QuestionI have been having back pain on and off in sciatic nerve region for the past 10 years however, for the last 7 months the pain has been constant and the pain (numbness) runs from my left buttock to my left ankle. I recieved an MRI and the finding were as followed, A large left paracentral disc extrusion is noted resulting in mass effect on the transisting left S1 nerve and due to height loss of the intervertebral disc there is mild to moderate neural foraminal narrowing. The L5-S1 disc also has a small broad-based disc bulge which contacts the right transisting S1 nerve and moderately impinges upon ther right neural foramina. Mild to moderate central canal stenosis related to distal extrusion is noted. Please any help would be appreciated.
AnswerHello Chris,
I am sorry to hear of your pain and condition.
You state: "....I have been having back pain on and off in sciatic nerve region for the past 10 years...."; TEN years--- your problem certainly has a LOT of momentum, a head start, a lot of progress in the wrong direction. What kind of treatment have you received for the past TEN years? What has your Doctor of Chiropractic done for you, there are MANY different types of Chiropractic treatment; some approaches more appropriate for certain patients at certain times!
"....for the last 7 months the pain has been constant and the pain (numbness) runs from my left buttock to my left ankle.....", certainly a deterioration in your condition. Usually when a patient is under Chiropractic care, this degeneration can be halted before it goes this far.
What techniques does your Chiropractor use? There are many different techniques, and many different specialties in chiropractic. While your presentation is not uncommon in the 'regular' Doctor of Chiropractic's office, perhaps you want to look for a Doctor with additional credentials, SEE: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf
Perhaps you have a Chiropractic Neurologist, Orthopedist or Rehab specialist close by to you.
"....large left paracentral disc extrusion is noted resulting in mass effect on the transisting left S1 nerve and due to height loss of the intervertebral disc there is mild to moderate neural foraminal narrowing. The L5-S1 disc also has a small broad-based disc bulge which contacts the right transisting S1 nerve and moderately impinges upon ther right neural foramina. Mild to moderate central canal stenosis related to distal extrusion is noted....."; while your cse is complicated, progressed and significant; conservative care can often remiss pain and manage findings such as these. What has your 'in-person', treating Chiropractic Doctor said about these findings? What has been your response to your current Chiropractic treatment?
As I stated earlier, there are many different techniques and specialties available within Chiropractic (often called the 'spine specialist' by the lay public). Has your doctor discussed chiropractic spinal MUA (manipulation under anesthesia)?, noninvasive spinal decompressive traction?
In my Staten Island Chiropractic office I give out the following handout sheet:
Disk Herniation
Low Back Pain can be caused by many different things.
Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).
Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).
Bad things, like - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic. Sometimes LBP is caused by a Herniated disc: Herniated disk is actually a quite common condition.
However, the course of the condition is highly variable.
Some patients with a herniated disk literally cannot walk, yet other patients with similar MRI findings may be able to run marathons or lift heavy weights. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful. Disk Herniation is often caused by, or often concurrent with the Vertebral Subluxation Complex.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine, Invited to Colorado Springs (Olympic Training Center) to Care for USA Olympic Athletes 2010
Be cautious on medications (another patient handout sheet):
Pain Killing medication??? = 16,000 deaths ( probably under-reported )
DEATH ! ? ! ? better watch out on those medications!!!
PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
Think you should listen??
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?
Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?
Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468 Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001) Motrin, Advil = NSAIDS
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition. Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine, Invited to Colorado Springs (Olympic Training Center) to Care for USA Olympic Athletes 2010
You ask, "....Please any help would be appreciated.....", I recommend you talk with your treating Chiropractic Doctor. Perhaps his(her) technique is not the most appropriate/ efficient for you; perhaps referral to a different DC is needed at this time.
Surgery is an option, but surgery is complicated and risky. Usually a long period of conservative care is recommended before surgical intervention.
Your condition is painful and complicated, but not uncommon. Chiropractic can be helpful. Physical therapy and acupuncture may also be helpful. Various conservative apporaches would be my recommendation before proceeding to more invasive procedures.
I wish you good luck!
If further information is needed, do not hesitate to REcontact me here at ALLexperts.com
Thank You for the question,
Dr. Victor Dolan, DC, DACBSP
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