Question
I was diagnosed with cervial spinal stenosis following a lifting injury over 2 years ago. MRI scans and xrays revealed bulged discs with moderate nerve impingement. At the time of injury my sympyoms included pain and stiffness in my neck and shoulder region and lower back pain. These have worsened over time. I underwent a gym program but was advised to stop this and continue with light massage and TENS only as the exercises aggrivated my synptoms and resticted neck movement. Approximateley 11 months ago I was involved in a MVA. I was stationary and was hit from behind. Following the accident my neck/back symptoms intensified. I also had severe headaches that continue today. The head pain I get is mainly on the top of my head and I sometimes experience sharp shooting pains. I received no tests etc following the MVA and have been advised to continue with massage and pain medications. My doctor said I have post MVA traumatic headaches. It is difficult to say if the MVA symptoms have resolved as I feel the cervical stenosis had been worsening over time. The headaches are regular and have not subsided although I have been told that the symptoms from the MVA should have resolved by now. A couple of months ago I experienced pain (similar to siatic pain) down the full length of my left leg and under the left foot. This was an aching pain and the sensation in my shin was similar to having gravel rash or a numbness. It is quite an annoying/nagging type of pain (which has since returned and usually lasts for a few days to a week). I did undergo an xray and CT scan to ensure it was not related to the nerve problems and to rule out siatica problems, however the leg and lower back was normal. I would like to know if you think the headaches are indeed related the the MVA, and in your opinion, should this settle in time? I would also be very appreciative if you could shed some light on the possible cause of the leg pain as this has been a concern for me. Many thanks for your time!

Answer
Dear Audrey,

First of all, I can't believe with your history that you were not imaged after the car crash...you should have at least had x-rays with flexion and extension projections and a possible follow-up MRI to re-examine the disk and stenosis issues.  

Now, headache after rear impact is a common problem and the type of headache needs to be differentiated.  Does its stem form the occipital joints or the upper cervical joints of the neck, is it referred from the soft tissue of the neck (sclerotogenous pain), or is it a result of post concussion syndrome/mild traumatic brain injury?  These are the most common post crash headaches and they need to be treated differently.  

Due to the clear imaging studies in the low back, I would expect the symptoms you are experiencing down the legs is probably due to the sacroiliac (SI) joints or something called a long track sign.  The SI joints frequently create low back and leg pain which is misdiagnosed as sciatica, and consequently mismanaged...I see this all the time in my practice.  Concerning the long track sign, this can be created from the stenosis in the neck which is pressing on the spinal cord. The spinal cord is arrange in a ordered manner and when pressed upon can irritate nerve tracks that extend into the legs...hence the name long track sign.  All of this needs to be documented further with a complete physical, orthopedic and neurological examination...these are rarely performed in general medical practice.  If you want an exam of this magnitude, you will have to be seen by a good orthopedist, neurologist or chiropractor who will take the time to be meticulous with the procedures...the exam will take 30 minutes minimum.

I assume that you are being managed by your family physician from what you have said up to this point...due to the lack of knowledge clearly shown on this topic...you need to be seen by someone who understands these injuries and how to manage them appropriately, and I would suggest that you check out a website www.srisd.com which is for the Spine Research Institute of San Diego (the leader in education/research and certification for physicians on crash injuries).  Chiropractic physicians are the experts in this field and generally treat with the most efficacy.  The institute has a physician listing on the site for you to check your local area or state to see doctors (chiropractic and medical) who have completed certification.

Moreover, I would encourage you to contact the Spine research Institute by phone through the website and purchase their new textbook (written by Dr. Art Croft)which I have had the priviledge to review.  It is magnificent and geared more toward patients and the lay public than treating doctors...you will get a wealth of information from it and be better informed than the majority of medical professionals around the country.  I have read this book cover to cover twice now, it is packed with scientific information and I cannot recommend any other book on the topic.

Lastly, I would like to send you some research data I have on the SI joint, sclerotogenous pain, and rear impact crashes (whiplash) but my computer is not allowing me to attach the files here.  So I would encourage you to search these terms in the Allexperts database in my name or in the chiropractic section, and you should be able to pull up previous articles where I have attached the research.  You can also search sclerotome and stenosis on my website in the glossary section. Hope this helps Audrey.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net