QuestionDear Dr. Dolan:
I am a 35 year old female who has lived with chronic neck and shoulder pain for the last four years. I have tried chiropractic work, physical therapy, massage, acupuncture, pain meds, muscle relaxers, heat, etc., but these methods only relieve the pain for a few minutes, then my muscles tighten up again. This tightness occurs all day, every day. I am trying to get assistance from medical professionals, but nothing is working and I am not able to find a professional who can get to the root cause of my pain. I had an MRI done about 6 months ago. Here are the results from this test:
1. Multilevel cervical spondylosis. A central disc protrusion at C5-6 causes moderate central spinal stenosis.
2. Right paracentral disc osteophyte complex at C4-5 causes moderate central spinal stenosis.
3. Mild broad leftward disc osteophyte at C3-4, causes mild central stenosis.
4. Straightening of the cervical spine may be due to muscle spasm or positioning.
Three years ago I started going to a chiropractor. He had me visiting him 3 times a week for 2 months, then down to 2 times a week for 1 month, and then I saw him every week for about 9 months. During that time, I found that my pain increased. At one point, it was severe and the pain was shooting up the back of my head. The method he used was to crack my neck on both sides. I quit going to him. I did acupuncture and this stopped the pain in the back of my head. However, the pain in my neck and shoulders continued. Upon a recommendation from my acupuncturist, I went to a Blair chiropractor and he told me that my spine has a reverse curve. I continued to see him and I felt that I made some progress with him. However, I was also getting massages at the same time and I often felt more pain the next day. Regardless of both methods, I continued to feel constant pain. I asked my MD to do an MRI and that is when they found the ruptured discs. My MD sent me to a neurologist and he said I did not need surgery but recommended that I do physical therapy. Since then, I have been doing physical therapy twice a week. The traction and ultrasound has helped me, but I still feel constant pain. At this point, I really just need a professional to tell me which specialist I should see to help pinpoint the cause of my chronic pain (extremely tight muscles in my neck and shoulders with a clicking and popping sound coming from the back of my neck). My condition limits my ability to do just about anything. I am a professor and I have to spend much of my time grading, reading, and preparing classes. I am finding it extremely difficult to do work, much less basic tasks around the house. Everything I do causes muscle tightness and pain. If you have any suggestions, I would greatly appreciate your advice.
Thank you in advance,
Janet
Answerneck pain, shoulder pain, cervical spondylosis, disc protrusion, spinal stenosis,
Hello Janet,
Sorry it has taken me time to respond. My home computer is on the fritz, having problems, and I can only answer in the office.
Sorry to hear of your complaints/ condition.
Let me say that a regimen of chiropractic: "....3 times a week for 2 months, then down to 2 times a week for 1 month, and then I saw him every week for about 9 months. During that time, I found that my pain increased.....", should have helped you,
given the findings mentioned: ".....1. Multilevel cervical spondylosis. A central disc protrusion at C5-6 causes moderate central spinal stenosis.
2. Right paracentral disc osteophyte complex at C4-5 causes moderate central spinal stenosis.
3. Mild broad leftward disc osteophyte at C3-4, causes mild central stenosis.
4. Straightening of the cervical spine may be due to muscle spasm or positioning......".
Seeing the Doctor of Chiropractic 3 times a week for 2 months CERTAINLY shows you gave that doctor MORE then a fair shot at 'fixing' you.
There are excellent Doctors of Chiropractic (DCs) out there, good Doctors, and hacks; just as there are Excellent MDs, good, average, and hack MDs. Every profession has good and bad.
For medicine, fortunately for medical doctors, patients may say- '....that MD stinks!...': he 'cost too much', 'I waited too long', 'too quick to give out pills', 'too quick in and out- never listened to me', etc. etc. People often say: '.... I did NOT like THAT medical doctor!...', BUT- they keep going to medicine, they just try a different medical doctor, blaming the practitioners, never blaming the practice of medicine.
For chiropractic, unfortunately for Doctors of Chiropractic, patients sometimes say: '....chiropractic stinks!..., I went, it did not help...', and they only tried one doctor, one approach; but paint the entire profession on one doctor. Patients quit chiropractIC, not the chiropractOR , whereas patients will quit the medical doctOR, not all of medicine.
Your Doctor of Chiropractic did you a dis-service by not: re-evaluating, re-examining, changing techniques, changing approaches.
There are many, many, many different approaches within Chiropractic.
Depending upon your condition, depending upon patient response, different approaches within Chiropractic can be tried. From SOT technique to Gonstead, from Activator to Kinesiology, from noninvasive
spinal decompression therapy to infrasound, ultrasound, nutrition, etc.: your doctor of chiropractic should have tried different techniques rather then keep 'banging away' with the same maneuvers for "...3 times a week for 2 months, then down to 2 times a week for 1 month...", etc.
Thank you for your dedication to ChiropractIC- the 'spine specialist', but I think you need to try a different ChiropractOR.
There are different Chiropractic Specialties, and I think a DC with additional credentials could be helpful to you (for different chiropractic specialties:
http://www.amerchiro.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf ).
Your findings are complicated, but not uncommon in chiropractic practice. A website I recommend to you which has doctors listed I think would be helpful to you: http://www.Lifechangingcare.com , please vist there.
I recommend return to a different Doctor of Chiropractic. I recommend CONSERVATIVE appropriate chiropractic. I recommend a DC with additional specialty training. I recommend visiting http://www.Lifechangingcare.com . I recommend noninvasive spinal decompression therapy, adjunctive physiotherapies, conservative chiropractic spinal adjustment. SOT technique- stairstepping cervical adjustment could help, activator technique could help.
I recommend eating an anti-inflammatory diet, with anti-inflammatory nutritional supplementation. Your well-credentialed DC should help you here also.
Some information I hand out in my Staten Island Chiropractic office may be helpful to you:
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Spinal Stenosis :
Spinal Stenosis is a highly VARIABLE condition.
Some people run marathons and lift weights with stenosis.
Some people cannot get out of bed with stenosis.
Stenosis is a narrowing of the spinal canal. There is not a lot of room in the spinal canal. Take a nickel coin and a dime coin, place the dime upon the nickel- if the nickel is the canal (the space that the spinal cord/ spinal nerves have to run through), the dime is the spinal cord/ spinal nerves. There is not a lot of space left in reserve,,, not a lot of space to 憄lay with? (note difference: spinal CANAL vs. spinal CORD ).
A condition due to narrowing of the spinal canal which can cause nerve pinching which can lead to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity (to avoid the pain).
The Silent Epidemic
The most common indication for surgery in persons aged over 60 in the United States is Lumbar Spinal Stenosis (LSS). Currently, it is estimated that as many as 400,000 Americans, most over the age of 60, may already be suffering from the symptoms of lumbar spinal stenosis [The American Association of Neurological Surgeons (AANS) and The Congress of Neurological Surgeons (CNS)] and this number is expected to grow as members of the baby boom generation begin to reach their 60s over the next decade.
According to the U.S. Census Bureau, people over 60 will account for 18.7% of the domestic population in 2010 versus 16.6% in 1999. According to the United Nations' Population Division, Department of Economic and Social Affairs, the trend is global with the number of persons aged 60 years or older estimated to be nearly 600 million in 1999 and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14 years) for the first time in human history. The majority of the world's older persons reside in Asia (53 per cent), while Europe has the next largest share (25%).
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Exercise: The Miracle Cure
It seems the more options you give people, the more they demand. Exercise, for example, is well known for its dramatic and wide-reaching physiological effects. Yet when you counsel a patient to exercise, they generally say something like, "Yeah, doc, I know all about exercise and diet, but what can I really do to help?" Often it appears that things with which you are very familiar are automatically either ignored or discounted (married people understand this concept well). Among the many benefits of exercise that have been scientifically documented:
? exercising three days a week raises basal metabolic rate so that even on the days you don't exercise, you are burning 300 more calories each day;
? Finnish study found exercise relieves knee pain more than anti-inflammatory drugs or rest;9
? provides long-term relief of spinal stenosis symptoms
? lowers cholesterol levels;
? improves balance and coordination, even in the elderly;
? strengthens bones;
? fights insomnia;
? reduces the effects of mental stress;
? relieves depression;
? helps control type II diabetes;
? dissolves or prevents blot clots,11 possibly explaining exercise's protective effect against heart attacks;
? decreases breast cancer risk by up to 60 percent
? cuts the risk of gastrointestinal bleeding in the elderly in half
? postpones many effects of aging;
? increases resistance to infections.
Spinal Stenosis is a narrowing of the spinal canal. This can create irritation of the spinal cord or the spinal nerves. Stenosis can come about from many different causes. Just saying 搮stenosis厰 does not say much. Stenosis can be due to big bad things like a cancer or a tumor that irritates or puts pressure on the spinal cord. Stenosis can be due to a bulging or herniated disc. Tests should include MRI, Xray, perhaps CT scan to visualize the stenosis and the cause of the stenosis.
Many times stenosis can be handled through noninvasive conservative care such as Chiropractic. Unfortunately, sometimes after conservative care has been tried unsuccessfully, more invasive treatments must be tried: medications (with attendant side effects), injections (with inherent risks), all the way up to invasive surgery.
One of the common causes of Spinal Stenosis is Degenerative Joint Disease (also known as Degenerative Disc Disease, Spondylitis, Spondylosis, or OsteoArthritis).
Degenerative Disk Disease
DDD = Degenerative Disc Disease; DJD = Degenerative Joint Disease; = similar/ same OsteoArthritis.
Degenerative Disc Disease (old term = DJD) is actually a quite common condition. However, the course of the condition is highly variable. Some patients with DJD literally cannot walk, yet other patients with similar X-ray/ MRI findings may be able to run marathons or lift heavy weights. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful. DDD, DJD, OsteoArthritis, - deteriorating discs (disk) is/ are often caused by, or often concurrent with the Vertebral Subluxation Complex. VSC is a misalignment which hastens deterioration of the joints involved, and can 憄inch?the space available for our nerves.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of joints, and can cause osteo-arthritic degeneration, Degenerative Disk Disease, degenerative joint disease, etc.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Inflammed Discs can easily bulge, herniate, tear, or degenerate. Other soft tissues may also suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, Disk Degeneration, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Certainly; safe, effective, cost effective, noninvasive, conservative Chiropractic care should be utilized, if even for a few weeks- before proceeding to risky medication or risky, invasive surgery. Visit your local family Doctor of Chiropractic for an evaluation and treatment which may be necessary.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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Perhaps certain nutrition will help the pain and inflammation:
Proteolytic enzymes are beneficial to counteract the inflammation. Bromelain is an example of a proteolytic enzyme.
Essential fatty acids are precursors to potent antiinflammatory substances. Essential fatty acids include fish oil, flax oil, evening primrose oil, black currant seed oil and borage oil. Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
Quercetin is a potent bioflavonoid, in fact, it has been named, "the most important flavonoid" by a leading peer-reviewed journal (Nutr. Cancer 1993, 20:21-9). It is a powerful antioxidant, and Michael Murray suggests that, "quercetin appears indicated in virtually all inflammatory and allergic conditions" (Murray, M. Encyclopedia of Nutritional Supplements, 1996, Prima Publ., Rocklin, Ca. p. 327).
Vitamin C is essential to the healing process. Bioflavonoids in general operate to stabilize cell membranes, decrease the release of inflammation mediators and inhibit the inflammatory process (Amella et al. Inhibition of mast cell histamine release by flavonoids and bioflavonoids. Planta Medica 1985;51:16-20).
Both calcium and magnesium relax the muscles. Magnesium inhibits inflammatory prostaglandin synthesis (Fontana-Klaiber, H., and Hogg, B. Therapeutic effects of magnesium in dysmenorrhea. Schweiz Rundsch Med Prax 79(16): 491-494, 1990).
Zinc promotes healing.
Boswellia serrata is reported to have strong analgesic (pain-relieving) effects (Kar, A. & Menon, M.K. Life Sci. 1969;8:1023), along with antiinflammatory and anti-arthritic activity.
Tumeric research has demonstrated excellent antiinflammatory and antioxidant properties of turmeric, and especially of curcumin, which is the active component of turmeric that is responsible for the yellow pigment (Reddy AP & Lokesh, BR. Mol Cell Biochem. 1992;111-117). The antiinflammatory properties are due to the ability of curcumin to reduce histamine levels and possibly increase natural cortisone production by the adrenal glands (Aora RB, Basu N, Kapoor V, Jain AP. Antiinflammatory studies on Curcuma longa (turmeric). Ind.J.Med Res. 1971:59:1289-95).
Ginger is an herb known mostly for its therapeutic effect in nausea. Ginger also has powerful abilities to combat inflammation, and these antiinflammatory effects are well-backed by scientific studies. Ginger contains phenolic compounds that inhibit the enzymes responsible for generating important mediators of pain and inflammation in more than one pathway (Kiuchi et. al. Inhibition of prostaglandin and leukotriene biosynthesis by gingerols and diarylheptanoids. Chem Pharm Bull. 1992;40:387-91).
Milk thistle has always had a strong reputation for supporting liver function and pathways of detoxification. Removal of wastes and toxins is crucial in decreasing inflammation. Silymarin, which is one of the main ingredients in milk thistle, has an antiinflammatory effect on blood platelets (Altorjay I et al. Acta Physiol Hung 1992;80:375-80), and the ability to inhibit free radical production and leukotriene synthesis means that it prevents the powerful, inflammatory leukotrienes from wreaking havoc in the body (Alarcon de la Lastra, C. et al. Planta Medica 1995;61:116-119; Fiebrich F and Kock H. Experientia 1979;35:148-150).
Herbs to aid in muscle relaxation include valerian, passion flower, kava kava, and scullcap. Do not use kava kava if liver disease is suspect.
White willow is an antiinflammatory and analgesic agent. White willow was used as far back as the Middle Ages to reduce pain and fevers. The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects. Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
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Beware of overutilization of PAIN MEDICATIONS :
PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car- -- do you ignore it until the car breaks down, or do you get it checked and correct the problem?
Pain,
pain in your body-
-- do you ignore it until your body breaks down, or do you get it checked and correct the problem? Pain, do you cover up the pain by taking a painkiller? Take a painkiller, mask the pain, and allow a problem to progress in your body?
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition.
Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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".... Everything I do causes muscle tightness and pain....",
Break up the monotony, break up the muscle, postural fatigue: by that I mean- change positions frequently. Every 15 minutes, get up from the desk, change postitions. Every 15 minutes- go for a brief walk down the hall and back. Place the book, paper you are reading slightly to your right,,, then slightly to the left. Monotony makes fatigue, fatigue causes inflammation and pain.
I know I have given you a lot of information. I believe most problems, most conditions, - have multiple factors that cause the problem: therefore, most conditions need a multi-faceted approach for treatment and resolution.
I hope the above helps. If further info is needed, do not hesitate to
re-contact me here at AllExperts.com
( http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm )
Thank You, your Staten Island Chiropractor friend signing off,
Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com (email newsletter)
