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Tim--I'd be glad to add to the confusion! Kenny's statistics are interesting, and help me avoid less-specific statements. And that is the problem. If we could say that bulges are all pathologic and that every bulge should be fixed, and that fixing them would always solve the problems, the world would be a better place, at least for back-pain sufferers and spinal surgeons. But many people who have no real problems have bulges. Bulges in and of themselves are not pathological, and usually should be ignored.
So let's say that you have a bulge in 1 or 2 discs, and that they have been there for many years, you just don't know it. You develop back pain for who knows what reason. Ligaments strained, muscles pulled, arthritis in a facet joint, etc., due to bad posture, overweight, lack of exercise, strain, sprain, or whatever. You go to the doc, who sends you off for an MRI (because if he or she missed something important, they could be sued, and so they don't want to trust the fact that nothing in your physical exam suggests that you have anything worse than a strain). The MRI shows the bulging discs, so your doc refers you to the local spinal surgeon, who has just grown tired of his Porsche, and is thinking Maserati (no they aren't all greedy villains, but hey, let's pick on them for now), who offers to operate and relieve you of the bulges, and your insurance company of a few grand. What do you do? Most people don't see an alternative. Surgery goes well, and you fee better for a few months, but as you get back to work at your desk job, away from PT, etc. the pain recurs.
Here's how I would proceed if it were me. First, determine if there are significant neurological symptoms or findings. If there is a focal weakness (specific muscle groups are significantly weaker than the others, and this is almost always asymmetrical, since it's hard for a bulge to affect nerve roots on both sides equally) or a sensory loss (significant change in sensation) in specific skin areas, or decreases in tendon reflexes, then I'd want the MRI. If not, I'd change my exercise patterns to try to reduce the pain. That interview with Brian Nelson is applicable here. He uses strength training for almost any kind of back pain (except cancer, of course, or cases with compelling clear indications for surgery). I think he uses hyperextensions as his primary modality.
If there were significant neurological symptoms or findings, AND the MRI showed that the bulge was in contact with the particular nerve roots that provide the function that is abnormal, if pain was severe, and if exercise was not helping, THEN I'd consider surgery. If you have a symptom that is attributable to the L5 nerve root, but your bulge is on L3, surgery can only make you worse. Most reputable spinal surgeons will only operate under the conditions I have outlined. I'd also seek 2 or 3 opinions before proceeding to surgery. This is a big operation, recovery is long and difficult, complications can be devastating, so I would never do it lightly, and neither would a good surgeon.
I don't know about Louie Simmon's reverse hyper machine. What is it like? Does he feel that reverse hypers are more effective than conventional hyperextensions?
I don't have time to discuss the placebo effect of surgery. You think a pretty green pill can have a big placebo effect? Nothing to the powerful placebo that is potential in surgery. There are several cases of proven placebo effect. So just the fact that some people feel better after an operation doesn't prove that the operation benefited them physiologically. Material for another rant at another time.
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