Question
Hello - I injured my lower back doing shrugs at the gym 8 months ago. I have always been in great health - I am not overweight and exercise regularly. I was diagnosed with 2 disk bulges in L4/L5 and L5/S1 (mri & ct scan). I went to an orthopedic surgeon several times. He suggested PT, which I tried, but all exercise inflamed my lower back. The pain was always localized to the lower back with muscle spasms in the mid-back as well. I decided to try a chiropracter last week, since no other options were releiving my pain to a suitable level. The chiropractor took x-rays and indicated that my disks were approximately the same height and he could see no damage. I filled him in on the results of my MRI and CT report, to the best of my ability. He said the x-rays show my right hip is higher than the left, and decided to do an adjustment. I laid on my side on a table and pointed my knees one direction and my head and shoulders another. He pushed down on my knees and the table dropped, and my entire lower spine popped. There was a flash of pain, but it was fine after a few seconds. He repeated the adjustment on the other side. I had previously pinpointed the source of my pain to the sacral area (the skin was hot from inflammation below), and the pain radiated a few inches from the sacrum in all directions. The Chiropracter did a sacral adjusmten, where he I lay on my stomach and he pushed very hard on the sacrum and the table dropped. He repeated this 3 times. The next day, I could barely walk. There was excruciating pain down from my butt and down the back of both legs, through the calves and ankle, and on my left side, down the bottom of my foot. I went for several treatments since them, but no adjustments. Ultrasound, E-Stim etc. Prior to this adjustment I never had sciatic pain down my legs, and my pain was more irritating than debilitating. Is it possible these adjustments did serious damage to my disk(s)? It has been a week and the pain has not let up the least. The last time I went, the doctor tried to adjust the sacrum again, which feels like it is broken right now, and he used the drop table unexpectedly. I told him absolutely no adjustments on my until this pain gets under control. I am only willing to undergo ultrasound and e-stim therapy. Sorry for the long story but I am trying to get a second opinion (informally) as the chiro seems to think that this is all a coincidence and I have a very different opinion. Thanks in advance for taking the time to answer my questions.

Best Regards,

Shawn

Answer
Hello Shawn,

Sorry for your pain, sorry the adjustments did not help.

"diagnosed with 2 disk bulges in L4/L5 and L5/S1 (mri & ct scan)"
"but all exercise inflamed my lower back."
"pushed very hard"
Also of significance you describe multiple adjustments (adjusted on your side- both sides, adjusted prone & 'pushed very hard' "

Shawn, often disc bulges are just as painful, just as troublesome as disc herniations.  The Key is inflammation. You state 'all exercise inflamed..."; this should have tipped off the Doctor of Chiropractic that less is more.

Some people cannot tolerate a lot of 'work' done upon them at the first visit, first week, first month even. Just as some people get sore after exercise, some people have pain after exercise, some people are immobilized after exercise, and some people feel great after exercise; the Chiropractic adjustment is very similar.

As a young, new Staten Island Chiropractor, I would adjust anyone and everyone any which way and every which way I could on their first visit.  Sometimes they felt  GREAT after their first visit- the old chiropractic 'miracle story'-  "....I walked in all bent over, in pain, and walked out straight and feeling great...".  But sometimes some patients would feel worse.  And when the patient feels worse, they are likely not to return (sad when they are appropriate for Chiropractic care) or be less compliant (not listen to the Doctor of Chiropractic, not follow through on instructions).

After 25 years of practice at the same Staten Island Chiropractic office I have become more patient and work with the body- looking to produce good health naturally.

Chiropractic has many techniques.  From the agressive forceful maneuvers to low force techniques like SacroOccipital Technique, Activator technique, slow low mobilisation, up to the forceful adjustment s that people are most familiar with.  Also, adjusting one segment- for instance just adjusting one side; could have been more then enough for you that first day.

Your family Doctor of Chiropractic sounds like he (she) was working very hard on you, trying to get from here to the moon in just one mission.  It took years and many missions to put a man on the moon; it can sometimes take many visits to get to where you want to go in chiropractic.

Your description also seems to describe a very vigorous chiropractic.  Again, different chiropractors, different techniques, various wide array of approaches.  People who are hurting (inflamed when they first walk in) are treated super-conservatively by me and most Chiropractors.  First visit: history, exam, Xrays, referral for other tests if indicated, and SOT or activator with physiotherapy at the office, recommendation for appropriate nutrition, exercise and heat or cold.  Sometimes a new patient will ask, "you are not going to 'crack' me?",,, first visit?- I probably will not.  People walk in for their maintenance adjustments, NOT in pain, NOT inflamed, and long term patients- I know their body, their body is used to chiropractic; THAT is the patient I am more vigorous with- they get the bilateral adjustments, the forceful work (IF indicated by findings THAT visit).

Sounds like your disc bulges could have been irritated by the vigorous approach your chiropractor took.  Milder chiropractic techniques could have been used, and could be used now.  The idea that you do not want to be adjusted should be modified to not being adjusted forcefully, SOT or activator, or perhaps the Chiropractor knows other 'soft tissue', 'low force' techniques could be utilized.

Harder is not better.  All at once is not advisable. Existing disc bulges are easily irritated.  Slow and steady wins the course.

Yes Shawn, over ambitious or overly vigorous technique could have upset things.  If you will pardon me,,, there is an old story in Chiropractic school:  Doctors of Chiropractic make a mistake- chiropractic failures are left sore, sometimes painful, and left with a big mouth to tell everyone of the problems "chiropractic" caused; , , , Doctors of Medicine are lucky- when the MD makes a mistake, no one knows, medical mistakes are buried with their mouth shut.  Please notice I put "chiropractic" in quotes; it is not "chiropractics" fault that things did not work, it is the single overly ambitious DC's fault.

P.R.I.C.E. - Protect, Rest, Ice, Compression, Elevation:  protect rest ice your lower back.  Your problems should heal.  If you feel they are severe enough problems- certainly complain/ communicate to your DC or change to a different DC.  If you feel problems are severe enough, perhaps it is time for a new MRI to evaluate the area.

Chiropractic is extremely safe and effective.  According to studies chiropractic does not herniate discs or fracture bones.  But aggressive chiropractic can certainly leave you sore.

I wish you luck.

As always, this article is for discussion purposes only.  A conversation with information and education, not to be construed as a doctor/patient relationship. Specific evaluation, DX, TX, RX, PX must be performed in person by a treating health professional.

Thanks, Good Luck, and Good Health naturally!

Victor Dolan, DC
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com  (email newsletter)