Zero response to any treatment for LBP

Zero response to any treatment for LBP

Right side L5 - S1 Facet Joint Arthritis ( Bone Scan Study ) Nov 2011

Dear Dr Barry,

I have had back pain for 4 years. I originally hurt my back while I was sitting in my car and I turned to the left to get the road map and I overstretched and felt some pain in my lower back on the right side.

Since then to help get a diagnosis I have had

CT scan
Bone Scan Study ie: MRI with a contrast medium

All that that these scans could detect was some arthritis at L5-S1 facet joint on my right side.

I have seen the following therapists with no success.

3 different chiropractors 10 treatments or more for each one
3 different physiotherapists over 10 treatments
2 different Acupuncturists and TCM practitioner over 20 visits
Deep tissue massage therapist over 5 treatments
2 different Osteopaths over 10 treatments
Alexander Technique 8 visits
Bowen Therapy 4 visits

I have seen a Rheumatologist who gave me a cortisone injection into my right iliolumbar ligament which did not help. She said there was nothing else she could do for me and that I just needed to manage the pain with medication and exercise and modify my activity so as not to aggravate the pain

I have seen a neurologist who said my scans are really good and there is plenty of room for my nerve roots and disks all look really good. All he could for me was give me some nerve medication called Neurontin ( gabapentin )to help with the pain and to take pain medication if this Neurontin did not help. The was nothing else he said he could to for me.

I work at a Community Health Center and a new physiotherapist just last week had a look my back and said the following.

She did some range of motion tests and said that my lumbar spine moves as a block and that the lumbar vertebrae are sort of stuck and not moving freely in forward flexion. She said this causes my back to hinge above and below the below and might be the reason for my ongoing pain.

She gave me an exercise to help loosen up the lumbar spine to free it up so that each vertebrae moves freely on it own and is not stuck to other ones.

My Question:

Are there any exercises you could recommend that will help loosen up my lumbar vertebrae and help me with this on going pain?

I have been doing your back exercises twice a day for over 6 months and my back is still sore.

Also any other suggestions you could offer would be much appreciated.

I am going to a pain management clinic in the near future to see what they can do to help me with this back pain.

Sorry about the length of this inquiry I just wanted to give a good idea of what I have been going through.

Thankyou so much for your help

Yours sincerely

Nando Melbourne Australia.

Dear Nando,
Gosh you have been persistent and thorough. Well done, and it must be very distressing that you haven't responded to ANY treatment.

These are the kinds of thoughts that go would be going through my mind.

1. Firstly that this is unlikely to be anything serious in the sense of cancer and the like, but it is serious because it's seriously disrupting your life.

2. Secondly, is this a referred pain? The spine is notorious for what we call "incidental findings". That L5/S1 facet arthritis may be COMPLETELY irrelevant. It's there but not the cause of your pain.

One particular area to look at is the Thoraco-Lumbar junction. It is well known for referring pain to the buttock and sometimes groin. Read more at Maignes syndrome ...

3. Next, do you perhaps have a short leg? Sometimes a simple insert in the shoe can make a vast difference. The difficulty being how thick, and whether it should be under your heel, or the whole sole, or a shaped (and expensive) orthotic. Leg length inequality …

I do have different exercises, but if those haven't helped an iota, others probably won't either.

4. Often knowing exactly what provokes the pain, and what relieves it, a)helps you to understand what to do, and what not to do, and b)may give the clinician a different slant on your problem.

5. Could this be an inflammatory process? Look to your diet, and in particular the ratio of omega-6 / omega-3 in your diet. If it's high then one has general inflammation: muscles, joints, blood vessels, bowel... foods to reduce inflammation ...

I really commend you for being persistent. Don't give up. Press on...

Go from Zero response to any treatment for LBP to Chiropractic Tips …

I hope this has contributed. Like to read? If so, this is my second book of chiropractic anecdotes, available on Amazon for $2.99. Bats in my Belfry … Chiropractic anecdotes from the coalface.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

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Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

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