Question
i got in a car accident in 2001. i was told i had a mild back strain. The pain went away and came back 5 years later. i finally went to a doctor in march 2009 and got an mri in September. I fond out i have a degenerative disc in the lumbar region. So i went to pain management and got 3 cortisone shots. It did nothing and now i have muscle tightness. So i have physical therapy. I was told that i have a twisted spine. I can turn a 180 to the right but not the left. I also have a lot of tightness in hamstrings. My pelvic bone was also out of alignment which my therapist fixed. can the twisted spine be fixed. will this help my back feel better or should i just get used to living in pain

Answer
Dear Chris,

Unfortunately, you are not alone in your pain and frustration.  It is possible that the accident in 2001 set you up for the degenerative changes that you are now experiencing in your lower back, although it is impossible to prove one way or the other.

I am sorry that you did not get any relief from the steroid injections.  Often times the injections will help you to manage the condition, even though it will not cure you by helping you to grow new discs in the lower back.

The truth of the matter is that nothing that I am aware of will help you to grow a new disc in the lower back. Once a disc begins to degenerate, it tends to progress through degeneration.  Surgery will not change this, and neither will Chiropractic or physical therapy.

Even though the disc degeneration is permanent, there are some things that can be done to help you to manage the condition. Some of them will be more beneficial for you than others. Everyone is different.  The goals of your spinal care should be:

1) Eliminate or control the pain.
Spinal adjusting or manipulation, like chiropractors do, is one option. Stretching and strengthening exercises can help. Acupuncture and massage have been shown to help control pain. Of course, pain medications are an option, but I believe that their long term ill-affects make them less palatable. In my office we also use electrical stimulation therapies and ultrasound to help control the pain.
2) Slow the degenerative process.
Spinal surgery, steroid injections, and even some medications have been shown to accelerate the arthritic degenerative process that is happening in your spine, so in my mind, these procedures and medications should be last-resort...  Although it is controversial, chiropractic manipulation might actually reduce the rate at which the spine degenerates. It does so by restoring intersegmental motion, or in other words, the movement between the bones of the spine. By so doing, it allows the discs to move and pump fluids, nutrients, and metabolic waste into and out of the disc, improving its viability and health.  Stretching and strengthening exercises help to protect the lower back from further injury, again by providing stability during full range of movements.  I also like to use long axis traction or decompression traction to help induce movements in the joints of the spine with the goal of reducing pain and improving disc health.

The pelvis and/or spinal alignment issues that you describe as having can be the result of muscular spasms, or they can be structural, meaning that they are more permanent and long term. It is possible that the pelvis/spinal alignment issues have been present for years... even before your accident in 2001.  These distortions, which are common in humans, cause stresses on the joints of the spine and can lead to accelerated degenerative changes in the discs and other joints of the back.

If the twist to the spine is the result of recent muscular guarding, then it can be improved through therapy and/or adjustments. If it has been present for a long time, even prior to the accident, it is unlikely to change.

The good news is that even if the spinal twist is permanent, there is still a fantastic chance that you would respond to conservative chiropractic/stretching/strengthening care.  You must, however, shift your thinking away from a total cure and more towards a management strategy. Otherwise, you will be disappointed with any care that you receive.

I hope that this helps you to think about your spine in a different light, and that it gives you some ideas of things to do. Please understand that any opinion that I express carries little or no weight compared to those expressed by your therapists and doctors who know your history and have performed good/complete examinations.

Keith Biggs, DC
http://www.eastmesachiropractor.com
http://www.biggschiropractic.blogspot.com