Question
I am from Uk but resident in Cairo Egypt, i contacted one of the Chiropractors (Dr Timothy Durnin) he is on vacation now but i need some more information. I am suffering constant pain in my back as well as sciatica, the doctor recommended i find a chiropractor who has the flexion/distraction table.  I found it even difficult to find a chiropractor here never mind one who can offer therapy with this table. Please can you advise me on what credentials the chiropractor should have and what successful treatment can be offered other than flexion/distraction???  I had a steroid injection into the muscele and have been prescribed mobotil 15mg daily however i am still in extreme pain.
Many Thanks

Answer
Disclaimer: please do not take any of my advice without at least consulting with your doctor(s) first. If necessary, print this email in its entirety for your doctor(s) to read. In addition, please do not attempt to use this website or my advice as a substitute for your healthcare needs, as a substitute for the advice of your doctor, or as a substitute for any legal advice. There is no way a thorough health evaluation or assessment of any medical condition can be properly made via email. Please only use the contents discussed as a guide or tool to address your health matters with your doctor(s). If any of the information I provide conflicts in anyway with the information your doctor(s) provide, it is always best to default to the information provided by your consulting doctor(s) or to seek additional opinions from qualified, licensed healthcare providers as needed.

Hello C.,

I抦 sorry to hear about your pain.  Disc herniations can be extremely painful.  

Flexion distraction machines help to separate the vertebrae by gently stretching the low back.  When the lower spine is pulled/distracted, it reduces the compression on the herniated disc.  Additionally, because the connective tissues attach the disc to the vertebrae, the pulling helps bring the disc to a more midline position and reduce the herniation.  These tables should be used with caution on discs, especially severe herniations.  They may help reduce the bulge, but over-treatment can exacerbate your condition.

As far as evaluating the chiropractor抯 credentials, it can be very difficult.  Chiropractic is a hands-on and technique-based profession, so having the most brilliant chiropractor does not mean he/she is good at technique.  Oppositely true, a not-so-brilliant chiropractor may have incredible technique that could fix almost any painful musculoskeletal condition.  It抯 always best to ask around and see if your friends or physician recommends someone.  Most American-trained chiropractors undergo rigorous training and education, though that doesn抰 discount some of the other chiropractors trained in your country.

Of course, I cannot make any recommendations without evaluating you myself, but what I can tell you about disc herniations is that they often respond well to McKenzie extension exercises, seen here: http://www.mckenziemdt.org/images/BronzeLady.gif
When doing these exercises, move slowly and stop at a tolerable point, holding for 30 seconds.  Go over these exercises with a licensed practitioner familiar with them.  I often find when patients do them without instruction, they end up bending at the incorrect point.  What these stretches attempt to do is extend the lumbar spine, which squeezes the herniated disc material forward to a more central position.

Additionally, if you can find a chiropractor or physical therapist with a simple traction machine, it may help.  Traction theoretically works similar to the flexion-distraction machines but without the flexion.

Also, it is wise to avoid any bending over, heavy lifting, or sitting for long periods of time.  All of these positions can further herniate the disc.  If you bend over, make sure to bend at your knees and not at the hips, keeping your back straight.  Also, if you have to sit for a long period, try to find a good lumbar support or pillow to place in the small of the back, which will help maintain the supportive lumbar curve.

Lastly, do not follow any recommendations mentioned above without first going over them with your doctor and obtaining a thorough evaluation of your condition.

I hope this helps a bit, and best of luck!
Dr. JR Strecker, D.C.