QuestionQUESTION: Hi there: I'm a 51 year old female. I have severe back pain in the lower left
area and my left lower leg and foot are numb. I have exercised my entire life,
since teens. The pain is so bad in my back sometimes that I have to bend
over just to get some relief and sometimes receive no relief at all. I've been
to an orthopaedic dr. and am waiting for my new insurance to come through
because the dr. diagnosed a bulging disc and pinched nerve. He gave me a
muscle shot which last not even 24 hours. He says the area is very inflamed.
He wants to do a nerve study, MRI and epidural lumbar injection. I have two
questions. Once I have the injection, do the prescribed physical therapy and
follow up with my chiropractor will I get back to normal? My second question
is, I have been off work and will possibly lose my job if I don't return soon--I
can only stay in one position maybe 5-10 minutes, I find it very hard to drive,
I have a clutch. Walking is very difficult--I can't even imagine getting ready
for work right now. I am not a lazy person and I am so depressed that my
boss of over 23 years would fire if I am having trouble getting our new
insurance stated. Everyone has different degrees of pain and I can take a lot
of pain--but this is almost unbearable. I just wanted to find out if I will ever
be the same again. I;m not taking pain pills because I am allergic to
something in them. I'm taking probably 3600 mgs. of ibuprofen and
sometimes it doesn't even touch the pain. My husband makes me stay down
so I take less of the ibuprofen. Just some advice would help. Thank you.
ANSWER: low back pain, pinched nerve, herniated disc, 3600mgs ibuprofen, pain, sciatica, numbness, low back pain, will I get back to normal,
Hello Laurie,
Sorry to hear of your pain and problems.
Unfortunately health care costs and insurance coverage are big problems in the USA right now. I know NO good answer for that. I wish you luck with the insurance coverage part of the problem. Write/ complain to your State Department of Insurance if you feel you have been promised, paid for, and then denied particular insurance coverage. Usually even Insurance companies do NOT like compliants against them to the Insurance department.
Proper , thorough evaluation is necessary. Certainly physical examination, history consultation, Xray, MRI, perhaps CT scan, perhaps EMG/ncv; appropriate testing must be done. Your Doctor of Chiropractic can certainly order all of these examinations for you.
Once appropriate workup is complete, analysis, diagnosis, treatment plans can be made. The patient must be compliant with the recommended treatment regimen.
I would also look for a Sensory Nerve Conduction Evaluation- perhaps through a neurometer or a neural scan. These devices are sensitive to nerve changes and can help isolate the CAUSE of your complaints.
Handout information I utilize in my Staten Island Chiropractic office:
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Disk Herniation
Herniated disk is actually a quite common condition. However, the course of the condition is highly variable. Some patients with a herniated disk literally cannot walk, yet other patients with similar 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.
Disk Herniation is often caused by, or often concurrent with the Vertebral Subluxation Complex.
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 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. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may 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, 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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How It Works - Neural-Scan Physiology
Referred pain results in 30% of patients misdirecting doctors away from the source of pain, and physical exams have even less sensitivity. This explains why the Massachusetts General Hospital Handbook of Pain Management states; "In MOST cases (over 50%) of neck and back pain the anatomic and physiologic diagnosis remains unclear."
The mechanism causing this is explained by Guyton's Textbook of Medical Physiology: Over 90% of A-delta fibers reach the sensory cortex allowing exact localization of the source of pain, but C fibers do not reach the cortex. C fibers are so poor at localizing pain that it can seem to be coming from the opposite side. Following injury C fibers continue firing, but A-deltas fibers down-regulate, so localization is poor. Guyton states; "This explains why so many patients have serious difficulty localizing the source of pain."
The Neural-Scan detects down-regulated A-delta function to locate injured nerve(s) with 95% sensitivity. Its patented modulated electrical signal selectively stimulates A-delta fibers. The higher the amplitude causing an action potential is above the normal range the more indicative of pathology. The Neural-Scan potentiometer verifies firing by detecting the amplitude of the action potential. The patient is his own control, so the test is independent of age, gender and population variables. High potentiometer amplitudes have been reported to have a close correlation with high VAS ratings. The Neural-Scan can also test C and A-beta fibers, which is useful when RSD or sympathetically mediated pain syndrome is suspected.
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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). Only a Doctor of Chiropractic will evaluate and treat for VSC. The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. 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.
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 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. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may 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, 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.
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揝ciatica? ( Also Known As- neuritis, neuralgia, sciatic-radiculitis )
Sometimes we can wake up with 憇ciatica? .... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a 憇ciatica? Frequently- the true c a u s e of the 憇ciatica? = pain in the lower back, buttock(s), thigh, calf and/or foot (even to toes); is a misalignment, a 慿ink?in the neck- more properly termed a Vertebral Subluxation. 摂Sciatica敂 is only 1/2 a diagnosis .... what is causing the sciatica?
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is often the underlying cause of sciatica and many healthcare problems. 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.
++++++++++++++++++++++++++++++++++++++++++++++
Will you get back to normal?
At this distance, I cannot say.
To Get back in shape, and back to work, with less pain: I recommend the above thorough testing, and Chiropractic treatment if appropriate. Chiropractic is safe, effective and cost effective. It could get you back; see your local family Doctor of Chiropractic armed with the appropriate tests and reports.
Watch out on the heavy use of medication, even over the counter medication (OTC). Medications often have side effects and complications:
Notes on pain meds:
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).
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). Only a Doctor of Chiropractic will evaluate and treat for VSC.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. 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.
++++++++++++++++++++++++++++++++++++++++++++++++++
I hope this helps. I wish you good luck and Good Health Naturally, your Staten Island Chiropractor friend signing off,
Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com (email newsletter)
---------- FOLLOW-UP ----------
QUESTION: Thank you so much Dr. Dolan for taking your time to answer my questions. I
was going to a chiropractor but the pain became so unbearable that I had to
go see my GP. He sent to a physiatrist (sp?) and that's the dr, I'm waiting to
get into now. My plan is, after the MRI, nerve study and lumbar injection, I
will continue with the chiropractor. I'm an avid walker and hiker here in the
Reno/Tahoe area and I think I might loose my mind if I don't get out of the
house soon. Everyone's pain and diagnosis is different, right? I think my
boss thinks that since his wife got the epidural lumbar injection and that her
pain was so/so before, that I am just like her. It's so frustrating to get people
to understand. What is spinal stenosis? I saw my xrays and all the discs look
good except for one that the physiatrist thinks is causing my pain. This has
been going on for a month now. In the past years I would get a little pain in
my back, have a few chrio. adjustments and I was fine. The physiatrist says
once he shrinks the swelling that the physical therapy will help. Of course,
after he does all the tests first. Thank you again for taking your precious
time to answer my many questions. Like I said, if I don't get out of this house
I think I'm going to lose my mind so thanks again for listening.
AnswerHello Laurie,
I guess we are both on the computer at the same time !!!
Again, sorry for your condition.
Glad to hear you have a Doctor of Chiropractic in the mix.
YES, EVERYones pain, structure, condition is DIFFERENT, even with the SAME diagnosis. Everyones reaction to a treatment is different.
I am surprised the DC did not order the MRI, this information can be invaluable.
Spinal Stenosis?_ a narrowing of the spinal canal. Some people are born with BIG canals, some people small canals; some of us have BIG feet, some have little feet.
With a narrow or small canal- DJD (osteoarthritis, spurring, disc bulging) is VERY important. With a BIG canal, the same conditions may not cause near the same pain.
again, a handout I utilize in my Staten Island Chiropractic office:
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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.
++++++++++++++++++++++++++
I am a little surprised your DC did not order the MRI. This will help the DC to decide on an appropriate treatment protocol. If you do not make progress with this DC, do not hesitate to try a different DC.
Again I wish you good luck and Good Health Naturally.
Further ques??- write again!
Thank you, your Staten Island Chiropractor friend signing off,
Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com (email newsletter)
