50 percent less pain

CHIROPRACTIC HELP Newsletter #20

The really nasty backs we see at the Chiropractic Coalface frequently follow this course:

* An initial injury to the spine or pelvis, but it applies equally of course to a sprained ankle or any other joint and even tennis elbow, for example. It often comes after bending and heavy lifting, with a little twist at the hips.

* Pain and restricted movement often begins immediately, but it could be that you go to bed with no inkling you have had an injury. Then next day on waking... It swells during the night and in the morning one is astonished to find one can barely move.

* Then follows a period of recuperation. There may be treatment, Chiropractic or other, or none at all. The pain reduces and movement increases within a few days or a week or two. 50 percent less pain.

* Then either something silly happens, like lifting again, but possibly only a prolonged period of sitting as in a long car trip, or perhaps something unavoidable like a shower of sneezes. You may go into an odd posture, leaning to the side, like the young man above: The sign of Pisa.

* It's sometimes because you stopped the treatment, thinking it would now get better on its own, and you could save some money.

* It could be that you weren't put on a rehab programme, or you didn't do the exercises faithfully.

* In short, something goes wrong. Bingo. What started as low back pain now has a nasty extra. Pain and tingling in the leg.

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5 grades of slipped disk

Grade 1: Low back pain only

Grade 2: LBP radiating into the buttock and leg

Another stab of pain in the back, and now you can feel the pain spreading into the buttock and leg. It could be just a little tingle, a numb feeling, or you could have severe leg pain. Grade 2.

Critical, is that when your Chiropractor examines you, there will be no actual numbness, or increased pain on testing with a pinwheel, no change in the reflexes and no weakness.

The SLUMP TEST for sciatica is likely to be strongly positive. When s/he raises your leg there will either be pain in your naughty leg, or a very tight feeling compared to the other leg. The so-called "Braggard's Test" will be negative.

Grade 3: LBP + leg pain + increased sensation

The Slump test will now be very strongly positive, and the test of Braggard will probably be positive: Pulling your toes towards your head will provoke pain in the naughty leg.

But, in my 5- point grading system, there are still no reflex changes, nor signs of weakness.

By now, your leg may start to be more painful that your back. That's an ominous sign. TINGLING IN FEET AND LEGS ...

Grade 4: LBP + numbness + reduced reflex and specific weakness

Or it could involve the Femoral nerve in which case you would have pain in the groin (perhaps) and radiating down the front of your leg.

What is critical in a Grade 4 injury is the development of "motor" signs. The motor nerve that drives the muscles in the leg is affected, so there will likely be changes in reflexes and the ability to stand on your toes, on your heel, or to squat on one leg. The leg feels and is weak.

This is now a very serious injury and your Chiropractor will almost certainly send you home. You may not sit at all. Bending is forbidden, and you will probably be directed to have intermittent bed rest, with gentle exercises, and walks around the house periodically. Ice treatment for pain control. Listen to him or her, but don't panic. Nevertheless, the surgeon is sharpening his scalpel in anticipation! An MRI scan may be called for.

Grade 5: Much less LBP + but your leg is on fire.

Ten years ago I would not even accept a Grade 5 disc injury case, but surprisingly, I have found that even the true hernia will respond to gentle Chiropractic manipulation, correctly done, in perhaps 50% of cases. If after 3-4 weeks you are not responding, at least 40-50% less pain, a surgical consultation will probably be requested.

Dr Mardy Grothe

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50 percent less pain

Here's the deal. Understand that 50 percent less pain does not mean that your condition has healed by 50 percent. More likely 10 percent, and you are now in a very vulnerable period. You feel 50 percent less pain but in reality you are only 10% better.

If it's your back, one unavoidable sneeze (try blowing your nose, you can often avert a sneeze), one silly movement, a long sit in a bad chair (or even a good one), neglecting to do your exercises, and suddenly a Grade 1 has progressed to a Grade 2, or Grade 3 or 4. If it's your shoulder, it could be an awkward movement that you wouldn't have dreamed of attempting a month ago, but now you might be tempted.

Emphatically...