, maybe in their glute or hip area, and maybe pain traveling down the bottom of the leg. Each different clinical presentation requires a different approach, analysis and approach. So, it may be in a particular order and may not, but all of these six protocols, it’s something that we do to help our patients in an overall objective. The other thing too is that healing takes time. You can’t expect to have massive degenerative changes in your lower lumbar spine and disc bulges and disc damage and expect the actual healing process to occur over a matter of weeks, maybe months. It may take longer than that, but when the right things are done in the long run
people tend to get better when they’re done correctly. So step number one, as a chiropractor, one of the first things that I do is assess the spine, whether it’s a neural spinal assessments in the office or x-ray analysis, and we determine where the spinal misalignments, are also called vertebral subluxations. And step number one for me and my office is to begin to correct the structural distortions in the spine, aka for vertebral subluxations. Oftentimes when people have chronic degenerative discs or symptoms associated with chronic disc bulges it’s because of a structural misalignment or distortion on the spine that needs to be corrected with specific scientific chiropractic adjustments to the spine, especially the sacral part of the spine, the Sacrum, the pelvic region, and the lower lumbar vertebrae, so spinal adjustments and spinal correction is very, very key. It’s often missed with many people, especially if they haven’t had chiropractic care.
This component is often missed. I can’t tell you how many times someone’s come to my office and they’ve been to other types of offices, whether it’s physiotherapy, massage, acupuncture, sometimes some other types of rehab offices and they’ve been under care for such a long time and I’ve asked them if they ever had their spine corrected or adjusted and the answer is “no”. In many cases, and in some cases just maybe “once or twice or once in a while”. That’s not good enough. The spine needs to be assessed and corrected structurally with spinal chiropractic adjustments to improve the structural alignment of the spine and reduce the distortion on the disc. Because oftentimes that distortion is causing an inflammatory process in the disc that’s creating a whole bunch of noxious chemicals elicits that pain response in the body whether it’s a local pain or a referral pain response. So no amount of pain relief type therapy,
No amount of drugs, hot packs, cold packs massage will correct the spinal distortion that’s insulting that disc and causing that chronic damage and chronic inflammation. So, step number one is checking the spine for misalignments or subluxations and beginning the corrective process. Okay, this is step number two, stretching and mobility exercises and possibly not in that order. So at this point, once we begin the structural correction of the spine and begin to restore some spinal function and the actual pain in the local area in the back and even the legs begin to reduce, I began to introduce some home exercises which are typically stretching, so and also mobility. And again, not that order. It can be mobility first or stretching or stretching first then mobility. It’s based on the person’s clinical presentation. Stretching, we want that patient to stretch their glute muscles and the lower back muscles.
Knee-to-chest stretches we call them. Maybe even their piriformis muscle, their hamstring and quad muscle because they attach to the pelvis and it can create distortions on the spine or vice versa at the distortions on the spine can create tightness in the in the hamstrings and quad muscles. So we need to evaluate that. So, the piriformis stretch is very, very important because that stretch, that muscle in particular actually, when it’s really tight due to distortions on the sacrum can actually irritate the sciatica nerve, which is a nerve that is fed from the lower lumbar nerves that goes into the leg. So, that can oftentimes be associated with a disc bulge irritation. So, those are the stretches that I will give my patients. With mobility exercises, it’s very, very important. You want to begin to get a mobility in the lower lumbar spine where the disc are. Now, this is the one key thing I want you to understand about discs, is by the time you’re an adult, there’s no more blood supply to the disc.
So how does it get its nutrients? How does it get its, its hydration? The only way that this stays healthy by getting nutrients and hydration is with mobility. Mobility. Reduced mobility leads to degeneration in your disc and, and dries out and eventually gets damaged in the long run. Mobility adds health to the disc. There’s a process called imbibition, which means a drawing in of nutrients and fluid into the disc, which only occurs in the disc by mobility. Mobility is health to the disc. So, we give patients pelvic tilting type exercises at home and in our office we have something called wobble chair, which is a very specific device that people sit on and do this elaborate motion on their, on their lower lumbar spine to help hydrate that disc. So, stretching exercises and mobility exercises I began to introduce as we’re adjusting and correcting the spine,
again, this is still in process, and after the inflammatory stage is being reduced, which means now the patient can tolerate more of this active work at home, and also possibly in our office as well because now there’s reduced inflammation and of course reduce pain, that’s beginning to happen. Okay, step number three in the protocol. Posture. Posture needs to be assessed. That’s very, very important. As a corrective care chiropractor, we don’t just look at the spinal alignment and correct the individual spinal alignment problems or global spinal alignment problems. We’re also working on posture. So we evaluate posture through observation, through an app that we have called PostureScreen Mobile on our iPad, and we get a baseline of the posture. Based on that, we do some corrective postural corrective techniques, which is part of global adjustments of the body and the posture, and then we give people some postural exercises.
Now you need to understand that posture exercises cannot be done during the acute phase or when a person has a lot of pain in their lower lumbar spine. So, this is typically introduced after, of course, the stretching and mobility exercises and after the patient has, is able to tolerate more active things at home because now the pain is beginning to reduce in the lumbar spine. Okay. And again, all this is happening as we’re continuing to adjust and correct the spine. So, posture exercises. What I mean by that. You need to really understand that the whole person needs to be evaluated, not just the local disc problem in lower lumbar spine. And that’s the biggest concern I have with with therapies that just focus on relieving pain locally. If you don’t look at the big picture, you can’t help that person significantly. So, what I do in my office, because I’m a corrective care style chiropractor, is we’ll look at someone’s posture. And you can’t see this fully here but just imagine that if my hips are forward, my torso / rib cage is back, and my head is forward
there is a the tremendous amount of of impact and loading that’s occurring in my lower lumbar spine right now and I have a good spine. I have no disc bulges and I can feel the stress already down here because it’s being compacted in and extended and it stuck like that and the forces of gravity are acting on it, that if you don’t begin to restore this posture, then whatever it is that you’re doing with the disc bulge it not going to help. So, that needs to be introduced. So, we’ll assess someones posture and then we’ll begin postural corrective adjustments in the office and then we’ll also send home, send people home with postural exercises to help restore that normal, neutral alignment of the spine as best as we can. Alright, here we go. Coming right along here, step number four, traction. Now there are different types of traction.
There’s decompression traction, which is axial traction of the spine. Basically, distracting the spine from head to, head to foot, essentially in that direction. And then there’s also sagittal style traction which is realigning spinal curves into their normal, natural alignment. So, both may be warranted, both have their uses. I don’t do too much decompression style traction in my office. So if that’s required we’ll send that out to another chiropractor or a doctor that does that type of therapy. And people are telling me, have told me that, that it does have its merits and it does work and I’ve heard from other practitioners and doctor friends of mine that do it and there is some merit to that. The type of traction that we work on is called saggital traction, which essentially it’s improving the actual alignment of the spine. So, the spine has these normal curvy alignments from the side and based on the xray analysis
if we find that the lower lumbar spine lost its curve and essentially it should be, it should be elliptical shape. Maybe it’s lost it’s elliptical shape, or it’s reversed or its reversed or there’s a distortion on its alignment in the lower area where the sacrum is, then we begin to give traction devices that people can do at home to improve that curve and also traction in our office as well to help improve that curve in the lower lumbar spine. And in doing so, it helps to remove the added pressure on the spine from that abnormal spinal alignment. So that’s traction. Now again, this is more advanced structural rehab work that cannot be done at the very beginning when someone has massive amount of pain locally in the back or referral down the leg. So it needs to be done as that pain is beginning to subside and they can begin to tolerate this.
All the while, we’re still doing spinal corrections and the patient is still working on the stretching and mobility. And then we’re also working on the posture exercises and postural ,adjusting techniques as well. So that’s traction. So the next step in the six step protocol, number five, is introducing exercises to help with balance and proprioception training. So, what the heck does that mean? First of all, you to understand that when there’s damage to the structures of a joint. It can be an extremity joint like a shoulder, elbow, or ankle, or even the joints of the spine. Those structures begin to lose their sense of position. That’s called proprioception. Proprioception is your brain’s ability to know where your body is in space. So technically I can have you close your eyes, put your hand in front of your front of your body and above and then with your eyes closed, ask you where your hand is located?
And because of all the sensors in your, the joint position, sensors in your hand and wrist, elbow, shoulders, your brain knows to answer you, to say that your hand, your right hand is above you to the front and to the right. That’s called proprioception. So, when there’s damage to a joint proprioception gets disrupted. When it gets disrupted, there’s bad information from the joint position sense from the joints in the body to the brain and bad information from the brain back to the body. Give you an example. If you ever known someone who sprained their ankle or if you sprained your ankle, even if it was five or ten years ago, if I asked you to stand on that ankle that’s been sprained in the past and that has not been properly rehabilitated, especially with balance and proprioception training, then you’ll find that you’re going to wobble on that ankle compared to the good one.
That’s a lack of purpose proprioception training in that joint. So, the same thing occurs in a lumbar spine. When there’s a disruption in lumbar spine, a distortion biomechanically, that’s insulting the joints and disc, it needs to be, the proprioception needs to be retrained. So, the joints in the body are sending good information with that training to the brain and the brain sending good information back to the joints and the functionality of the joints in the spine tends to improve. So that’s very, very important. So some of the, some of the techniques that we use for balance training is walking on a straight line. So, you can’t see it here. But imagine someone is with no shoes and they’re walking on a straight line like this, so they’re walking heel to toe on a straight line. We get them to go forward. Then we got them to go backward, touching heel to toe. It looks like it’s easy, but it’s challenging for people who have had damage to their joints, whether it’s in their spine or in their extremities.
Then we get people to do single leg stance. Again, you’re not going to see it here. But, single leg stance. One knee is up to my hip level standing over here like this, and then other things will do is I get them to balance on a wobble board to retrain the positions of their sense, the joint position sensors and their spine in their joints and get good information to the brain and good information back into those structures. So that’s balance and proprioception training. You need to also get that this cannot be that the very beginning when someone has a massive amount of pain because of the chronic inflammatory response has been going on in their spine. So this can only be introduced later on again, after we’ve done introduced the spinal corrective adjustments, after we have introduced the stretching and mobility. All of this is still going on. After we’ve introduced the postural corrective adjustments and exercises and then you know the traction.
So they’re still doing all this and now getting proprioception and balance training. Okay, next step number six. Last but not least is core stability exercises. And you’re probably asking,”when is Dr Walter going to introduce core training”. Well, we we start now. So also get that when someone has a massive amount of pain due to that chronic inflammation in the back, which was referring pain down the leg, if it’s there, you can’t start introducing advanced core strength and exercise that point. The patient will not do them, the compliance will be low, they’re just not ready for it. So this has got to be introduced when we began to get some structural stability on the spine, we’re getting some stretching and mobility going on, posture is beginning to improve. Right? Traction and sagittal alignment of the spine is beginning to improve, balance and proprioception has been introduced for training.
Now we talk about core stability. Why? Because we need something to package everything all together and basically retrain the spine and the back to hold all that good information there. And that’s with training the stability and training the core muscles, which are the abdominal muscles, which are the paraspinal muscles in the back, the gluteal muscles and those core stability muscles. So the glutes, these are all very important things to train. So some, I’m not going to get into all of them right now. Maybe I’ll do another video, but we started to introduce extension exercises, right? We introduce superman exercises, you know, they’re prone and do superman exercises. We introduce some planks, whether it’s on the hands and knees and you’re doing a plank or a prone plank, some side planks. if the person can do some advanced side planks and even some bridges.
So we start to introduce these core stability exercises to basically package and hold everything together and stabilize the corrections that we’ve done through this whole time. Okay, there you have it. This is the six step protocol that I’ve used with many of my patients in my office that have come in with disc bulge complaints on their lumbar spine and symptoms associated with that, whether it’s local, back pain or leg pain, and essentially they had their life disrupted, t,heir quality of life disrupted their functionality, their work, their home life, their leisure life, has all been disrupted because of the damage and pain associated with chronic disc bulges, whether it’s L4 L5 or L5 S1. So the key thing is, like I said at the beginning of the video and you should go watch it again, and you show go back and watch it again, is that it’s a multifaceted approach to correction and healing.
It’s not just one thing, so it’s multifaceted. So, like I said, there are many ways to approach the correction associated with disc bulges and the healing process associated with disc bulges. This is the way that I’ve done it with our patients. They’ve done really well with it. If you have any questions, leave them in the comments below. If you found this useful throw some thumbs up down there. And also if you think this is something important for someone else to hear, just share with them as well. Okay. This is Dr. Walter Salubro coming to you from Vaughan, Ontario. And if you have any questions, again ask me below. I answer all questions whenever I can get to them and I appreciate you following me and watching our YouTube channel here. If you liked this, click on the subscribe button below and also hit that notification bell so you get more videos coming your way. Dr Walter here. Talk to you soon.
Learn more about how corrective chiropractic care at Back To Health Care Chiropractic Center can help you with your chronic pain problem, visit www.iBTHCC.com. Back To Health Chiropractic Centre is located at 20 Cranston Park Av, #6, Vaughan, L6A 2W2.