LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Low Back Pain

LUMBAR DISC PROBLEMS? YOU MAY HAVE THIS…

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Nothing in the body happens in a vacuum.  Every single systems interacts with every other system.   People at increased risk for heart disease are at increased risk of colon cancer.  Diabetes increases the risk for Alzheimers and Parkinsons.  So what about disc degeneration / arthritis of the lumbar spine?

First of all, we need to understand what contributes to disc degeneration in the lumbar spine.  Several factors have been identified.  Genetics may play a role, but it’s likely to be the smaller role.

There are some strong associations between cardiovascular disease and disc degeneration.  The inside 2/3 of the disc does not have its own blood supply, but rather gets its nutrients from small blood vessels in the bone of the vertebral body above and below.  These small blood vessels may very likely be what links heart disease and disc degeneration. 

Early atherosclerosis (plaquing of the arteries) due to cardiovascular disease, will reduce blood flow through these small blood vessels and thereby reduce nutrient delivery to the inside of the discs.  In addition, the outer 1/3, which does have its own direct blood supply, will also be affected by this plaquing.

Less nutrients means less ability to heal which means a greater likelihood of breaking down faster.  This leads to early onset disc degeneration.  So what does this really mean? 

It means that disc degeneration, because it is occuring throughout the body, is not going to be limited to only one area of the spine.  Supporting this, this study finds links between lumbar disc degeneration and cervical disc degeneration.  As a matter of fact, in those patients who had lumbar disc degeneration, almost every one (98%) had cervical disc degeneration.

However, in the control group who had neither low back or neck pain, 88.5% had disc degeneration in the cervical spine.  Wow!  That’s a really high number.  Keep in mind these people were pain free, and yet the vast majority had “problems” found on MRI.  Consider this next time your primary care doctor orders an MRI and refers you for a surgical consult…

WHAT HAPPENED AFTER YOUR MRI?

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It doesn’t happen all the time, but it is not uncommon for a patient to call our office to cancel an appointment because they went to their PCP, the PCP ordered an MRI and now they have to see a specialist. Sound reasonable?

There are multiple layers of “wrong” in this scenario. First and foremost is that, in most situations, we have already identified whether a disc bulge / sciatica was present based on talking to the patient and our exam finding. At this point, without any type of red flags, it is never, ever recommended to order an MRI this early in the treatment. Happens all the time, but apparently, those ordering the MRI are not reading the studies.

Not only is this a tremendous waste of resources, but it is well documented that this starts the patient on a MRI to epidural to surgery pathway, despite evidence that this is not the best pathway for the patient. It is also far too common for the PCP to steer the patient away from chiropractic care to a specialist–when chiropractic care is exactly what they need.

So what about the epidural’s effectiveness in the case of chronic (>12 weeks) radiculopathy (leg pain)? This particular study finds it worse than worthless—actually giving a small injection of saline was massively more beneficial than the steroid injection (Oswestry change after 52 wks– saline 14.3 points improvement, epidural 1.9 points worse). So basically, the epidural clearly made the patient worse as time went on.

The bottom line is that chiropractic care, for all musculoskeletal complaints, is the best place to go to get the best outcomes for your pain. Let the chiropractor decide if an MRI and epidural is appropriate.

MY DAD HAD LOW BACK PAIN, SO I GUESS I’LL GET IT

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It is not an uncommon belief for a person to think that, because one or both of their parents suffered from low back pain that they, too, will suffer from low back pain.  While genetics may play a role, it is nowhere near the most critical one.

This particular study on twins finds that genetics only play about a 11-13% role for patients who have both low back pain and lumbar disc degeneration.  This means that there are other factors at play in the risk for developing low back pain.

In general, the better we take care of ourselves, the lower our risk of developing disc degeneration.  This means adopting a lifestyle that avoids diabetes, exercising and maintaining flexibility through things like yoga.

You see, the discs of our spine do not have their own blood supply. Rather, they are fed nutrients through smaller blood vessels.  So what happens if plague begins to form on these important blood vessels bringing nutrients to the disc?  You guessed it–reduced nutrient delivery and the disc cannot keep up with physiological demands so it begins to break down.

So, protecting your heart will also protect these important blood vessels which will, in turn, protect the discs of your spine.  Certainly other factors like imbalance, poor posture and past trauma play a role as well, but I do not feel that the role is as great as protecting the blood vessels that feed nutrients to our discs.

The lucky thing is that an anti-diabetic lifestyle just so happens to also be an anti-heart disease / pro blood vessel health lifestyle.  See how nicely that works out?  Just when you thought you were going to have to pick a disease you wanted to avoid with lifestyle..

I CAN’T SEE A CHIROPRACTOR–I’VE HAD SURGERY!

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This is certainly a phrase I’ve heard many times in the community.  Usually someone stating that there is nothing that chiropractic can do to help them because they’ve already had surgery.

Obviously, seeing a chiropractor BEFORE the surgery in the hopes of avoiding the surgery altogether is the preferred method, but should you miss that opportunity, fret not.  Somehow, when patients unfamiliar with chiropractic care envision a treatment session in a patient who has had surgery or maybe has osteoporosis, it involves the chiropractor jumping off from the desk to deliver a ninja-like adjustment.

I know that in our office, with the heavy soft tissue approach, we have been able to provide significant relief to those patients who have had surgery and who thought that there was nothing that could be done to help with their pain levels.

While this study is a case series and involved lumbar surgeries (the best response being those with the more invasive surgeries), we have seen both neck, ankle, wrist, shoulder, knee and low back surgeries that did not resolve the complaint but responded well to care in our office.

So, next time you hear someone say that they can’t see a chiropractor because they’ve had surgery, point out this study.

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DID YOU HAVE AN MRI FOR LOW BACK PAIN?

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There are definitely times when knowing less is a good thing.  It occasionally happens where a patient who has signs and symptoms of a disc herniation presents to our office.

Based on an exam and the history given by the patient, disc involvement (bulge, herniation, rupture, etc…) can be diagnosed and treatment started.  A full blown disc bulge may take several days to start to show a response, but the outcomes are usually very good.

Sometimes, it is not a disc problem that is causing the patients’ low back and leg pain.  Sclerotogenous referral from the hip (I really love the word “sclerotogenous”–makes me sound smart) or involvement of the fascia is also notorious for causing leg pain.

Sometimes, it may take a few days to be able to tell the difference.  Certainly an MRI would be helpful, right?  Not so fast…

You see, there is a large chunk of the population that has disc abnormalities on MRI (we can argue about the percentages, but let’s just agree that not all disc abnormalities on MRI cause problems).  We have also seen that MRIs done before and some time after a patient has a disc bulge don’t change much, even though the pain may be gone.

This particular study contributes to what any chiropractor can probably tell you.  MRIs increase the risk of having surgery.  Sounds strange…I mean–how could having an MRI affect your back?

It’s the mindset and the potential diagnosis of a disc problem, even if the disc problem is not what is causing a patient’s pain.

In this study, when the primary care doctor or orthopedic doctor had a financial incentive to order an MRI (usually because the unit was installed in their clinic) the number of MRI for low back pain went up.  In addition, in the orthopedic surgeon’s office, the number of patients getting surgery went up 34%. 

Just something to consider the next time you THINK you need an MRI… 

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BUT CHIROPRACTORS WANT YOU TO COME BACK IN FOREVER…

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As a chiropractor, I obviously have an opinion on this one.  My profession has had a tendency to get dirt flung at it in the past.  We’ve always been treated as the red headed stepchild of healthcare despite very strong evidence that we are damn good at treating patients effectively and saving money while doing it.

But what about those chiropractors that want you to come back endlessly week after week after month after month, even after the pain’s gone?

Personally, in our office I always explain to patients that, so long as they avoid gravity, stress and computers they’ll probably be just fine going forward.  After all, chiropractic care is an intervention–I’m doing something to the patient that they can’t do themselves.  I do not believe that, in a perfect world, we should need any type of intervention.  But, given the reality of our lifestyles, however, my biased opinion is that some degree of regular care is good.

That may mean weekly for those with decades of musculoskeletal “baggage” from decades of improperly treated pain.  Or every month or every few months for the average person.  This has always seemed to work out well, although this has been limited to my own experiences and opinion.

Now this particular study adds some evidential weight to my personal experiences.  This looked at patients with chronic low back pain.  Basically, the participants in this study who were seen for an initial course of chiropractic care but were seen every other week after the initial trial of care did better after 10 months than those who did not receive the regular care.

Maybe we’re not so crazy after all… 

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THE “WAR ON DRUGS” WAS LOOKING AT THE WRONG DRUGS

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In 1971, President Nixon declared a war on drugs.  Unfortunately for our country, that war was limited to illicit drugs.  For the next several decades, drug overdose deaths were largely attributable to these drugs.  However, beginning just after this century, these statistics began to take a scary turn.

In this recent report from the CDC’s report looking at data in Florida from 2003-2009, the numbers of drug overdose deaths increased 61%.   NONE of this increase was from cocaine or heroin.

 The death rate for prescription drugs increased 84.2%, with the greatest increase from oxycodone (264.6%), followed by alprazolam (233.8%) and methadone (79.2%).

By 2009, the number of deaths involving prescription drugs was four times the number involving illicit drugs.  Four times.  Were exactly is the “war on drugs” when it comes to prescription medications?  Glaringly absent.

Notice that these drugs are primarily used for pain control.  While some cases may be for intractable pain from situations like cancer, pancreatitis or kidney stones, I frequently see patients coming into my office on Oxycodone for a condition that would’ve been gone had they seen a chiropractor first.

So long as mainstream medical providers like PCPs, orthopedic surgeons, neurosurgeons and physiatrists are seen as the first point of entry for musculoskeletal complaints, the risk of getting drugs prescribed and aggressive procedures performed will remain high.  In general, for at least one of the larger insurers in the US, chiropractors provide about a 30% cost savings when they are seen first.

Other studies confirm that imaging, surgery and, most importantly for this study, pain medication use are much lower under chiropractic care.

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HAD A SPINAL FUSION? WAS THIS MATERIAL USED?

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I would have to say that in all but the most astute, few dug deep enough into their surgical procedure of fusion to find out how the surgeon was going to help the bones fuse together.  As a chiropractor, obviously the idea of fusion scares the heck out of me and I fear that far to few of spinal fusion patients have undergone a solid course of chiropractic care.

Back in 2002, the FDA approved the use of a type of cement in spinal surgeries.  This cement, called recombinant human bone morphogenetic protein-2 (rhBMP-2), was designed to cause your body to produce more bone to allow a faster and more complete fusion between the vertebrae that we being fused. 

Sounds great, right?  Unfortunately, in most of the studies conducted on this compound (the manufacturer was Medtronic and the product was called Infuse (R)) they left a little something out.  Adverse effects.

Of 13 studies done by Medtronic, not a single one reported adverse effects related to the use of this compound.  In this particular study, the authors took a new look at the data and found an adverse effects in 10 to 50% of the patients that received the compound.  Additionally, there were very strong financial ties between the researchers of these studies and Medtronic.  The authors of this current study call the original research “biased and corrupt.”

Wow.  I have had a select few patients in my office who, quite frankly, we tried everything possible to keep them from having surgery and we not successful.  I see a need in the right time and place for spinal fusion when EVERYTHING else has failed.

But what about the patients that were steered into spinal fusion far too soon (it is well documented that those who see a surgeon or primary care doctor first instead of a chiropactor, are more likely to have surgery)?  And what if these patients had a surgery that used this compound and they were in the percentage that experienced adverse effects?

All too often in medical research the story is the same.  The data is manipulated to favor the funding biotech or pharmaceutical company.  The doctor or surgeon places false benefit on the product leading to recommendation to patients.  It is ultimately the patient that may pay for this transgression.

The bottom line is that we need to always, always, always do our due diligence with anything being done to our bodies if it was not in the original plan by Mother Nature.

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