As a Denver chiropractor, many people step into my treatment room seeking help from their neck or back pain. Most patients have several thoughts on their mind when they enter the clinic. The primary question being; Can you help me? That being the most important, other questions such as; why they have this pain, how can I avoid this from returning, how long will it take for the pain to go away, and how much will this cost are the usual and most typical.
Although there are many causes for neck and back pain, this post will revolve around the infamous disc / disk herniation. A disc herniation can cause considerable pain and brings about the question; What is the best way to manage a disc herniation?
First, a disc herniation will cause dermatomal radiculopathy. Meaning that pain will be in typical locations on the body. I must say that if you are experiencing pain that radiates that you should see your doctor of chiropractic ASAP.
You should goto the emergency room if you have: cauda equina syndrome, epidural abscess, or severe and progressive neuromotor deficits.
A review of the literature key points include: (from October 1 issue of American Family Physician)
1. If red-flag findings are absent, a patient with sciatica should try conservative management for up to 6 weeks before obtaining imaging studies and considering surgical approaches (evidence rating, A).
2. Patients should be advised to stay active (evidence rating, A).
3. Nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants may be effective for nonspecific low back pain but have not been extensively studied with lumbar disk herniation pain (evidence rating, B).
4. Systemic steroids are no better than placebo in the treatment of lumbar disk herniation pain (evidence rating, A).
5. If symptoms persist after 6 weeks, or if there is worsening neurologic function, imaging studies and invasive procedures may be considered.
6. Computed tomography and magnetic resonance imaging provide similar sensitivity and specificity for lumbar disk herniation, although magnetic resonance imaging provides a more detailed evaluation of the nerve roots and soft tissues of the spine.
7. Most patients with lumbar disk herniations improve after 6 weeks.
8. Because there is no difference in outcomes between surgical and conservative treatment after 2 years, patient preference and the severity of the disability from pain should be considered when treatment modalities are chosen.
9. Invasive nonsurgical treatments involve steroid injections into the epidural space or herniated disk. 10. Epidural steroid injections for acute lumbar disk herniation may modestly improve pain in the short-term but do not affect long-term outcomes (evidence rating, A).
11. The indications for emergent surgical intervention for sciatica include cauda equina syndrome, epidural abscess, or severe and progressive neuromotor deficits.
12. Selected patients with lumbar disk herniation pain that is not improved after 6 weeks of conservative management may benefit from diskectomy for faster clinical relief (evidence rating, A).
13. Compared with surgical diskectomy, microdiskectomy, which involves disk removal with the aid of a surgical microscope, has similar surgical outcomes.
14. Diskectomy has similar long-term outcomes as conservative or nonsurgical management (evidence rating, A).
As noted from the Journal of American Family Physician, conservative therapy should be tried before imaging. The chiropractor is one of your best choices for conservative management of the disc herniation.
To Your Health,
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
303-455-2225
Most people are not familiar with the sacroiliac joint or SI joint. Most commonly patients erroneously refer to it as their hip joint. You have two SI joints, one on either side of your sacrum.
Your pelvis is your center of gravity, and is responsible for bearing the brunt of your weight with walking, lifting, and moving. So, with this joint having to do so much work, it has to withstand lots of force and is so built to do this.
On occasion this joint does not quite work right, and can cause considerable amounts of back pain that can literally stop a person in their tracks. It is estimated that problems with the SI joint may account for up to half of all low back pain cases.
So, what causes dysfunction in this joint? Here is a list of common causes:
- Fall to buttock(s)
- Misjudged step (e.g. off curb, stairs, etc.)
- Prolonged bending, stooping, squatting, etc. Overuse & fatigue.
- Pregnancy (ligamentous laxity & altered load)
- leg/foot problems (leg length discrepancy, pronation syndrome)
- Asymmetrical loading (e.g. sitting on wallet, etc.)
- Secondary injury
How would you know if your SI joint is the cause of your back pain? Presentation can vary from person to person, but in general looks like this:
- local pain around the SI joint, possibly radiating to buttock or groin
- referred pain to thigh, usually not past the knee, and a vague feeling of numbness or tingling in the thigh
- pain may be aggravated by weight bearing, moving from sitting to standing, bending.
As a doctor, I must advise you that if you are having any pain that radiates, that it should never be ignored and you should consult your chiropractor immediately.
As a chiropractor here in Denver, I manage problems with the SI joint almost on a daily basis. The beauty of this problem, is that chiropractic adjustments can do wonders for this condition. I’ve had patients have their pain cut in half with just one adjustment.
Now every patient responds differently to treatment, but in general, 2-3 weeks of treatment is all that it takes to resolve the problem.
Being a Denver chiropractor, I enjoy treating the SI joint. First of all, it can cause lots pain, and second, it is an easily treatable condition.
In Health,
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
303-455-2225
