Question
I thank you for your very informative response. Would it be possible for you to recommend a qualified Chiropractor or physical therapist in my area? Or perhaps you could recommend a site that I could use to search for one. I live in the Columbus, GA area. I thank you in advance for all your help.
-------------------------------------------
The text above is a follow-up to ...

-----Question-----
My wife has been diagnosed with having 2 degenerated discs. Located, I believe between L1, L2, AND L2, L3. It has caused her severe pain including sciatic nerve pain in her legs. We have made repeated trips to the ER late in the evenings for pain injections. We have also seen orthopedic specialists in the field of spinal injuries. We have had little success. She has basically been relegated to picking between a life in constant fear of her back "going out" or a double vertebral fusion. My question is do you think this is the type of condition that a chiropractor can help her with?
-----Answer-----
Matt,

There is a great deal to be said on this subject. I shall attempt to summarize some of the more important points:

Degenerative discs are a common magnetic resonance imaging (MRI) finding. Degenerative discs may or may not be associated with low back pain.

Herniated discs may cause pain due to chemical irritation of nerve roots, or when the nucleus pulposus (the gel-like substance found in the inner-most part of the disc) escapes through tears and fissures in the outer fibers of the disc, and is interpreted as a foreign substance by the immune system. An immune and inflammatory reaction occurs in this case because the disc does not receive a direct blood supply, so its contents are not recognized by the immune system when they come into contact with the blood stream.

Because the disc does not receive a direct blood supply, it must absorb its nutrients through the vertebrae above and below it. When the endplate of the vertebra becomes degenerative, disc disease often follows, because the process of nutrient absorption (called imbibition) is impeded.

A true "pinched nerve", usually the result of a disc herniation, will produce numbness and loss of function, not pain.

The L1-L2 and L2-L3 discs would not produce sciatic neuropathy; sciatica would be a result of an L5 disc herniation abutting the S1 spinal nerves.

Fusions have recently been criticized in the medical literature as being performed too frequently with poor or mediocre results. One recent report on lumbar spinal fusions, presented at the 2006 Primary Care Forum in Amsterdam in the Netherlands, found that of 725 subjects on workers抍ompensation claims who opted for lumbar spinal fusion surgery as treatment for back pain in this study, 64 were still off work more than a year after the surgery. Only 6 had gone back to work and stayed for a full year.  Twenty percent had significant complications. There was a 27 reoperation rate during follow-up. Additionally, fusion surgery appeared to lead to an increase in the utilization of narcotics for pain relief among these subjects. Ninety percent were still taking narcotics at follow-up.  

In my opinion, given your wife's symptoms, I would not recommend thrusting-type spinal manipulation techniques. The research shows that the use of appropriate lumbar stabilization exercises can be very helpful in empowering a patient to control a significant amount of their low back pain symptoms in cases similar to what you have described. I opt to use soft-tissue manipulation techniques with patients who have chronic, severe low back and disc problems, in conjunction with appropriate spinal rehabilitation exercises. A good chiropractor or physical therapist can be of assistance to patients in this regard.

I also often recommend that a patient receive acupuncture, which can be very helpful in reducing muscular tension and in controlling pain. I refer my patients to an acupuncturist for co-treatment.

One book I recommend for additional information is "Treat Your Own Back," written by the Australian physiotherapist Robin McKenzie.

Other factors that exacerbate low back syndromes include general deconditioning and a sedentary lifestyle; obesity; smoking; dehydration; and diets that produce inflammatory reactions (typically diets high in refined and simple carbohydrates, sugars, animal products, and lacking in sufficient fresh fruits and vegetables).

Low-impact exercises such as swimming and light walking can be helpful in providing joint and muscle mobility without straining the back.

Your wife shouldn't live in constant fear of her back collapsing on her. She needs to be instructed in the right rehabilitative maneuvers to help her regain control over her back and her life.

The bottom line is that the 揷ure?for your wife抯 chronic back pain is probably not going be found strictly in the hands of a chiropractor or physical therapist; manual therapy is helpful, but appropriate rehabilitative exercises are a must for obtaining optimum results.

I hope that this answers your question. Best wishes, and good luck.

Answer
Matt,

I just got a referral for you from a colleague in Georgia- try Dr. Jim Aspinwall in LaGrange
at 706-884-8360.

Happy New Year!