CHIROPRACTIC COALFACE 2CHIROPRACTIC COALFACE 2, in response to the overwhelming interest in what actually happens in a Chicopractic Clinic, continues the series of weekly chiropractic answers to your problems.
CHIROPRACTIC COALFACE 2: ANKLE JOINT PAINThere is a (fortunately fairly small) group of chiropractors who still believe that diagnosis is not important. All we have to do is find subluxations, and correct them.Mr S, a 52 year old man, consulted me two weeks ago with lower back pain radiating down his leg to the foot. The chief complaint was pain in the foot. He had a back operation several years ago that was only partially successful, leaving him with nagging pain in the leg. For the last six months he had quite nasty foot pain. His assumption, and that of his doctor I might say, was that it obviously coming from his back. The neurosurgeon was less convinced but when it became clear that he was facing another back operation, Mr S decided it was time for Chiropractic help. Yes, sir! Whilst it was true that he does have a back problem, and some remaining discomfort in the leg, the Slump test (for me the gold standard for sciatica) was clearly negative. Looking further, it was immediately abundantly clear that the man was suffering from ankle joint pain. The fixation in the cuboid bone in his foot was the spoke in the wheel. It was gratifying to hear him say this morning that the 'pressure' in his foot is at least 40% less, and the nagging pain on the side of his leg was gone. After only four Chiropractic treatments. It's not yet over ... rehab is vital, or the pain will just come back.
LOWER BACK AND LEG PAINCHIROPRACTIC COALFACE 2The Mayo clinic gives moderate support for the Chiropractic treatment of lower back pain, but quite wrongly states:
"Don't seek chiropractic adjustment if you have osteoporosis or signs or symptoms of nerve damage, such as numbness, tingling or loss of strength in an arm or leg." MAYO CLINIC
Yesterday I was delighted to see a patient again who first consulted me eighteen months ago with severe leg pain, numbness and a foot drop. It all started in his back six months before; he went the usual medical route, the pain started in his leg, and then ominously under medical care, the pain in his back leg up completely and his leg was filled with flames of fire. Numbness, tingling, loss of strength, all of the above. I won't pretend it was an easy case as he is a high profile business man, and insisted on continuing at work, but I did convince him to take a roll up mattress, and do my exercises every hour. I hadn't seen him for some months. He's had six pain free months, and came in for a tweak, he started getting a few warning signs in his back. Absolutely no sign of the weakness and numbness, and Slump test was negative. The Mayo statement should read:
"Don't seek medical treatment if you ... signs or symptoms of nerve damage, such as numbness, tingling or loss of strength in an arm or leg!"
This is only an anecdote and carries no weight. But there's heaps of evidence now that if you consult a chiropractor first, you are more likely in the first place not to get those leg pains, and if you do, you'll get over them quicker, more cheaply, and back to work sooner. That's why more and more insurances are including chiropractic, and why chiropractic flourished even when no insurance paid. (PS. I stress medical 'treatment'. Investigation is fine, but having diagnosed a lower back condition, there are heaps of RCTs (the best research), many of them done by medical doctors, that manipulative treatment is then the appropriate referral.) As for the osteoporosis remark from Mayo, that's twaddle too. Just let them come and let them tell that to the elderly ladies I treat on a daily basis, and they'll be run out of town. Like the case after this. Scroll further down. But yes we do have to be careful with ribs, and I confess to my share of cracked ribs. Chiropractic too makes a (small) contribution to iatrogenic illness. But compared to the horrific side effects of anti inflammatory drugs, that's small beer!
CAUSES OF OSTEOPOROSIS, and care for ...
It was a tricky case as she has a history of TIAs and stroke. A high risk case for the chiropractic adjustment. I say high risk. That should read highER risk. With osteoporosis and a history of a stroke the MAYO clinic would probably say that both and I and she need our head's read! But, after about ten chiropractic treatments, she's one very happy lady. But yes, I do tread gently ... the truth is that even in highER risk cases, gentle chiropractic treatment is a good deal safer than all the dual antiinflammatory drugs she was taking. And a lot more effective. There is now increasing evidence, though I confess no RCTs, that this kind of hyaline cartilage damage could have been prevented, or at least curtailed if the appropriate mobilising and manipulative and rehab treatment was applied to her neck thirty years ago. In Chiropractic we believe in prevention. Medicine says, "take pills". Your choice. Oh, and of course I have got her off tea and toast, and back to walking every day. Think causes of osteoporosis long before it arrives. CHIROPRACTIC COALFACE 2
A GOOD DOCTOR - What does it take?CHIROPRACTIC COALFACE 2Three skills are to my mind important:
Yesterday was a thought-provoking day.
Why am I telling you all this? Recognise that, from your perspective, what is important is, can your doctor fix your problem. If his bedside manner is weak, he is rude, she is abrupt, they don't present you with a comprehensive plan ... it's silly to stop attending him/her when you know that they can help you. I'd rather attend a doctor strong on diagnostic and treatment skills, than the very plausible doctor with a wonderful bedside manner, but can't fix your problem. It's a compelling thought that 505 of doctors, chiropractors too, graduated in the bottom half of the class! Nuff said! Chiropractic Coalface 2
SHORT LEG - another CHIROPRACTIC COALFACE 2 study.A leg length inequality is not uncommon. Usually it's less than 2-3 mm and of no significance, but more than that it is sometimes critical.Mr P, a 25 year old man, is the simplest case of low back pain that I've had to deal with. He's had daily LBP for six months.
Whilst a heel lift is no cure-all, sometimes has no profit at all, and occasionally may aggravate the problem, it should always be considered in the case of a scoliosis caused by a short leg. Oh, yes, and a set of back exercises. He's well pleased. Nice to be told you have 'golden hands' but in fact it's not rocket science.
VertigoIf you follow this website with any consistency you will know there is one area where Chiropractors tread very carefully. It is the patient complaining of dizziness or, as it is known in medical jargon, vertigo. Hence this case from CHIROPRACTIC COALFACE 2. Dizziness is caused by many different problems.
And why do Chiropractors tread warily? Because research shows that dizziness is one of the conditions where patients may occasionally react badly to a cervical adjustment. In thirty years I have had just four serious cases, all women aged 40-50. Considering that I give about 1000 cervical manipulations per month, this makes manipulation of the neck statistically a very safe procedure. Nevertheless, all four cases had both themselves and their Chiropractor very anxious! To say the least. All four I'm glad to say recovered completely within a few days, with no lasting adverse affects.
Diabetic weight loss - our next CHIROPRACTIC COALFACE 2 anecdote.Chiropractic Coalface 2Remember, these are no more than that. Anecdotes. They will not stand up to scientific investigation. Perhaps there was an eclipse of the sun, and that's what cured them! Seriously, anecdotes are interesting, but should be treated with some sceptism. Mr S, a 67 year old obese man, consulted me a year ago with a fairly typical but nasty lumbar facet syndrome. Lumbar facet syndrome. That holds no particular problems for Chiropractic. He's been fine and comes every 6 weeks under control. It creaks occasionally. What is noteworthy is that under my badgering he's lost 14 kg. And AS A RESULT, THE INTERNIST HAS CUT HIS INSULIN BY A HALF. That's significant for a diabetic osteoporosis. Also, he's much less likely to get hip arthritis and foot pain. CHIROPRACTIC COALFACE 2
Two men aged early fifties and an elderly woman.CHIROPRACTIC COALFACE 2Last Friday I was consulted by two men around fifty, and a very elderly lady aged 85. All three were coming for their 7-10 th consultations, suffering from vertigo. One was referred by his doctor after not responding well to medication, the other with a very long history of severe neck pain and equally serious dizziness, and the elderly lady initially with severe back pain. The last two were persuaded by family and friends to consider Chiropractic. All three had normal blood pressure, obvious neck problems and most important the two men had a negative HALLPIKE-DIX test, at the initial consultation, but Mrs B a very strongly postive test with what we call nystagmus. Her eyes flicked violently from side to side and she was very giddy when I did the test. This is a test for vertigo dizziness that is emanating from the inner ear. CHIROPRACTIC COALFACE 2
More about the Chiropractic management of Vertigo Dizziness ... I adjusted the two men gently and cautiously, their dizziness clearly associated with their neck pain, and both have responded extremely well. The recent onset case, referred by his doctor, I have discharged, to return in two months for maintenance care. He's a fellow motor cyclist so we've had plenty to chat about! The other man with the chronic neck and dizziness problems, (actually he has been diagnosed with Meniere's disease) is still coming once every three weeks. He had no dizziness at all on holiday for three weeks in Italy, and still has none, but he neck is painful again after the 1500 km drive. UPDATE: Our Italian is doing fine, and has no dizziness, and minimal neck pain. The elderly lady's neck and vertigo are great, but she's done her SI in again and needing sacroiliac joint treatment.
I did not adjust Mrs B inititially. Instead we did the Epley manoeuvres for the inner ear condition, and she has continued with the so-called Brandt-Daroff Habituation Exercises at home. You can download them from Chiropractic Tips.
Read more about Chiropractic Tips. She was so excited, itching to tell me. Since starting the Brandt-Daroff exercises eight months ago, which she does faithfully every morning, she has had only one attack of vertigo, compared to SEVEN last year, each of which had her flat on her back for three days. That has other repercussions for a lady of her age. I occasionally adjust her neck, very gently. Once she reacted badly, and so I tend mostly to mobilise her neck. f It's the younger women ... CHIROPRACTIC COALFACE 2
I was also consulted at CHIROPRACTIC COALFACE 2 a few weeks ago by one of the women who reacted so badly to a neck adjustment. She was nauseous for three days after the treatment. Although she also has a neck condition, I declined to adjust her neck. Rather, we did the Epleys and I stretched her neck and used my activator, instead of the traditional adjustment. I consider her a high risk case. She was not pleased with me and decided to consult a local Physical Therapist. Low and behold, her husband told me, she had another severe spell of vertigo after his manipulation of her neck. If you suffer from Vertigo, talk frankly to your Chiropractor about the prognosis, risks and alternatives to manipulation of your neck. CHIROPRACTIC COALFACE 2
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