Question
Hi, I抦 a 56 year old, 5?7?and just under 13 stone male who has suffered from LBP for a number of years. In all other respects I am healthy and fairly fit individual but about 4 years ago I visited one of my local chiropractors and was treated for a stiff joint at the L4/5 L5/S1 level. The chiropractor placed me on my left side whilst pushing down my right leg and pushing my right should in the opposite direction. After this procedure I was in so much pain that I had to have 4 months off work to recover. During this time I regularly visited an osteopath. However 8 weeks ago I was in so much LBP I had no option but to return and had a MRI scan. The results are below. My questions are these 1. As an avid golfer who plays at least twice a week are my playing days over? 2. What treatment plan should I peruse? 3. What exercises should I do?



MRI Scan 6th September 2008
Findings

Disc degeneration is evident at L3/4, L4/5, and to a lesser extent, L2/3

L2/3: No disc protrusion or root compression

L3/4: Small posterior annular tear, but no evidence of disc protrusion or root compression.

L4/5: Posterior annular tear with an associated broad based disc protrusion, tending to the left of the middle. No evidence of root compression. Mild facet joint degeneration

L5/S1: bilateral facet joint degeneration (right greater than left). No evidence of disc protrusion or root compression.

No Evidence of canal stenosis
Normal conus and cauda equine
No focal marrow abnormalities

Summary Comments:
Disc degeneration at L2/3, L3/4, L4/5
Annular tears at L3/4 and L4/5 but no evidence of significant disc protrusion
Facet joint degeneration at L5/S1 and to a lesser extent at L4/5


Answer
Dear Stephen,

First of all, let me apologize for the poor chiropractic care you had received earlier.  Unfortunately all chiropractors are not created equally and I hope you do not judge my profession on a previous bad experience.  I am not sure what type of examination was conducted before the chiropractor adjusted your spine, but it seems as though he used too much force, and you likely should have been thoroughly stretched out beforehand.  That being said, I do not think that your golf playing days are over, but you may need to limit the rotation of your torso and reduce your swing so that your lumbar spine can be under reduced stress while swinging.

The annular tears of the disc at L3, L4, L5 areas can easily cause significant pain levels, and referred pain as well down the legs.  This is sometimes known as sclerotogenous pain, and often does not match neurological or nerve root pain referral patterns.  The fact that you have joint degeneration at these levels can also cause referred and localized pain.  

I would suggest that you seek out the care of a better chiropractic physician and get a new examination of your functional capacity.   Cox flexion technique, thompson drop or arthrostim adjustments may be better suited for your low back than traditional manual spinal adjustments. I would further suggest that you seek out the care of a chiropractor who has been trained and certified as a sports physician through the American chiropractic board of sports physicians.  You can find doctors who have been through he certification program at www.acbsp.com.  Lastly, you may want to try decompression therapy even though you have only a small disk bulge because decompression also stresses the annular fibers of the disk which will help to break abnormal scar tissue formation while pumping the disk material with fluid.  You cannot fully rehydrate a degenerated disk, but you can get some improvement.

Good Luck.

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