Did I alienate my chiropractor?

by SJ
(California, USA)

Slump test for sciatica

Slump test for sciatica

Dear Doctor,
Thank you for maintaining this site. I have read through a lot of useful information, though I cannot seem to find anything that specifically addresses my concern. Please feel free to point me to the appropriate pages that might answer my questions.
Last October I developed a case of sciatica due to a herniated (slipped) L5-S1 disc (which was also degenerated, and I think there were some Modic changes in the adjoining endplates). I went to a chiropractor who recommended axial traction decompression (Kennedy decompression technique) along with a class IV deep tissue laser, rapid release technology, Pettibone wobble chair stretching, and manipulation. I was mostly functional again in 4 weeks. However, 9 months later, I still get intermittent, mild-moderate sciatica (frequency several times per day or every few days), low back pain, leg cramps and claudication, plantarflexion motor deficit, partial foot paresthesia, and my ankle has been sore for about 2 months. Pre-existing neck and rib pain re-occurred.

I have a lot of questions and concerns and probably sound like a hypochondriac. I try to mention this stuff to my chiropractor, and sometimes he will ask further questions, but thus far has not addressed my concerns; he seems content with a few manipulations and scheduling my next appointment; then off to check another patient.

I understand it can be busy in his office, and I cannot remember everything I want to ask anyway, so I sent a rather lengthy e-mail of my questions and concerns, thinking he could reply as he has time. Previous e-mails (about scheduling an appointment) were replied within 24 hours. It has been 10 days now, and I have heard nothing, not even acknowledgment of receipt of the e-mail.

I am not very eager to go searching for another chiropractor; this one was recommended by acquaintances, but my family and friends do not see chiropractors so to find another I likely would be going by newspaper advertisements and Google searches. We seemed to click at first, but lately it seems he would rather check Facebook status than have a serious discussion about my current symptoms and treatment options.

My questions to you are (1) is it normal for sciatica and related symptoms to last this long (9 months)? Or is this as good as things get after a 1 cm disc herniation? and (2) is sending a rather lengthy e-mail of my questions and concerns a no-no in the chiropractic world? Have I alienated my chiropractor? It could take some time to address my concerns, but is it too hard even to acknowledge receipt of my e-mail? Is there a better way to inspire him to address my questions and concerns?

Thank you for your insights and advice.

Dear SJ,
Apologies for the delay in answering this.

You ask legitimate questions but it's difficult to give very specific answers to some.

Certainly it is normal to expect at least some acknowledgement of your email from your chiropractor; unless of course you were rude, or offended him in some way; I doubt you alienated him; all chiropractors need a thick skin. But you probably posed some difficult questions, like those above, that a simple answer was not forthcoming, and then got forgotten.

I follow a five grade categorization of disc injuries, and with loss of plantar flexion, unable to lift your heel, you certainly are a grade V. Most grade Vs are sent immediately for surgery, and so in one sense his treatment was certainly satisfactory, and some residual issues are likely; that would have been true if you had surgery too.

One can put up with some paresthesias in the foot, some lower back and leg pain, but what is important in my book is that you regain the strength in the calf muscle. Standing on one leg, touching a chair for balance, are you still unable to raise your heel? Does it feel unstable, and do you have a limp?

If you sit in a kitchen chair, flex your head on your chest, and then ask the good wife to raise first the normal and then the naughty leg parallel to the ground, is there significant lower back or leg pain?

Do you think that pain in the ankle is part of the sciatica, or a lower limb issue? A limp from an old ankle injury can certainly disturb your lower back.

Are you doing simple lower back exercises every day? You'll find some in the navigation bar at Chiropractic Help; I recommend doing them before arising in the morning. In other words, how much are you doing to help yourself?

Most serious medical conditions are not 'cured'. They will come back, need maintenance and the correct self care; that applies to a serious sciatica just like it does to diabetes. Committing to a daily exercise programme is your lot; perhaps some swimming or a daily walk too. These are disciplines that will determine whether you come close to ultimate near complete healing, and whether it will all start again next week, or not.

Accept that lifting deepfreezers, grand pianos and pushing stalled motor cars is not for you.

An occasional, but regular consultation is a must in my book after such a serious injury.

May I recommend you schedule a consultation, making it clear to the secretary that it's not for treatment, but to talk; you want his ear and some of his time. And go and talk like two adult, mature men. If he won't listen, or give you the time of day then sadly you may be on the search for a new chiropractor; it sounds like he did a good job so don't be in a rush to go off elsewhere. In fact, how about recommending him at the bottom of the page on leg pain below?

I hope this contributes; again apologies for the late reply.

Dr B

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Nov 10, 2017
What annoys chiropractors?
by: Anonymous

What do patients do that really annoys chiropractors?
For example, I ask my chiro a lot of questions; anything from "Is this as good as my symptoms will get?" to "How do you diagnose a subtalar fixation?" to "How does costochondritis cause neck pain and radiculopathy in the upper extremity?" Are chiros annoyed by a barrage of patient questions?

How about patients not following a chiro's advice? Patients questioning a chiro's diagnosis, or showing the chiro that he is wrong? Anything else that chiros find annoying?

To be clear, I am not trying to annoy my chiro; quite the opposite; and if there is a way to address these topics in a less annoying manner? I would love to hear suggestions.

All doctors need a thick skin and shouldn't easily be annoyed; if they are, that's their problem.

Right across the medical spectrum research shows that doctors get the diagnosis right less than half the time; and half of them graduated in the bottom half of the class. So questioning, and thinking for yourself is healthy in my book; that doesn't mean you need to be aggressive about it.

All patients ignore their doctor's advice periodically, but you do it at your peril and have to have the right reasons to ignore it. And yes that probably will annoy your chiropractor! But he's not always right.

In Holland we say, those who will not hear, must feel. Listen to your chiropractor carefully, give it your full attention and be careful if you decide to go it alone. Revaluate in a couple weeks whether you could have been wrong and he right.

Does that make sense?

Dr B

Nov 03, 2017
by: Anonymous

Sometimes I have sciatica associated with a metallic taste. Any idea what might cause that? I do not take any medication.

I'm sorry, but it rings no bells.

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 have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is 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 is 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 pain-free. 

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 is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has 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 stroll 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; he has a short leg.

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. X-rays 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 few months 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 is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year 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 could not 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 should not be treating the elderly most medical sites state but that is so much bunkum.

Do you have a problem that is not getting better?

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Interesting questions from visitors

CLS writes:

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.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is 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.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.