Chiropractors vs. Sciatca ...calling Dr. Dave

[Algunderfoot]

After 5 weeks of incessant sciatic nerve issues I'm curious if any forumites have turned to chiropractic care for relief. This followed a sore lower back after two days in the pow. That pain and stiffness responded to treatment but obviously an underlying issue remains..

[davekempmeister]

After 5 weeks of incessant sciatic nerve issues I'm curious if any forumites have turned to chiropractic care for relief. This followed a sore lower back after two days in the pow. That pain and stiffness responded to treatment but obviously an underlying issue remains..

I have always resisted the urge to give advice (even if solicited) about riding and the medical issues that result because it seems like an invitation for disagreement. That "said", this is an exception because your description so closely matches one of the several issues that I find myself trying to remedy season to season (with some success). For what you describe I would suggest taking a look at the video that's linked and, if your state legally permits the practice of "Trigger Point Dry Needling" (a/k/a Intramuscular Therapy) seek it out and request that a practitioner who works in a physical therapy setting apply the technique to your piriformis and any other muscles that might pressure the sciatic or refer pain accordingly. All the best in your efforts to alleviate what has to be one of the most uncomfortable of all conditions. Sorry your experiencing that Al-g.

edit: if your state does not allow TPDN - consider a D.O. (Osteopath) who can also administer a trigger point injection, albeit with an unnecessary dose of lidocaine (the needle's mechanical action is the remedy, not the drug component). everything i've described in this post has been nearly miraculous for me, at one time or another. lastly, i know i am hardly the dr. dave that you referred to in your subject line but i did respond first ;)

Edited April 13, 2013 by davekempmeister

[www.oldsnowboards.com]

Trigger Point<iframe width="420" height="315" src="http://www.youtube.com/embed/9Aakc59YFJE" frameborder="0" allowfullscreen></iframe><iframe width="560" height="315" src="http://www.youtube.com/embed/oVpr8DYm1EY" frameborder="0" allowfullscreen></iframe>

Edited April 13, 2013 by www.oldsnowboards.com

[ecshredder]

I use an electrical muscle stimulator and I've had great results. I found that using it for long periods losens the muscles enough to where I can stretch and relieve nerve pressure. I also tried chiropractic several times and it never helped.

[bigwavedave]

Hi Al, In looking for a Chiropractor, try to find someone you know and trust that has had good results with similar symptoms to recommend one in your area. You wouldn't shop for a surgeon in the yellow pages, like surgery, Chiropractic is an art. No one technique is likely to be the answer, so I'ld recommend finding someone who has several techniques at their disposal. In addition to the manipulation/adjustment, which is the Chiropractor's unique area of expertise, most Chiropractors incorporate other modalities such as electical muscle stimulation, ultrasound, trigger point therapy, acupuncture, exercise therapy, etc. Find someone who doesn't limit themselves to one tool for the job.

Sciatica as a diagnosis only infers that you have some kind of leg symptoms--pain, numbness, tingling, it doesn't tell you what is causing the symptoms, which you need to know to treat the problem.

How did the pain start? Have you had similar symptoms in the past? One leg or both? How far into the leg, below the knee? Into the foot? What part of the leg--back, side, front, heel, toes, which toes? What aggravates or relieves symptoms? A hands on examination is needed to further confirm the source of symptoms, often several things are contributing and need attention.

[dbmgreen]

If you want to educate yourself about Back Pain / Sciatica there is no one in the world who has done more research into this area that Stuart McGill http://www.backfitpro.com/ it's worth taking a look at his site, Stuart McGills work is peer reviewed scientifically valid work. There are so many snake oil salesmen / charletons out there, very few GPs know much more than just to prescribe nurofen you need to educate yourself and make an informed decision.

[SunSurfer]

After 5 weeks of incessant sciatic nerve issues I'm curious if any forumites have turned to chiropractic care for relief. This followed a sore lower back after two days in the pow. That pain and stiffness responded to treatment but obviously an underlying issue remains..

Having had sciatica since August 2012 I have not, and would not ever, consider going to see a chiropracter. I have a very small L4-5 disc prolapse which is irritating one particular nerve root. The findings on the MRI are entirely consistent with the distribution of symptoms that I have. I am an anaesthesiologist (specialist anaesthetist) who works regularly with a spinal surgeon. He has provided advice to me as I've worked through this.

Do you actually have sciatica, or just a sore back?

Sciatica is a syndrome of ache/pain, numbness or altered sensation, and/or leg weakness, with symptoms extending below the knee. The primary cause is nerve irritation to one or more of the nerve roots of the sciatic nerve, or the nerve itself. The irritation can be at spine level or occasionally by muscle pressure as the nerve follows it's course through the buttock to the back of the leg.

At spine level the pain can be due to a combination of physical pressure from a squeezed out (prolapsed) intervertebral disc, or from narrowing of the spinal canal, or narrowing the holes in the side of the spine where the nerve roots exit to join up and form the sciatic nerve. If the problem is due to a disc prolapse part of the problem may be due to inflammation chemicals released by the damaged disc.

How to relieve the symptoms will depend upon what the actual problem is.

If you have a sore back, see who you like. Keep active, concentrate on exercises that strengthen the muscles of your abdomen and spine.

If you have sciatica and the symptoms have not resolved spontaneously within a couple of months then go see a doctor to find out what is actually causing the problem.

Controlling my symptoms:

I have a small prolapse. For me, 200mg of ibuprofen taken twice a day controls most of my symptoms to where it doesn't stop me doing stuff. Occasionally I add in a 500mg acetaminophen (paracetamol)/8mg codeine tab.

I do core muscle strengthening exercises. I stretch out my hamstring muscles, which have been very tight for many years, to take some of the pressure off my lower back when I bend forward. I sit as much as possible on a kneeler chair to improve my posture.

Late last year the tablets and the exercises were just not cutting it. I was starting to get ready to consider having a surgical procedure to treat the problem. It was at this point that I had my MRI because up until then I was not willing to even consider having an operation. When the prolapse was found my surgical friend recommended a steroid epidural, with the aim of damping down the inflammation from the chemicals released by the damaged disc. I took my time thinking about that as an option, steroids are very powerful drugs and there are, like everything in medicine, some potential side effects and complications from the treatment. I was planning to go to SES in February so I finally had my epidural done in mid January, long enough ahead for any problems to be sorted and for the treatment to have a good chance to work but to have not yet worn off.

It took about 2 weeks for the effect of the slow release steroid drug to really kick in. I was essentially symptom free for SES and remained so up until about 6 weeks ago when the symptoms gradually started to return. They remain controllable with exercises/stretches and the same sorts of doses of medication that I used before.

My spinal surgeon colleague is very clear. Don't have an operation unless you have exhausted every other option and you are desperate to get relief.

The studies in the orthopaedic literture are pretty clear too. Sciatica tends to resolve over time, with or without an operation.

That said, it is something you should be guided through by an expert, not by people who cannot talk to you directly or examine you on a snowboarding website.

The appropriate treatment depends upon what is the underlying cause of your symptoms.

SunSurfer

[dbmgreen]

..................That said, it is something you should be guided through by an expert, not by people who cannot talk to you directly or examine you on a snowboarding website.

The appropriate treatment depends upon what is the underlying cause of your symptoms.

SunSurfer

Sage advice :)

[bigwavedave]

Having had sciatica since August 2012 I have not, and would not ever, consider going to see a chiropracter.

Never take advice from someone who admits to having no first hand knowledge on what they're about to advise against, and then advises you to take drugs.

[www.oldsnowboards.com]

Thanks for sharing your real life experiences!

It is of keen interest to me also.

We all have different life scenarios and history.

Keep the focus on helping others out there on the forum, the benefits of allowing our different takes on this to exist could

be key in helping each other.

I have tried numerous methods/treatments over the years and will continue to be open to anything that will improve my health and allow me to continue to ride.

Edited April 14, 2013 by www.oldsnowboards.com

[SunSurfer]

Hi Bigwavedave,

You seem to have misunderstood me.

dbmgreen quoted my advice. The rest was my conventional medicine understanding of what causes sciatica, and my personal experience so far.

As an anesthesiologist I'm a conventional medicine practitioner. Chiropractic is an alternative/complementary treatment system whose explanation for illness and disease has little in common with the way conventional medicine explains the same problems. That is the primary reason I wouldn't go to a chiropracter. I don't believe in the treatment.

Obviously other people do, otherwise all the chiropracters would go out of business.

I'm not going to hijack this thread to debate the merits of chiropractic. I just hope Algunderfoot gets seen by someone who can take a good history and properly examine and diagnose his problem, and that his symptoms go away long before the 8 months that I've had so far.

Cheers, Sunsurfer

[bigwavedave]

Hi Sunsurfer,

No misunderstanding, you were fairly clear in that you were advising Al, who was asking about Chiropractic and sciatica treatment, that you "have never and would never consider seeing a Chiropracter"? (sp), apparently based on antiquated assumptions about Chiropractic and further that you don't "believe in the treatment" yet still, have no first hand knowledge.

No debate, but to set the record straight you should re-read my first post (2 above yours) in response to Al's query and then re-read your post. We give similar advice regarding diagnosis and history and finding a good doc. We differ here...

Chiropractic is "alternative care" only from your allopathic perspective. From my perspective, as a doctor of Chiropractic for 33 years, drugs, surgery and steriod injections are the risky alternative to be used as a last resort. You inference that Chiropractic is unscientific implies that it is a risky alternative to "conventional medicine". Consider that my malpractice insurance is $850 per year as opposed to $25,000-$100,000/yr for an anesthesiologist, neurosurgeon or most any other 'conventional' practitioner. In the U.S. Chiropractors are primary care physicians, no referral needed. Chiropractors earn a doctorate degree with a basic science education equal to any medical school and are trained in differential diagnosis.

I have literally treated hundreds of patients that have presented with similar symptoms to Al's. I refer patients for MRI's and neuro consults when (rarely) necessary.

See what you started Al. I wasn't sure which Dr Dave you were looking for but I hope you find this discussion helpful and find some help.

Edited April 16, 2013 by www.oldsnowboards.com

[davekempmeister]

since clarifications are in order, here's mine: my suggestion that Al try the stretch in the video that i posted and that he also consider Trigger Point Dry Needling to aleviate symptoms is based purely on my own experience with the same symptom. i obviously don't pretend to know what specifically is the cause of Al's sciatic irritation, however i can state with certainty that (in my experience) the two options i suggested are potential remedies that are no or low side effect/consequence.

Ursle suggested a trip to an Osteopath (D.O.) a few years ago and it was through that experience that i learned about TPDN in a Physical Therapy setting. for me, it's been life changing as a non-pharma option. it is NOT acupuncture. thanks Ursle - forever grateful.

[CarvingScooby]

After 5 weeks of incessant sciatic nerve issues I'm curious if any forumites have turned to chiropractic care for relief. This followed a sore lower back after two days in the pow. That pain and stiffness responded to treatment but obviously an underlying issue remains..

Al, if you tried all the treatment you can get and if not working try painbreakthrough.com

I've tried all treatment I can get in Canada from Chiro, Prolo, Cortison in spine, Life X-ray injection nothing worked.

Is my personal experience and this treatment worked for me!! 15 second it took and lay down for 15 minutes...and that's it. Not cheap thou...

Good luck & get well soon.

RT

[www.oldsnowboards.com]

Al, if you tried all the treatment you can get and if not working try painbreakthrough.com

I've tried all treatment I can get in Canada from Chiro, Prolo, Cortison in spine, Life X-ray injection nothing worked.

Is my personal experience and this treatment worked for me!! 15 second it took and lay down for 15 minutes...and that's it. Not cheap thou...

Good luck & get well soon.

RT

I looked at the site briefly. Lots of testimonials etc.

Can you sum it up in a paragraph or two? What is expensive? How much? Covered by insurance?

Thanks in advance. Bryan

[skatha]

Ahhh......first off, the prerequisite to be a chiropractor varies state to state. In TX, chiropractic school is 2 years long and you can enter school at your high school graduation. That being said, the medical literature is full of research showing PT=meds=chiropractic care for back pain. I have referred many people to chiropractic care for chronic back pain, that is, pain that falls into to 20% of patients with persistent back pain that lasts over 6 weeks. As for non-back pain, plenty of research has shown that chiropractic neck manipulation can give a patient a stroke. I had one such patient last week, in fact. The staff of the chiropractor called 911 when she walked out to the car and sat in it for over 30 minutes, staring into space. The neurologist at the receiving hospital told me she did quite well after TPA. The take home message-your sciatica/lumbar radiculopathy is best managed by consulting with your doc. He/she can assess how urgently the workup needs to happen. Most pain will resolve spontaneously. Signs that lead docs to urgent referral are things like incontinence or foot drop or loss of an extremity reflex. MRIs of the back can be abnormal in 60% of the population-even people who are asymptomatic, so nerve testing like NCV or EMG are critical. Back surgery is unsuccessful 60% of the time so it's the last thing that should be considered. Epidural steroids have questionable efficacy if you look at the literature. I can manage most of my patients with sciatica/lumbar radiculopathy with a good clinical exam, core exercise recommendations, and a short course of oral steroids.

[bigwavedave]

Ahhh...skatha, where to begin, I guess we'll pick out the misinformation first, from the beginning. Yes, every state has it's own licensing and scope of practice laws for both Chiropractic and medical practitioners. I looked up Texas, 'cause you never know with Texas, both the Chiro college and state license laws require 90hrs education in basic sciences (specified curriculum) at an accredited college/university prior to admission. Eerily, this is exactly the same as requirements for admission into most medical schools. 10 trimesters of Chiro school would take 3 1/2 years going to school year round, no breaks, or 4 1/2 years if done in semesters with summer breaks.

Regarding the stroke myth, there is no documented evidence in an unbiased study that shows cervical manipulation causes a stroke. It may have happened, but I don't know of any cases. Often conclusions are made based on limited facts. What in fact has been shown to be true, is that patients already experiencing symptoms of a stroke, typically headache symptoms (the worst headache of your life is a red flag) sought treatment for the headache from a Chiropractor prior to being referred to the hospital. If the risk of stroke from cervical manipulation was real, Chiropractic malpractice insurance would be at least as expensive as yours, maybe more. Mine is $850/year. Typical medical malpractice insurance runs anywhere from $25,000 to over $100,000 per year. Is the risk of having a significant adverse reaction from a medical procedure 25-100 times more likely than from a Chiropractic adjustment?

"most pain will resolve spontaneously" is spoken by someone who hasn't experienced debilitating back pain.

I would agree with most of the rest of your advice regarding urgent referral, MRIs, back surgery and injections.

My original advice to Al in looking for a Chiropractor was to get a referral or recommendation from someone who has had good results, preferably for similar symptoms. I would give the same advice in looking for a surgeon. There is a great difference in the skills of various practitioners. I further advised to find someone who employs several techniques (there is no one treatment that will work for everyone). Find someone who employs a variety of therapies like ultrasound, electrical muscle stim, trigger point therapy, flexion distraction and more than one type of manipulative therapy.

Edited April 21, 2013 by bigwavedave

[Algunderfoot]

Well I always try to be as informed as possible to make the best (not always proper) decisions for my health and lifestyle, but I'm thinking ignorance may have been bliss in this case. These x-rays are from last week, can't imagine why my sciatic is angry...hmmmmm.

[www.oldsnowboards.com]

Wow. Looks like some serious miss-alignment there Al. Did the hip replacement effect that?

Edited April 23, 2013 by www.oldsnowboards.com

[Algunderfoot]

Wow. Looks like some serious miss-alignment there Al. Did the hip replacement effect that?

No, at least not directly, I had lower disc issues in the past, compressed and degenerative discs around L5. According to my attending medical team a situation like this develops over an extended period of time. If it did, I would just rush to get the left one done, lol. So over the next two weeks there will be lots of EMS treatments, strecthing, low back excercise, and adjustments to see if we can't re-stack this deck and eleviate the sciatica

Edited April 23, 2013 by www.oldsnowboards.com

[Galen]

No, at least not directly, I had lower disc issues in the past, compressed and degenerative discs around L5. According to my attending medical team a situation like this develops over an extended period of time. If it did, I would just rush to get the left one done, lol. So over the next two weeks there will be lots of EMS treatments, strecthing, low back excercise, and adjustments to see if we can't re-stack this deck and eleviate the sciatica

My ex-ray looked almost exactly the same, also sciatica issues. It took about 6 chiro visits and as many massage sessions spread over 3 weeks to get it back and stabilized. If you can schedule the chiro/massage on the same days, so much the better. A good stretching regimen and core exercises are also a key part to the puzzle. Good luck!

[CarvingScooby]

I looked at the site briefly. Lots of testimonials etc.

Can you sum it up in a paragraph or two? What is expensive? How much? Covered by insurance?

Thanks in advance. Bryan

Brian I posted here

RT

[SnowNBeachAddict]

Al,

As you know I have nothing but problems LMAO:) A couple of things that help me are foam rollers and I FINALLY got approval from my insurance company for a home device that does IFC, TENS and NMES. The device really helps me a LOT! It is made by a company in CO http://www.zynexmed.com/ Your doctor should be able to call a DME provider and order this for you. The device is small so I travel with it all the time. I use it up to 3-4 hours a day and it really helps. Hopefully I can get back to riding next year. This getting old stuff SUX :(

I have:

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2. Degenerative L4-5 disk disease with anular tear

3. Axial low back pain with left sacroiliitis and sacroiliac joint pain

4. Arthrodesis

5. Left sacroiliac joint pain

6. Sacroiliitis

7. Left Trochanteric bursitis

8. Iliotibial band pain

Fibromyalgia

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[dragonrider]

Trigger Point<IFRAME height=315 src="http://www.youtube.com/embed/9Aakc59YFJE" frameBorder=0 width=420 allowfullscreen></IFRAME><IFRAME height=315 src="http://www.youtube.com/embed/oVpr8DYm1EY" frameBorder=0 width=560 allowfullscreen></IFRAME>

look simple,:nono:watch it only dont try to do it to your friend, it may cause more problems, it is better save for accute puncher doctor.

[drschwartz]

Have been reading the posts with some interest, and trying not to get embroiled in the chiropractic/alternative medicine/conventional medicine arguments. Would love to see the lateral x-ray.

Very bad degenerative arthritic problems in lower lumbar spine. Totally agree with conservative management as long as you are not getting worse, and as long as you have no hard neurologic deficits in your legs (numbness, weakness, bowel, bladder symptoms). Lots of times, sciatica will spontaneously subside with time.

Be clear on one thing, the conservative treatment will not realign that subluxation in your lumbar spine. I utilize chiropractic as a treatment method, and one of my partners in our practice is a chiropractor, but any thought that the degenerative subluxation seen in the x-ray will actually improve with manipulative treatment is, in my opinion, false hope. Having said that, the actual subluxation does not need to change in order for the symptoms to improve, they may get better with time and treatment. If they do not improve over 1-3 months however, I would certainly consider further evaluation with MRI, and consultation with an orthopedic or neurosurgical spine specialist.