Did I alienate my chiropractor?
Slump test for sciatica
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.
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