Question
It all started with sciatica a sore foot on left side 01/2006.  I went to chiro and a couple adjustments(low back & foot-gonstead method) fixed it.  A few weeks later I had sciatica on right side.  MY WORLD HAS NEVER BEEN THE SAME.  I found another chiro who took xrays(spine slightly curved to right) and he referred me to Physical Therapy.  I found another chiropractor and went for 5 months starting with 3 x a wk and getting down to 1 x per wk.  Still  had sciatica.  Miserable. Found new chiro and he did deep tissue massge on right pirformous.  At the time I couldn't walk 1/4 mile without my leg stiffening up in pain on me.  Been going there 2 months now and I can walk 3 miles.  Logged 13 miles last week.  I am very excited about that.  I have been doing inversion therapy and talking systemic enzymes.  I am 50 years old, and sit on computer by day.  I am overweight by 40 lbs and have been the same weight since 1985.  My problem is this:  Sometimes I can't stand in one spot.  It is very uncomfortable.  It is (off & on) pain and pressure on low back.  I never know when it is going to happen.  I can't shop or stand in any kind of line.  This is hard to deal with.  I am fine if I keep moving.  What can I do?  This is scary.  My boss, family, & friends think I am crazy.   I have not missed any work, but she wants me to go on these tours and I am physically unable to.  No MRI just xrays.

Any input would be much appreciated.

Beth

Answer
Dear Beth,

The first thing I have to say is you seem to be swapping doctors like you would socks.  It seems like the first chiropractor that you went to and the current chiropractor you are seeing now have done the most for you, so I would recommend that you stick with what has helped only, such as adjustments and soft tissue work.  The inversion table will definitely take pressure off the spine, but at 50 yrs and being overweight, inversion could lead to aneurysm or stroke due to the increased pressure in the brain while inverted...if there is any weakness in the vasculature of the brain, this could happen, and if you have high blood pressure or you smoke, you are at an even higher risk.  Please use inversion with caution.

You stated that as long as you keep moving it is fine.  This does not sound like a disk problem to me, or nerve root encroachment, because these conditions are usually exacerbated by movement, therefore this could be a problem with the sacroiliac joints in the low back...they can refer pain down the entire leg, front and back.  Or this could be due to significant muscle imbalance to include trigger points in the myofascial system.  Bottom line is that I am just guessing without a complete functional examination to include posture, orthopedic tests, neurological tests, range of motion, and x-rays.

Now, you did not give any explanation of what is the problem.  Do you have a diagnosis?  What is causing the sciatica?  Has any doctor explained this to you?  If not, they might not know what is going on...ask for a complete diagnosis, sciatica is descriptive of the pain presentation but gives me absolutely no information of what is causing the problem. The immediate next step would be to re-examine you, and then order an MRI of the lumbar spine if indicated.  This will determine if there is any disk bulge, soft tissue inflammation or nerve root encroachment. I can't believe that you have been treated for this condition for almost two full years, and an MRI has not been performed...that's ridiculous.

You most likely need a combination of spinal adjustments, core stabilization exercises specific for the multifidus muscles, and soft tissue work as well, but again what if there is a large disk herniation, or a small disk fragment...then a surgical consult should be made.  Again, we would know this if the MRI had been performed.

Lastly, if you were my patient, I would immediately have your metabolic profile checked, and your carbohydrate response checked and start you on a custom supplements (tailored for your age, sex, metabolic profile and carbohydrate response) to lower inflammation, increase antioxidant defenses, strengthen your immune response, and to focus on weight loss with specific dietary measures according to your individual lab results.  Realize that if you are 40 lbs overweight and have been for years that your metabolic function is obviously compromised as well as your carbohydrate response.  I have utilized this testing with many of my patients and have gotten amazing results with simple nutritional protocols.  Losing 20-30 lbs would be a significant reduction of stress on all of the tissue in your low back, especially the disks, the facet joints, and the sacroiliac joints,  and would additionally lower your inflammatory response which is responsible for increased pain.  Not to mention your overall health picture and future risk for degenerative diseases would improve drastically over 3-6 months.  Aren't you ready to improve or remedy this issue?

Bottom line:  get a new physical exam, make sure an MRI is ordered if the exam warrants, start stabilization exercise for the multifidus musculature, and get on track to lose the weight, improve your diet and balance your metabolic function.

Listen Beth, obviously I can't treat you physically, so make sure that the doctor you choose is comprehensive and takes the time to examine you fully.  But if you want to get tested, I can facilitate that very easily over the phone.  I work in conjunction with the two best labs in the country, Metametrix and HVL Douglas.  The process is quick and inexpensive, the lab reports are comprehensive and easy understand by the layperson, and the nutritional products are top notch, I use them myself and with my family...we have all been tested.  If your interested just send me an e-mail or call my office, the information is on my website.  I would be glad to help.

Good Luck Beth, I hope you do well.

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