Posterior Annular Tear

Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Herniated disc 1. Spinal decompression how it helps – spinal decompression should be the very first thing you do to treat a herniated or bulging disc because it essentially creates space between your vertebrae, and thus takes pressure off the discs. How to do it – use a bar or the top of a door (or anything you can hang from) and allow your body to “just hang”. – hang for 30 seconds and do 3 sets. – release very slowly from this so as not to cause any spasms. ** this should not cause any pain. If you feel pain during it is not a good one for you. In that case, stop and try some of the other exercises below instead. 2. Standing extension how it helps – this standing extension helps reverse what you do on a daily basis (hunching)… since most bulging discs and herniated discs are caused by poor posture and repeated flexion of the spine (esp bending fwd in bad posture), this stretch helps push the disc back to neutral position. How to do it – begin this exercise by standing up with good posture. Now take both hands and place them on both sides of your lower back. Now with the help of your hands push your pelvis forward and extend your spine back. Follow the extension with your neck so that you end up facing the ceiling. – start with 10 repetitions and do 2-3 sets. – this one is particularly great to do when you need a break from sitting at your desk. ** this should not cause any pain. If you feel pain during it is not a good one for you. In that case, stop and try some of the other exercises below instead. 3. Half cobra pose (prone lumbar extension) how it helps – the half cobra stretch helps to push the disc material back towards the center of the inter-vertebral disc to allow for improved healing. The goal of repeated lower back extension is the “centralization of symptoms”, which basically means pain that travels down the affected leg to the foot should come back up closer to the low back – which will in turn alleviate the pain. 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. If there’s any pain, try a different exercise instead. 4. Full cobra pose (advanced extension) how it helps – this stretch is based on the same principle as the half cobra pose above. This advanced extension helps to push disc material back towards the center of the intervertebral disc, with the goal of alleviating pain symptoms. How to do it – once you’ve mastered the half cobra pose, you can increase the difficulty by moving to the advanced version of this stretch. Begin this exercise by lying on your stomach in the prone position (lying facing down) and slowly press up on your hands while keeping your pelvis in contact with the floor and lower back relaxed. – hold the prop-up position for 10 seconds. Aim for 10 repetitions of this stretch. – eventually try to hold this pose for longer if it feels good (20-30 seconds). ** if you feel pain during this exercise, it is not a good one for you. In that case, stop and try some of the other exercises instead. 5. Cat-cow how it helps – this is one of the most popular herniated disc exercises. By combining two yoga poses, the cat-cow stretch can help to relieve pressure on the herniated disc by opening the intervertebral disc space. It also improves mobility of the spine, which may help to relieve disc herniation pain and speed recovery. How to do it – begin this stretch on your hands and knees. Inhale and let your stomach “drop” towards the floor as you look up towards the ceiling. – follow this by exhaling and slowly rounding your spine while pressing into the floor with your hands and slightly curving your neck to look at your feet. – aim for 10 repetitions of this stretch and do 2-3 sets. How it helps – this exercise will help strengthen and stabilize your lower back and deep spine muscles. This will help you to maintain a good posture and avoid future episodes of herniated discs. How to do it: – begin on your hands and knees with your hands positioned under your shoulders and knees positioned under your hips. – raise your left arm and reach it forwards until it is aligned with your torso; at the same time, kick your right leg backwards until is it aligned with your torso. – hold this position for 2-3 seconds before slowly returning to the starting position. – repeat with your right arm and left leg. – alternate sides for 10 repetitions and do 2-3 sets. ** ensure that your head, neck, and back maintain a neutral alignment to minimize stress on your neck. 6.plank: how it helps – just like the bird dog, this “core” exercise will help bring your pelvis into right position by strengthening the deep spinal muscles and glutes (butt muscles). How to do it – begin lying on your stomach with your forearms against the mat. – engage your core and lift your body so that you are resting on your forearms and toes. – start with 10 second holds and work up to 30 second holds, do 2-3 sets. ** ensure to keep your back straight throughout the entire exercise – spine in neutral position. Thoracic expansion if you’re using a chair, sit facing forward and allow your upper body to fall over the back of the chair. Extend your arms above your head for a deeper stretch. Hold either position for 10 seconds and release. Repeat 3 times. 7.sitting spinal stretch sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure on the sciatic nerve. 1.sit on the ground with your legs extended straight out with your feet flexed upward. 2.bend your right knee and place your foot flat on the floor on the outside of your opposite knee. 3.place your left elbow on the outside of your right knee to help you gently turn your body toward the right. 4.hold for 30 seconds and repeat three times, then switch sides. 8. Standing hamstring stretch this stretch can help ease pain and tightness in the hamstring caused by sciatica. 1.place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it. 2.bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain. 3.release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. 4.hold for at least 30 seconds, and then repeat on the other sideif you have low back pain and sciatica you can undergo intermittent pelvic traction where in your half of your body weight will be added in the electronic traction so that that would help you to reduce the pain, along with interferential therapy stimulations which would help you to get relieved from the radiating pain. 9.anterior pelvic tilt 1.lie on the back with the knees bent and feet flat on the floor, hip-width apart. 2.squeeze the buttocks and tilt the pelvis upward. 3.the back should feel as though it is flattening to the ground. 4.return to normal pelvis position. 5.repeat 10–12 times. Apply ice for the pain to get subsided immediately. If you cannot go immediately for the physiotherapy treatment. Ice can be kept in the low back where you have back pain. It is suggestible to wear lumbo sacral belt which would help you to build the abdominal muscle tone which itself would make you feel better. You can also wear mcr chappals which would help you to have less weight falling in the painful back. U have to take vitamin d rich foods. Likemilk, cheese, yogurt, brocoli, spinach. U need calcium consumption for increase the bone density. Lackof bone and bones crush inside the body vitamin d intake via supplements or exposure to low levels of sunlight. Vitamin d is used to absorb calcium in the bone and regulate calcium in the blood.this might be due to low calcium or vitamin d which has more impact on the bone density and also it makes one to feel that there is lack of bone strength or in a way the bones are brittle and almost breaking and they feel it is crushed in a way there are many bones breaking at the same time. You have to take vitamin d rich foods. Likemilk, cheese, yogurt, brocoli, spinach. U need calcium consumption for increase the bone density. 

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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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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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Dr. Julie Mercy J DavidErasmus Mundus Master in Adapted Physical Activity, MPT, BPTh/BPTPhysiotherapist

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Neck pain cervical spondylosis– chronic condition with radiating pain this is cervical pain (neck pain) and that's the reason the pain radiates until the shoulder blades. If you keep ice that would help and along side you can do hot water fermentation. You shall use cervical collar which would help you to reduce the radiating pain ie. Due to the nerve compression. You have to go for traction and also you can do ift. Please consult the near bytherapist for quick relief. Use collar will definitely be helpful for him to maintain the good posture. And also cervical pillow can be used which might make you to have better posture of the shoulder neck and arm. Neck tilt: from the sitting position, tilt your head down so your chin touches your chest. Hold this position for 5 second s. Return to the starting position and repeat. Do this five times. Side-to-side neck tilt. From the same starting position, tilt you neck toward one shoulder, leading with your ear. Hold for 5 seconds and then return to the starting position. Do this five times on each side. Neck turn. Look straight ahead, then turn your head to one side, keeping your chin at the same level. Do this five times on each side. Neck stretch. Holding the rest of your body straight, push your chin forward, stretching your throat. Hold for 5 seconds. From the same starting position, push your chin backward and hold for 5 seconds. Do the forward and backward stretch five times each. If any of these exercises cause severe pain or weakness in your hands or arms, stop right away and talk with your doctor.We suggest you to wear cervical collar which will help you to improve the cervical angle and also it definitely helps you to improve the neck posture due to which your neck pain is triggered more. The importance of wearing cervical collar is to give good stability to the neck and also it definitely prevents you to have excess neck movements which makes the condition worse. If you wear cervical collar you cannot turn your neck as you like which itself will help you to have better functioning of the cervical spine. This cervical soft collar what we are suggesting for you is available at our clinic. If you want you can buy from us, if you are far away from chennai we can send you by courier. The reason why we are conveying you to buy from us is we can demonstrate over the videocall (using whatsapp) and also we can monitor you throughout when to wear it and how long to wear it. And also if you find any difficulty wearing the brace you can also revert back to us for few more suggestions and we can propose you good solution how to go about it. 

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Dr. Karuna ChawlaBHMSHomeopathy Doctor

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Below are exercises that strengthen the lower back and help manage lower back pain: 1. Bridges—lie on the ground and bend the knees, placing the feet flat on the floor hip-width apart. Press the feet into the floor, keeping the arms by the sides. Raise the buttocks off the ground until the body forms a straight line from the shoulders to the knees. Squeeze the buttocks with the shoulders remaining on the floor. Lower the buttocks to the ground and rest for a few seconds. Repeat 15 times and then rest for 1 minute. Do 3 sets of 15 repetitions. 2. Knee-to-chest stretches— lie on the back on the floor. Bend the knees, keeping both feet flat on the floor. Use both hands to pull one knee in toward the chest. Hold the knee against the chest for 5 seconds, keeping the abdominals tight and pressing the spine into the floor. Return to the starting position. Repeat with the opposite leg. Repeat with each leg 2–3 times twice a day. 3. Lower back rotational stretches—lie back on the floor with bent knees and feet flat on the ground. Keeping the shoulders firmly on the floor, gently roll both bent knees over to one side. Hold the position for 5–10 seconds. Return to the starting position. Gently roll the bent knees over to the opposite side, hold, and then return to the starting position. Repeat 2–3 times on each side twice a day. 4. Draw-in maneuvers— lie back on the floor with knees bent and feet flat, keeping the arms by the sides. Breathe in deeply. While breathing out, pull the bellybutton toward the spine, tightening the abdominal muscles and keeping the hips still. Hold the position for 5 seconds. Repeat 5 times. 5. Pelvic tilts— lie back on the floor with knees bent and feet flat, keeping the arms by the sides. Gently arch the lower back and push the stomach out. Hold for 5 seconds, then relax. Flatten the back and pull the bellybutton in toward the floor. Hold for 5 seconds, then relax. Increase the number of repetitions daily, building up to 30. 6. Lying lateral leg lifts— lie on one side with the legs together. Keep the lower leg slightly bent. Draw the bellybutton into the spine to engage the core muscles. Raise the top leg about 18 inches, keeping it straight and extended. Hold the position for 2 seconds. Repeat 10 times. Turn onto the other side of the body and repeat, lifting the other leg. Perform 3 sets on each side. 7. Cat stretches— get onto the hands and knees with the knees hip-width apart. Arch the back, pulling the bellybutton up toward the spine. Slowly relax the muscles and allow the abdomen to sag toward the floor. Return to the starting position. Repeat 3–5 times twice a day. 8. Supermans— lie face down on the ground and stretch both arms out in front of the body, keeping the legs stretched out and flat on the ground. Raise both the hands and feet, aiming to create a gap of about 6 inches between them and the floor. Try to pull in the bellybutton, lifting it off the floor to engage the core muscles. Keep the head straight and look at the floor to avoid neck injury. Stretch the hands and feet outward as far as possible. Hold the position for 2 seconds. Return to the starting position. Repeat 10 times. 

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Dr. PoornanandOrthopedic Doctor

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Hi spine problems are sometimes frustrating. They don’t get better soon, as never doesn’t listen to you. They need time and patience. Sometimes it never get better. You need to keep your options open. Regarding your scan, you do have problem, doesn’t sound severe compression. Other compression of nerves will happen as coincidence. Like cubital tunnel syndrome if little and ring finger involved, if index and middle finger involved means carpal tunnel syndrome. Once someone correct these, things will improve. Wish you all the best. Get it checked by orthopaedic surgeon. Update me. 

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Dr. Rahul RaiMSPT (Master of Physical Therapy), Bachelor of physiotherapyPhysiotherapist

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Mckenzie exercises done only in supervison of physiotherpist. Take proper rest. Use lumbar belt. Apply hot pack. Can counslt privately. 

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Dr. Wajid MohammedD.P.T, BPTh/BPT, MD Acupuncture, Advanced Cardiac Life Support ( ACLS )Physiotherapist

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Visit nearest physiotherapy clinic and take electro therapy for 10-15 days. After a week of electro therapy ask for exercises to be done. With stretching and strengthening. It will be reduced. Rest for a week is compulsory if you wish to recover fast. 

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Dr. Jaskirat KaurMD- Ayurvedic PathologyAyurvedic Doctor

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If you are able to do physical activity without much pain and heaviness than you can visit a nearby panchkarma expert. He will guide u. Or you can share reports with us. 

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Dr. ArungeethayanFellowship of the Royal College of Surgeons (FRCS), Membership of the Royal College of Surgeons (MRCS)Orthopedic Doctor

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Surgery is reserved for pain that does not get controlled with conservative measures and provided the disc prolapse is causing nerve root compression. Your mri does not sound that drastic. Consult a spine surgeon who may offer you epidural steroid injection and that will also help him decide if surgery can be useful for you. 

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Deblina ChowdhuryGeneral Physician

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Because the annulus has such a limited blood supply, annular tears can take quite a long time to heal on its own — 18 months to two years. The majority of doctors will start with a conservative approach to treatment, prescribing anti-inflammatory medication to relieve the pressure and possibly steroid injections to alleviate the pain. Regular physiotherapy treatments, spinal traction therapy, and physical therapy can also bring relief to individuals suffering from annular tears.  if these conservative treatments are not effective, then surgical treatment may be necessary. Annular tears can be sealed off with a laser procedure to prevent any further injury. Or, a minimally invasive procedure called an endoscopic discectomy can be effective if there’s a painful loose disc fragment in an annular tear. In more severe cases, disc replacement or spinal fusion surgery can replace a damaged disc. There are also some highly advanced treatment options that are in development. For example, using a patient’s stem cells to regenerate their annular fibres. However, these treatments are only used on a case by case basis. If you are experiencing back pain that isn’t getting better with rest and a decrease in activity, then you should see your orthopaedician. Severe annular tears, when left untreated, can lead to more painful conditions, such as a herniated disc. A good treatment plan can relieve your discomfort, return you to your preferred level of activity, and keep your back healthy and pain-free. 

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