How to treat pervasive pain from various untreated injuries over time

by Jon
(Long Island, NY)

I feel like more and more of my joints are losing function and need to figure out a comprehensive course of treatment but at this point I don't know what to do first, after better diet and exercise:

I am a 44 yo male. Here's a brief chronology of what I think are relevant causes:

When I was 10 or 12 I sprained my right ankle pretty badly, no fracture, and have been susceptible to sprains and falls ever since; more so after 18 years old and then periodically since then; it's not uncommon for it to give out and I fall if my foot hits uneven ground; maybe a few times a year these days. It affected both ankles when I was younger but mainly the right now.

The outside part of my right ankle (the bulging bone) bulges much more than normal and much more than the left.

At about 13 years old, I was "knee knocked" by an adult while playing basketball so hard that I felt it in my stomach and it knocked the wind out of me. His knee hit my right knee and I had to sit down to catch my breath and I kind of 'walked it off' but it was never treated.

At about 18 I had two jarring injuries that went untreated - one I went to do a flip 'over' a gymnastic horse only to land on it square on my lower back, perpendicular to it, I guess hyper extending my whole spine.

Not long before or after that, I got my head caught between a heavy swinging metal carnival ride car and the steel bar that was supporting it, kind of hitting on the right side and "crushing" my head and neck to the left - I saw a flash or 'stars' - I sought treatment for the 'tear' in my skin on my head; it only took four stitches, but I was never treated for the trauma or likely neck damage.

Fast forward 10 years, (with no intervening major injuries) I had weakness in my right arm and leg - to the point that I was dragging my right leg as I walked and I went to an orthopedist who ordered an immediate mri and surgery that night - herniated disks and spinal cord protrusion - I had one disc removed and a plate put in; that was in 1999 or so.

I always have stiffness in many joints; I don't get enough or proper exercise, my right side has been weaker since that surgery.

Then after a long drive I developed a pain in my lower back/buttocks area; I was treated by a chiropractor who wanted to treat my whole spine, and on my second visit he twisted my neck in a way where i saw stars again and a few months later after increasing to excruciating pain (and decreasing nerve function in my left extremities this time ) later i was diagnosed with additional herniation in the neck and disc matter migrating in the canal. So I had my second discectomy, they removed the hardware from the first and now I have a 'double' bracket.

Then a year or two ago walking down the steps I slipped with my socks on the carpet, and landed on my lower spine / hip more to the left side... at first it felt like it actually 'loosened' up some of my other tightness in my lower back, but I let it heal on its own and since that and the prior surgery my left side never regained full nerve function; tingling in the edge of the palm of my hand and pinky on that side, tightness in the elbow shoulder.

Since now my knees both - but more so the right don't let me get up after squatting down, total weakness and they were painful to lean on a few months ago but not so much now.

Lower back pain and stiffness is getting worse, and - that's where I'm at now. Like the tin man without oil. I'm pretty sure I need a lot of things like pins in my ankle to chiropractic or reflexology - but again I don't even know where would be best to start in order to get a comprehensive treatment, not just a band aid.

Hello Jon,
Thank you for a very explicit history; keep it somewhere, perhaps print it out for future use when consulting a new doctor.

Firstly accept there are going to be no miracles wherever you go, and whatever you do. Each of these problems is difficult in itself.

Secondly, don't expect any doctor to address all of them immediately; his or her energy is so diluted. They need to focus on one of these areas at a time; then when it's improving nicely, it's time to start the next.

I'd do two things. Firstly start an exercise programme for each of these areas and spend ten minutes a day working your ankles, your quads, the lower back and neck. Take your time; you aren't going to be selected for the next Olympics! So don't rush it; careful not to overstrain. There are exercises at Chiropractic Help for of them. Be disciplined and do them daily like you brush your teeth.

Then secondly start looking for a doctor, perhaps a chiropractor if you feel inclined to risk it! after your bad previous experience who specialises in feet and ankles. Someone with a FICS qualification; that's sports chiropractic. Improving your gait can only help everything higher up.

Incidently, remember it's YOUR body. Never allow any doctor of any ilk to bully you into having a procedure that you aren't comfortable with. Manipulating your neck like that was plain dumb and I bet he never even saw the xrays first. It's easy to say with hindsight, but you should not have allowed him to do it. Do your homework carefully and thoroughly before chosing another chiropractor.

That's just the start. I hope these thoughts contribute. Incidently I have doubts about very expensive orthotics for the shoes. Certainly they help sometimes.

Let us know in a couple months how you get on.

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.

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