Hello,
Thanks for asking your question. Although I am an internal medicine
physician, please see your primary care physician for specific
questions regarding any individual cases – please do not use Google
Answers as a substitute for medical advice. I will be happy to answer
factual medical questions.
You asked the following question:
“I have a back pain problem (bulging at L4-L5) that affects my daily
activity, since I feel very sore on my legs, sometimes with cramps. My
physiotherapiest told me to sleep on a firm surface, I am not allowed
to carry (lift) heavy things. I have been taking celery for a long
time, since it reduce the pain. My questions are:
1. IS MY CASE CAN BE CURED?
2. IS TAKING CELERY USEFULL TO MY ILLNESS
3. HOW DOES CELERY WORK ON HUMAN BODY AND WHAT IS THE RELEVANCY TO THE
TREATMENT”
1) Can your case be cured?
The short answer is possibly - it depends on what the exact diagnosis
of your back pain is. I will not refer to your case specifically
(please call your PCP for individual treatment), but I will outline
the general diagnosis and treatment for low back pain (including
bulging disks).
Evaluation of low back pain
X-rays — It is natural to think that some tests should be done to
confirm the cause of back pain. However, regular back x-rays (plain
x-rays) are not useful in most patients with acute low back pain. They
do not show herniated discs or spinal stenosis. Plain x-rays may be
useful in patients with symptoms suggestive of a fracture, infection,
or cancer, all rare causes of back pain.
Tests such as magnetic resonance imaging (MRI) show the structures of
the back with amazing accuracy. This information is useful if you and
your doctors are planning surgery or if an unusual, severe cause is
suspected. But for most people with low back pain, they are not worth
the trouble and expense. Although MRI can show bulging disks very
clearly, many people without back pain also have the same
abnormalities. Thus, it is difficult to be sure that what is seen is
the cause of the pain. A careful description of your symptoms and an
examination are more informative.
Treatment of chronic low back pain
Unless your back pain is caused by a serious medical condition, you
can expect a rapid recovery, even if you have symptoms of a pinched
nerve. In the latter circumstance, the body breaks down bulging disks
and disposes of the offending material, taking pressure off the nerve.
Exercise and physical therapy:
Several studies and meta-analyses support the role of exercise for the
treatment of chronic low back pain. In a meta-analysis, for example,
there was strong evidence favoring exercise compared with "usual care"
(medications and resumption of usual activities).
For patients with persistent low back pain, without radicular
symptoms, various exercise are often recommended:
· Individual physical therapy sessions including exercises designed to
strengthen trunk muscles, increase flexibility, improve aerobic
capacity, and enhance the patient's knowledge of ergonomics
· Trunk strengthening exercises done with or without the aid of
resistive machines
· Aerobic exercise alone, without any strengthening or flexibility
enhancing sessions
Steroid injections:
Corticosteroids may be injected into the epidural space, facet joint,
or local tissues in patients with low back pain. The efficacy of
injection therapy is unclear due to a relative lack of good quality
data. Nevertheless, some patients may benefit from this type of
therapy.
Spinal surgery:
Only a small minority of patients suffering from low back pain ever
require surgery. It is almost never indicated if imaging studies do
not disclose a lesion that correlates well with the clinical findings,
or if there is no clinical evidence of compression of nerve roots,
cauda equina, or conus medullaris. Referral to a neurosurgeon or
orthopedic surgeon who is experienced in back surgery is indicated in
the following cases:
· Increasing neurologic deficit
· Severe leg weakness
· Sensory loss and bladder and bowel symptoms
· Failure to respond to an adequate trial of four to six weeks of
conservative management with persistent and severe sciatica and
clinical evidence of nerve root compromise
The last criterion is obviously a matter of clinical judgment, and
depends to a considerable degree upon the patient's tolerance for the
pain and on the degree and duration of disability.
The presence of foot drop or other motor deficit caused by root
compression is not an absolute indication for surgery because many
such patients will recover spontaneously. On the other hand, patients
with severe cauda equina damage due to a large midline disc herniation
may have persistent neurologic deficits, even after prompt disc
removal and root decompression.
Laminectomy with disc excision, the most common procedure, has been
reported to produce excellent results in 40 to 90 percent of patients,
depending upon patient selection and surgical technique. In one study,
for example, 280 patients with herniated lumbar discs were divided
into three groups. One group had signs and symptoms that definitely
required surgical therapy, one group had no indications for surgery
and was treated conservatively, and one group of 126 patients had
uncertain indications. Patients in the last group were randomized to
either conservative management or surgical treatment. Those treated by
laminectomy showed significantly better results at one year but
insignificant differences from conservatively treated patients at four
and 10 years after the operation (1).
So the bottom line is that spinal surgery *may* be effective in the
short run *if* you have a clear herniated disk as documented by an
MRI. However, after a longer period of time, there is no difference
from conservative treatment (i.e. pain relieves and exercise).
2) Is celery useful for the illness?
There is no consensus in the medical literature regarding the role of
celery. However, there are some smaller studies which suggest that
celery has some pain-relieving qualities.
From Dr. Murray online:
“Celery is a member of the Umbelliferous family along with carrots,
parsley, and fennel. The modern celery originated from wild celery
native to the Mediterranean where its seeds were once highly valued as
a medicine. Like many other folk medicines, modern research is
upholding the medicinal value of this common plant. In particular,
scientists are evaluating the most powerful of the healing factors of
celery, a compound known as 3-n-butylphthalide or 3nB for short.
3nB has shown tremendous promise as an anti-cancer phytonutrient and
detoxification aid in an experimental animal model, but it is its use
as a pain reliever in arthritis, fibromyalgia, and gout that is
getting most of the attention.
A celery extract standardized to contain 85% 3nB and other celery
phthalides has been evaluated in the treatment of "rheumatism"– the
general term used for arthritic and muscular aches and pain . . . The
results of the study were extremely positive and quite statistically
significant. The chance that such a positive effect in reducing pain
in these subjects was a placebo effect was less than 1 in 1000.
Subjects experienced significant pain relief after 3 weeks of use with
the average reduction in pain scores of 68% and some subjects
experiencing complete 100% relief from pain. Most subjects achieved
maximum benefit after six weeks of use although some did notice
improvements the longer the extract was used . . . Based on the
positive results in this small pilot study, a larger 70 patient study
was conducted. Test subjects received 75 mg of the celery extract
twice daily for three weeks. At this higher dosage, subjects reported
even better results than in the pilot study. Statistically and
clinically significant reductions were noted in pain scores, mobility,
and quality of life. ”
http://www.doctormurray.com/articles/celery.htm
3) How does celery work on the human body and what is the relevancy to
the treatment?
From Dr. Murray online:
“Based upon al of the existing research it is clear that 3nB exerts a
profound effect on many of the body’s control systems. Chief among
them the prostaglandin system. Prostaglandins are chemicals that
mediate or control many important body processes including regulating
inflammation, pain, and swelling; blood pressure; and heart,
digestive, and kidney function as well. Some of the effects noted for
3nB on the prostaglandin system are quite unique and novel. Rather
than simply inhibiting the production of prostaglandins by blocking
enzymes that produce them like aspirin or even the more expensive and
selective Cox-2 inhibitors, 3nB appears to help restore balance in the
prostaglandin system.”
http://www.doctormurray.com/articles/celery.htm
In other words, in these small studies, celery seems to work in a way
similar to NSAIDS (i.e. alleve, motrin or advil) or the COX-2
inhibitors (i.e. vioxx and celebrex).
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
Thanks,
Kevin, M.D.
Search strategy using Google:
celery pain
Bibliography:
1) Weber, H. Lumbar disc herniation. A controlled, prospective study
with ten years of observation. Spine 1983; 8:131.
2) Lehrich et al. Treatment of chronic back pain. Uptodate, 2002.
Links:
Dr. Murray online:
http://www.doctormurray.com/articles/celery.htm |
Request for Answer Clarification by
mamalily-ga
on
26 Dec 2002 03:53 PST
Dear dr Kevin,
First of all, allow me to wish you Merry Christmas and Happy New Year
2003. May the coming year brings us better, happier and healthier
life.
Thank you for your comprehensive answer to my back pain case, although
it gave me extra homework. Many medical terms I am not familiar to,
that I had to look up in the Faber Medical Dictionary.
I think it was my fault not to provide you with complete history of my
illness.
I (female, 50, 55 kg weight) have been suffering back pain for more
than 6 years. Initially, I did not recognize it as a back pain case.
What I felt was a severe stiffness and weariness at both sides of my
buttock down to my left leg, sometimes my right leg too, sometimes
with cramps, as if I had been running a 100 miles race. I cautiously
took several kinds of rheumatic medicines (such as voltaren 50mg,
devil’s claw, including celery), for I thought I had rheumatic. Until
recently, a friend of my husband, advised me to take a CT Scan.
I followed his advice and according to the Radiologist (also someone
we know well), I have a serious bulging at L4-L5.
I showed the CT Scan result to a Neurologist (someone we do not know
well), and he confirmed the Radiologist’s diagnosis. He suggested me
to have MRI and EEG test as well, and gave me prescription of some
medicines that made me suffer even more. So I threw them away. I then
saw a Physiotherapist (someone we know well for a long time). He
directly indicated the bulging and advised me to totally change my way
of life, because he recognized my case as the impact of lack of
exercise. He told me not to bow or squat too much. Sit or stand
upright (even when I brush my teeth or cough), which hopefully could
correct my posture. I should wear a sacro lumbar support, and swim. He
did not recommend me to be treated with traction device, although he
owns a Therapy Clinic complete with several kinds of physiotherapy
equipments. He only told me, that if my condition got worse, then I
should have physiotherapy.
So, generally, your answer is coincides with his. I did search
information in Google just to get second opinion, especially about
consuming celery as a treatment without side effect, hopefully.
By the way, do you take celery as your daily menu?
I feel better when I orderly take celery, and there is much
improvement if I do not forget to sit and stand upright and wear my
sacro lumbar support. Now, my question is: for how long?
I do not like sports; I do not swim, because I do not know how. I
realize that aerobic is the only choice I have. I do not believe in
steroid injection neither surgery / Laminectomy. Instead, treatment
with medium power (HeNe & Infra Red) laser is a therapy I eager to
try.
Before rating the answer, further information about physical therapy
sessions to strengthen trunk muscles, increase flexibility, improve
aerobic capacity and enhance the knowledge of ergonomics, would be
highly appreciated. At least your guidance about where I could get
such information for free.
Thank you again for your reply (and thanks to the IT that has brought
us to the borderless world!)
Mamalily-ga
Jakarta, Dec. 26, 2002
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