(Keywords: arthritis in lower back, back arthritis, lumbar spine stenosis, chiropractic help, arthritis of the back
ARTHRITIS IN LOWER BACK. Sometimes I am utterly humbled by the power of Chiropractic. When you as a practitioner are faced with a case history like this one, you absolutely know that Chiropractic Help has to do something special... it's an awesome responsibility.
Mrs P, aged 69 first consulted me two months ago with a fifty-year history of low back pain. Her mother too had a horrid back. For the last year it had been unbearable and the pain in the right buttock and both legs despite various medical treatments was disabling, and walking had become very difficult. Contrary to most backs, sitting caused no pain, and bending forwards relieved the pain. Extension, backward bending, was very painful.
It all added up a serious diagnosis: Lumbar spine stenosis. Call it back arthritis if you will, affecting the spinal nerves, and often the spinal cord itself.
There was nothing good about her case. As a smoker, I was concerned whether she would respond at all. Despite no mention on the radiologist report there are strong indications of heavy calcification of the aorta, the large artery suppling the kidneys, bowels, other organs, lower spine and legs. I need a second opinion, as I'm of the opinion there is an aneurism brewing. Only smokers and heavy drinkers get them. Many, perhaps most, Chiropractors, concerned about being sued wouldn't take on a case like this. The risks are high, the probability of a good outcome poor.
EXAMINATION: ARTHRITIS IN LOWER BACK
The first obvious abnormality was a short left leg, between 5-7mm. Sometime authorities think this not significant, but it's my fist step in a difficult case like this. She now wears a heel lift of 5mm in her left shoe. That immediately partially corrected the spinal curvature.
There were disturbing neurological findings in her left leg. Weakness of the quadriceps, change in its reflex, and numbness on the side of the leg.
The Femoral nerve stretch test was positive: pain in the upper leg.
Thirdly, her sacroiliac joint anatomy was absolutely haywire. Orthopaedic tests were positive, and the fixation I would describe as like 'concrete'. Absolutely jammed, stuck, fixated, subluxated... and badly.
No wonder the poor woman couldn't walk. All in all a tough call.
TREATMENT: ARTHRITIS IN LOWER BACK
The question is where to start with a case like this. Back arthritis is challenging for the practitioner, it's widely acknowledged. There are so many problems... I chose to start with some Thompson drop treatment on the sacroiliac joints and a very gentle side-posture drop bilaterally. There were no audible releases.
I haven't needed to change the treatment, it has been so effective. It's not perfect of course, but she has little pain, plenty of stiffness but she is faithfully doing my exercises. She can walk again! With the heel lift. I now need to get to her feet to see if there are fixations, and a dropped arch.
She's had nine treatments in nine weeks, and we are now spacing them out: the next over three weeks. When a 69-year old woman starts flirting with you, then you know it's getting better. I love the spirit of so many elderly Dutch people. So many of them at 70 and 80 and even 80+ are younger than some people I could name in their twenties. It's those brewing aneurisms that are going to get her, and probably quite soon. There are more than likely others in her head and neck. I don't touch her neck! She is on blood pressure treatment. Hopefully it'll be a quick and clean stroke, not on the day of a chiropractic consultation I hope, but it's coming... whether I treat her or not. We have discussed these things. She knows the risks, but her quality of life has improved to such an extent that she presses on. And so do I. Gently! Stop smoking? Never!
A hereditary condition: ARTHRITIS IN LOWER BACK
Mrs P is doing incredibly well, and now comes in every three weeks for maintenance care ... Yesterday she told me... Her great niece, aged 17 had Harrington rods put in her spine about four years ago for the scoliosis. It was apparently reasonably successful. But last week, the lass went in for a further spinal fusion at L5-S1 - and woke up with a foot-drop. Nuff said...
Update: Mrs P continues to do well. We have now exended the maintenance treatment to every six weeks. And, the arthritis of the back is no different. Another X-ray would probably look just the same. But she's a different woman. The arthritis of the back wasn't per se the cause of her pain.
The love of North Americans to sue their doctors at the drop of a hat, means that many patients with conditions like this go untreated, or undertreated. They must suffer; the Americans and Canadians have so intimidated their doctors that few would have the temerity to take on a case like this.
Enough said, nothing will change the culture of greed that characterises litigation...
In a landmark case a Chiropractor was successfully sued a few years ago after a patient had a stroke SEVENTEEN days after a chiropractic treatment. Mrs P could have one any day, and it would have absolutely nothing to do with chiropractic. The treatment with drops is really quite gentle.
It's said that a country gets the politicians it deserves. And certain other professions too. I'm sad.
ARTHRITIS IN LOWER BACK
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Hyaline cartilage is the super-smoother-than-ice (literally) substance that lines the ends of bones within a joint. The friction coefficient is lower than that of ice-on-ice. It's covered with highly specialised chemicals that retain water.
This cartilage has no blood supply of its own and its nutrients and oxygen comes from the fluid within the joint. If that fluid is deficient... or isn't swishing about, ARTHRITIS of the back.
Taking anti inflammatory drugs and particularly dual
antiinflammatory drugs for extended periods for arthritis in lower back
is nothing but a snare and a delusion. Those arthritic joints need to
start moving, that's their salvation, not drugs except perhaps in very
Perfect young pig cartilage...
Obviously I have no pictures of the hyaline cartilage lining the ends of Mrs P's bones, but it certainly looks more like the next graphic than our pig's beautiful shiny smooth hyaline cartilage.
Chalk and cheese, I can hear you thinking. Prevention is the name of the game, because once that hyaline cartilage is eroded away like this, pain and disability become the norm.
Research shows that if you are significantly over weight, that losing a lot of weight is the most important treatment you can do for arthritic hips, knees and feet. So choose: a knee replacement (or two?) or lose 50 pounds. Your call, it's probably going to be one or the other.
It's true in religion, but it's true in healthcare too. Like: "You have arthritis, Mrs Jones. I'm afraid there's nothing to be done."
It's a conviction commonly held in medical circles and light years from the scientifically proven truth. Think fatty fish, think exercise, think weight loss, think strawberries, think magnesium deficiency ( FRESH SPINACH RECIPES - the richest source of magnesium.) ... think Chiropractic.
But yes, sometimes it is difficult. Always? Definitely not!
Every chiropractor could write casefile after casefile like these. This lady has severe wear and tear in her back, two total hip replacements, and yet after chiropractic help can walk again without pain. Degenerative Lumbar disc disease casefile ...
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Interesting challenges of the day
1. Mr B has the trophy for the most acute neck in February. He has quite advanced lower neck arthritis for a forty year old, thanks to a severe fall on the head from a trampoline. But this is upper cervical pain. Right rotation is simply impossible. Luckily he is improving rapidly, eighty percent better he says after three treatments. See cervical facet syndrome.
2. Mrs C is a new patient with a long history of lower back pain, hip pain and pain in both feet. We'll see how we get on, Rome wasn't built in a day.
3. Miss U sprained her ankle two months ago, wearing high heels. She still has severe mid foot pain. Xrays and perhaps a CT scan.
4. Mr V is 86 years old and hurt his back helping his wife into the car. Just one treatment of the sacroiliac joint and he's eighty percent better. It's not always like that.
5. Mr W lay on his back knocking down a pillar. Turning his head causes severe vertigo. He needs the Epley exercises, not pills, research shows. Update, he's fine.
6. Mrs X, a young mother has severe lower back pain, with numbness down the posterior thigh, calf and side of foot. It started after a long drive in the car. Update, she's forty percent less painful after four treatments, but the leg is still numb. Update two; she 60% better, but it's slow and is going to take the full 6 weeks to heal. Further update; a setback, after lifting her child she now has leg pain. It's going to the be difficult.
7. Mrs Y, a 70 year old woman is on maintenance care fo a nasty lumbar stenosis despite having to do everything at home. Her husband has a hospital acquired infection in the shoulder. After 4 operations he is incapacitated and going rapidly down hill.
8. Mrs Z, an 78 year old woman is doing remarkably well with a bad sciatica. But at over 200 lbs she is not losing weight, in fact gaining despite my suggestions. She's high risk for a stroke. Referral to a dietician to crack the whip.
9. Mr A, a 73 year old engineer, still working, is doing fine after a long episode of lower back pain. Some pain on the side of the hip remains after five treatments. Reassured him it's not hip arthritis.
10. Mrs B, a 64 year old woman has had Scheuermanns disease; it's left with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment, provides she come every six weeks or so for treatment.
11. Mr C, a young engineer fell off his mountain bike injuring his cervical spine and pelvis. Luckily both responded very quickly to a few chiropractic adjustments. Update: his neck is sore again. It all goes back to a whiplash injury ten years ago when he was rammed by a fully laden truck carrying a load of stone. Time for Xrays.
12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Both Mrs E and I can't believe how much better her lower back and leg pain are. Surgery for a scoliosis and spondylolysthesis three years ago helped greatly for one year. But then her leg went lame and weak. He was responded extremely well despite all expectations.
And so the day goes. Chiropractors shouldn't be treating the elderly? Bunkum.
Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?
Greetings, Dr B.
You helped me quite some time back with a soothing and professional
response which turned out to be exactly correct. I now consult a local chiropractor.
You write a superb newsletter, too.
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