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.
Finally! Mr S first consulted me six months ago. Aged 75, he had had pain for fifteen years in the low back. X-rays revealed advanced degerantive changes in the facet joints. He got sufficient relief in the first month to keep coming, realising that he had tried everything else, without success. With the elderly, we try to use less power, less "brute force and ignorance", more kindness, but at his last six-weekly consultation I decided to give him a "goede pak slag" (a good hiding!). All smiles today, he can now get out of bed without pain every morning. Just some stiffness in the neck. Sometimes, brute force without the ignorance, measured and carefully applied, is the only answer. Sometimes. Plug "lumbar facet syndrome" into this search engine if you want more details on the condition:
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Marinka is only thirteen years old. When her mother first brought her a year ago, she could barely walk, the pain in her groin was so bad. On examination, it was clear that the range of motion of her right hip was grossly INCREASED. Normally not of concern in a child, but when I palpated the capsule of her hip, she screamed with pain. Of great irritation, her doctor refused to order X-rays. Ridiculous for a child to have X-rays! However, I was fairly certain the child had Developmental hip dysplasia (DDH), probably a mild case missed by the paediatrician at birth. Her mother, a woman not to be trifled with, went to a partner in the same firm, who agreed to refer Marinka to a orthopaedist. Indeed DDH. This morning Marinka said she has no pain in the groin, she can walk and even jog a little. What was interesting was that she volunteerd: "If I do my exercises in the morning, I have no pain in the groin. But if I forget... I get the account!" Marinka understands that she can hike and do normal things, but long distance jogging and marathon hiking is not for her. After all, only two-thirds of the hip is in contact with the cup. Interestingly she has been hiccuping a lot lately. I wonder if adjusting the subluxation of C5 will fix it. The Phrenic nerve C3-C4-C5 keeps the diaphragm alive. Why do we hiccup ...?
Mr B is 33 years old. He has had low back pain since he was 12 years old, but it's been much worse the last 5 years. 15 years ago he went to a chiropractor and obtained considerable relief, but was forced to stop because his insurance wouldn't pay for Chiropractic. Cezar posture treatment, physiotherapy and a special back school didn't help. All ranges of motion in the mid/ upper lumbar spine were painful. The X-rays told the story: Scheuermanns disease. Scheuermanns is usually in the thoractic spine, and then it's usually not a serious condition. But in the lumbar spine, it's always difficult. It was good see Jan this morning. "Aardig" said he. Pretty good. He's wearing the heel lift for a short leg, but I had to chivvy him a bit again about his exercises. When your teeth stop hurting, do you stop flossing and brushing, I asked. Sheepishly he said no, and we went through the exercises again. And added a more difficult core exercise. He comes once a month for maintenance.
SCHEURMANNS DISEASE ...
Mrs P has had foot pain for years. She consulted me yesterday for her six weekly treatment. Her foot turned out be remarkably simple and straight foward. Five treatments of her foot and she hasn't had pain for several months. But now her low back is playing up...
FOOT PAIN ...CHIROPRACTIC COALFACE 2: PAIN"As the pain that can be told is but half a pain... so the pity that questions has little healing in its touch." Edith Wharton, novelist (1862-1937) There's no pain like heart-pain. It's been an on-going saga but Granny was broken today when she told me that her daugher's breast cancer has progressed into the ribs and lungs. It all started a year ago when she was 31-years old and 3 months preg. Pity and sympathy have little healing in their touch, perhaps the sqeeze of her hand and shoulder when working on her neck and carpal tunnel. She has to be strong, I told her, she will be the mother to the child... fortunately Granny is responding very well to chiropractic, but it doesn't touch the heart pain, I'm afraid. The Dutch saying is: "Every house has its cross." So true. You be strong too. It's one of the reasons I'm a Christian. Just knowing that Jesus is there, is the best healer of heart pain. He is the bread of life, and feeding on Him every day is what relieves my pain... His touch does have the healing that mine does not. Interesting research in the Netherlands suggests that we have the highest breast cancer rate in the world because of too much animal protein in our diets. May I suggest a change to our authentic hummus recipe? A move to more vegetable protein makes sense... and it takes only four minutes to make.
AUTHENTIC HUMMUS RECIPE ... CHIROPRACTIC COALFACE 2: LOWER BACK AND LEG PAINTwo weeks ago I was first consulted by a young man with severe leg pain radiating to his right leg. What was ominous was the so-called crossed sign: raising his left leg produced sharp pain in the right leg. Not good.The pain started in his back three months previously, and just got worse and worse under his doctor's regimen of pills. There was slight improvement in the signs (the crossed sign became negative), but no lessening of pain, after four chiropractic treatments and he's been whisked into surgery. Whilst I could give him no guarantee, the bulge seen on MRI was large, I was disappointed that after three months of pain, he was pressured to go under the knife without a solid attempt at chiropractic. My advice: don't let anyone bully you when it comes to health. Listen to your doctor, your chiropractor, your spouse? and then make up your own mind. It is after all your body...
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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