Question
QUESTION: I have a spondylolisthesis at L4 and have been experiencing growing sciatic pain for the last year or more.  I have had several weeks of physiotherapy at the hospital but was still experiencing pain so I have been seeing a Chiropractic Doctor who had been recommended to me.  He uses an activator to adjust me.  I have been attending since the end of January and have had 33 visits (initially 4 times a week, but now twice a week).   I had experienced definate improvement, but now feel that I am slipping back again.  I have sciatica in both legs, but generally one leg at a time.  I also have a compression type pain in my bottom.  Will Chiropractic treatment be able to get rid of my sciatica, or am I wasting my time (and money)?

ANSWER: Dear Lindsey,

Remember the saying, "If your only tool is a hammer, everything looks like nails"?    Well, that's what you get if your doctor only uses an Activator.   33 visits?  That's a whopper.  How many ways are there to deal with sciatica, regardless of whether it's from a disc or spondylolisthesis? Lots.  There is flexion-distraction or Cox method (sort of like the modern version of the Medieval "Rack") that can stretch and decompress your spine.   There is the McKenzie method of finding pain-alleviating positions and then exercising into those positions.  There also is standard, hands-on, joint manipulation.  It is my opinion that hands-on joint manipulation is far superior an activator in many ways.  And what about soft tissues?  This means muscles, fascia, and ligaments.  Is there anything being done to release fascial adhesions such as active myofascial release technique or Graston Technique?  Or are you just getting clicked by an activator?   In a case series study on patients with spinal canal narrowing and sciatic-like symptoms, Dr. Donald Murphy demonstrated significant reduction in symptoms in about a dozen treatment sessions (see: www.medscape.com/viewarticle/528906) and these were more serious cases than simple sciatica.   My suggestion to you is to find a DC that has a Lloyd or a Cox distraction table and give that a try.  You should notice a difference in a few treatment sessions (sometimes it takes a few to get used to being stretched) and surely by about 6-8 sessions.  Not 33...   Also, the doctor should have some clue about how to strengthen your spine and core.   He/she should reference Stuart McGill's work for that, or Craig Liebenson.   If the doctor never heard of McGill, then he/she has no clue about spine rehab.   

Good luck with this.   

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Thanks for your very quick response.
I've been researching several of the terms you mentioned to understand them.  
I have been given lots of exercises to do which include McGill's horizontal isometric side support (Side plank), bird dog (Super man)and the flexion-extension cycle (Mad cat). I have also been stretching tight hamstrings and strengthening my quadriceps.  Also doing nerve flossing, amongst others. I have been very good at exercising every day, although over the last week, this sometimes causes some pain, so then I stop. I am starting to have pain in my pelvis/hips now.
This week he has also used wedges under my hips (asymetrically)while I was on my back and lifted and moved my legs.  He also manually adjusted my neck.  He has also given me a lift to put in my shoe. Next week, he wants to x-ray me to examine my spine as so far he has gone by the diagnosis I was given by the hospital and not seen an x-ray.

ANSWER: Dear Lindsey,

You are getting all the right stuff, except for that darn Activator.  NO MORE X-RAY!!!   Your spine is going to look exactly the same and the x-ray is not going to tell you what or where to treat.   The chiropractor is supposed to do his own diagnosis and not rely on a hospital's diagnosis.   The old hospital x-rays are fine to look at.  Also, stop stretching your hamstrings.   When you stretch your hamstring, you also are stretching your sciatic nerve.   The tight hamstring may be your body's defense against pulling on your nerve.  It's called "protective tension" that the muscle does as a natural reflex. I would rather you exercised and massaged your hamstring, not stretch it.  Also, be very careful about having a lift in your shoe.  It it is not 100% on target, it can cause more problems.  The doctor should have a pretty clear idea that you have a short limb (not based on a low back or pelvic x-ray).  If the lift creates immediate reduction in symptoms, then go with it.   If there are no changes or if there is worsening pain after a few days, then abandon it.   I would also highly recommend a general gym workout of your whole body.  Avoid exercises that provoke your symptoms (you'll have to test this a bit) as well as obvious offenders: seated abdominal crunch, heavy squats, heavy/unsupported rowing...    On a physioball, try the "prone tuck and roll" exercises.  On your belly, walk (hands) out into a push-up position with the ball under your knees, then flex hip/knees (tuck) towards your chest so that your thighs are vertical.  From this position, roll the ball side to side.  Keep your thighs, legs, ankles glued together.  This is a rotational core exercise.  You are twisting/rotating your torso left and right with the ball.  It's not easy, but you will strengthen different core muscles than the ones used in linear movements (e.g. superman).   Good luck, again.  I hope you get results.  

'Best,

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Could you give some advice on hamstring exercises.  I'm 53/female who has never been to the gym and would be very nervous of hurting my back.
Thanks for the advice about the shoe lift, I'll try it and see how I get on. It is great to be able to get second opinion answers on a topic I know nothing about.
Happy Easter!

Answer
Lindsey,

Go to the gym!  Hire a personal trainer for a few sessions and they will show you everything you need to know.   Having a personal trainer will be the best way to go.   Once at the gym, you will learn to use the equipment.  Also, as you condition your body, you may find that you are more motivated to try new things.  Maybe group exercise classes will appeal to you.  You must go to the gym first.  

'Regards,

Dr. g