Q: My wife has back pain for the past 10 years. We have done an MRI of the lumbo-sacral spine. The report says that diffuse circumferential disc bulging at L4-5 with hypertrophied facet joints causing bilateral mild lateral recess stenosis. Central spinal canal dimensions are relatively normal. At L5-S1 diffuse circumferential bulging and posterior of disc is seen with hypertrophied facet joints causing indentation of thecal sac and bilateral mild lateral recess stenosis. The lower end of spinal cord, conus medullaris and nerve roots of cauda equina are normal. No intra spinal mass or pre/para vertebral collection if seen. The study reveals mild degenerative changes as evidenced by anterior and posterior bony eburnations at vertebral margins. End plate degenerative changes are seen in L4 vertebral body. Degenerative changes are seen in the L5-S1 intervertebral disc as evidenced by reduction in the bright signal intensity of nucleus pulposus on T2 weighted sagittal sections and a posterior annular tear is also seen. My wife is exercising and we are against getting her operated. She has got 40% relief with exercise. What kind of exercises does she need to do?

A:It is very difficult to predict and ensure a 100% cure for anything in medicine. This is because for any symptom like pain there could be several modifying factors. The physical factor described in the MRI may be contributary but may not necessarily be the only factor. Each one of the findings described on MRI may contribute to pain. This may be further modified by emotional stress and psychological make up of the patient. Now this varies from patient to patient and it may vary on a day-to-day basis. In medicine there is no 100%. Having said that, she may benefit from extension exercises of the back. Often physiotherapists suggest a mixture of flexion and extension exercises. You could get in touch with the physiotherapists and start gentle extension exercises. This is difficult to describe but I will try. Patient should lie face down on a flat surface. She must keep both arms and legs stretched out straight. First she raises her right arm off the couch without bending her elbow. She must hold this for a count of 10. At the end of that, she gently lowers her arm. Next she repeats the same on the left side. Next she raises her right leg off the couch keeping her knee straight. Medically we call this extension of the hip. She holds this up for a count of 10 then she repeats this on the other side. Next, she raises her right arm and her left leg off the couch for the same duration. She repeats the same with her left arm and right leg. You would notice that turn by turn she has raised all her limbs once and crossed limbs once each a total of six exercises make one set. First day she does one set of this, next day she repeats the whole thing twice and third day thrice and so on till she reaches 20 sets. This will take about 3 weeks. She must maintain this for six weeks. She should start having some relief at the end of 3 weeks with gradual improvements after that. If at any time pain gets worse, stop the exercises and seek help from your orthopaedic surgeon. If she is better after six weeks, she should do just 10 minutes of this exercises everyday. I hope I have been able to explain sufficiently.