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what to do about Backache

My wife age 35 has back pain from the last eight months . MRI finding are as under :

Loss of Lumbar Lordosis seen.

Broad based right paracentral disc protusion noted at L4,L5 level resulting in severe right ,moderate left lateral recess and moderate canal stenosis.

Multilevel facet joint arthropathy and ligamentum flavum hypertrophy noted.

vertebral bodies return normal signals.

Spinal cord is terminating in the level of L1.

paravertebral soft tissue appear to be unremarkable.

Impression :

Br
Poster
  • Male | 40 years old
  • Complaint duration: 89 days
  • Medications: pain killer

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Featured Answer

2 UpVoted this answer Gregory E. Baldy, DC Chiropractor, Raleigh Marci Catallo-Madruga, PT, DPT, CFDN Physical Therapist, Greenwood Village
I'm not interested in cluttering this thread with another response about "my method" or you need a "fill-in-the-blank" type of doctor, so let me be succinct:

Your wife may benefit from the various therapies suggested, or she may not.

None of us can really honestly make valid recommendations without first analyzing the imaging and also performing a physical exam on her.

While I fully believe she can function better, get some lasting relief, and ultimately heal...I don't know that for sure until I run my checks and assessment protocol, and even then I can't promise perfection because some of my patients don't achieve the results we would like.

Bottom line: get her checked by someone who has the skills, training, and clinical experience to help her. We've seen better results with disc problems coming after a more precise analysis, more accurate location of the specific vertebral subluxation causing the problem, and then conservative individualized adjustments (only as needed) over time so the body can fix the cause of the problem naturally.

Concurrent care with other professionals often makes sense and has proven helpful is certain cases, but it is not recommended 100% of the time. Usually patients respond better with fewer spinal adjustments. This works so much better than general manipulations, aggressive therapies and treatments, and/or frequent adjustments.
Jason W. Blackketter
2 UpVoted this answer Bryan McAdams, DPT Physical Therapist, San Marcos Marci Catallo-Madruga, PT, DPT, CFDN Physical Therapist, Greenwood Village
The evidence for treating lower back pain is soundly behind a treatment-based classification approach, which is developed from the history and physical examination. Imaging findings (in the absence of "red flags") tend to have little meaning and may contribute to chronicity of symptoms.

Find an orthopedic Physical Therapist that specializes in spine near you for an examination. Avoid chiropractic, manipulation helps only a specific subgroup of patients with low back pain, and your Physical Therapist will identify if that is the case.
Dr. Nathan J. Savage
1 UpVoted this answer Valerie Gray, DC Chiropractor, Ashburn
It's great that you're concerned for your wife as evidenced by your inquiry here trying to determine what options are available and recommended. It appears you've already done some great testing and figured out some of the changes that are happening to her spine and her health.

While it's challenging to be a consumer in the health care world, it is also important to be a good, educated and aware consumer when it comes to health and well being. Gone are the days that we blindly follow the advice of the doctors we visit. Today's approach requires not only understanding of the problem and the potential solution but also understanding of the person who has the problem.

Find a provider who is willing to listen and take the time to work with your wife and create the outcome she's looking for. Although most people initially only want relief and get back to life, eventually most people realize that they also want to stay better and have great experiences in life instead of bad ones, so some level of ongoing care, maintenance, upkeep, etc. (doesn't really matter what you call it) is required. This includes check ups like you would for your eyes, teeth and even your car! Why is this important? Because a lack of maintenance is the number one reason we see people with these kinds of problem, even if it's from an accident or injury.

So be diligent, pursue optimum recovery, and stay the course.
1 UpVoted this answer Valerie Gray, DC Chiropractor, Ashburn
These findings are consistent with what we frequently see when assessing chronic low back pain patients. It is known as degenerative disc disease. When there is a loss of lordosis,that means there are unusual stressors placed on the spine and surrounding tissues. The disc is deteriorating, and begins to squeeze into the areas where the nerves are positioned. When this occurs, numbness tingling , loss of sensation or weakness can be present. In the past, often these findings would lead to surgery for the patient.There are now a number of techniques that are becoming more well known and should be attempted before this. Cox Flexion-distraction technique is a very effective chiropractic technique that opens up the space and uses the structures surrounding the joint to help draw the disc material back into place. Decompression Therapy is also helpful for the same reasons, and uses Axial traction.

When chronic irritation is present to a nerve,it creates muscle spasms and tenderness. It can also create an inflammatory condition called myofascitis.This can sometimes be helped with ice and rest. On the other hand, total bedrest is generally contraindicated, and some form of exercise is necessary to support the area around the joint, and keep movement the joint. Joints deteriorate when they remain inactive and there is chronic inflammation. A class 4 laser is a very effective tool in helping the inflammation and swelling associated with this degeneration, and optimizing the bodies own healing response.

Bottom line is, try conservative measures first. Just because she has a disc bulge doesn't mean she needs surgery. She may, but only after you have exhausted conservative measures. Good Luck!
Gregory E. Baldy
1 UpVoted this answer Valerie Gray, DC Chiropractor, Ashburn
As a chiropractor going into 34 plus years of practice I have seen many of these types of conditions relating to spinal stenosis, protrusions, herniations etc. The MRI only tells us part of the story. Likely your wife was pre disposed due to other underlying causes. A Chiropractor is able to determine the bio-mechanical and structural causes that might have been responsible for the shear axial loading, and gravitational pulls that predisposed your wife to the protrusion. Find a Chiropractor who performs non-surgical spinal decompression and cold laser therapy as well as foot orthotics. It is great to treat the site of the protrusion but if you have for an example a short leg, or are walking on an unbalanced platform, then the cycle will continue unless you correct it. You must remove the underlying cause as to the symptom. Chiropractors have a whole tool kit of ways they can treat this problem. It is up to the chiropractor to determine this not any other health care professional telling you to avoid chiropractic. Of course you will need an exam and report of findings to discuss how you and your chiropractor will proceed.
1 UpVoted this answer Valerie Gray, DC Chiropractor, Ashburn
Dear Backache,

Bottom line here is that your wife's lumbar spine has some important findings, especially the broad based disc bulge that is causing revere right and moderate left lateral recess and canal stenosis. There are many care options as to how to most effectively manage this in the physical medicine field: Chiropractic, physical therapy, injections, and surgical resolution as the last resort.

The first thing you need to do is find someone who will do a proper physical exam on your wife. No matter what the radiological findings and MRI findings are, she didn't get this way over night. I guarantee that there are additional physical findings and functional limitations that have been missed and gone unaddressed by her current healthcare team....so first get a second and third opinion from another professional...again make sure it is someone with a diverse background in managing/correcting these types of issues.

As a chiropractic physician, I utilize many techniques in my office: adjustments, decompression, directional traction , physical therapy (stretching, resistance exercises, stability work, etc...), Rocktape, durable medicals to aid care at home and more...often I will co-manage my patients with their medical doctor, or an outside physical therapist or neurosurgeon when needed. The reason I tell you this is that many available treatments have great efficacy when utilized with the proper patient base, and often you need a team of people working together....there is NO room for EGO or profession bashing when your wife's health is at stake, and your healthcare providers need to communicate well and explain your wife's conditions and findings fully.

From what you have described, I would perform a functional examination to include standardized orthopedic and neurological tests, a functional movement screen, active and passive ranges of motion, standardized disability indexes, and then I would also take into account the imaging findings before establishing a treatment plan. A good chiropractic physician or physical therapist will both do this, explain their findings, and create a logical plan to address the dysfunctions found. If any concurrent pain management is needed, your Medical doctor or Chiropractor can refer you to a pain management specialist, but you will still need to address the physical findings with active rehabilitation.

Lastly, one thing that the scientific literature has proven is that extension loading of the lumbar spine will reduce disc stress and can often reduce the magnitude of disc bulges. I perform this in my office, but only after the patient has started to stabilize...usually after a few weeks of care to get pain levels reducing. Extension loading has been very well researched and published by researchers affiliated with the CBP organization (DC, MD, and Ph.D's have been involved) You can find out more about this atwww.idealspine.com. Additionally, many chiropractic physicians and physical therapists will perform extension based exercises as you progress to help stabilize the low back and these are often referred to as McKenzie type exercises... they help to strengthen the intrinsic muscles of the spine which are the deepest muscles. One of the most important to work on is the multifidus musculature and there is a multitude of published research on how to best activate and rehab these muscles.

Remember this is just a start, and the best treatment is based on your wife's individual physical exam. Ask all of your healthcare providers logical questions, and expect to get logical answers backed by some clinical research. Hope this helps, and I wish your wife a speedy recovery.
The MRI report would indicate that your wife has a herniated disc at level L4-L5, most likely impinging on the right L5 nerve root. The loss of lumbar lordosis is caused by muscle spasm, which could be the primary cause of the herniation, due to increased loading thru the disc and the compressive action of the muscles. Or, the muscle spasm can be a secondary effect due to the body inherently "splinting" the weakened region. The multilevel facet arthropathy is a chronic condition that has been building up over several years. In short, your wife would be wise to begin spinal decompression therapy for several weeks. This is a safe, non-invasive way to address the herniation, facet joints, and the muscular spasm. Once she has improved significantly, she should begin rehabilitative exercises to strengthen her back and core. This will prevent a recurrence of the loading that caused the disc to bulge. Maintaining proper body weight is important, as is good posture and walking regularly.
Ouch! That is painful stuff. But, not at all uncommon. I would recommend a comprehensive chiropractic exam. This will guide proper care.

I suspect your wife has a long history of spinal dysfunction because of the comment about "multilevel facet arthropathy" which is doctor-speak for some of the results of a form of wear-and-tear arthritis called osteoarthritis. Bony findings usually take a period of years to become visible. So, my hunch is the disc was struggling to deal with dysfunction for a long time, and it finally failed.

She is pretty young to have such a severe disc issue, so I would be interested in getting her under a good care plan and restoring function ASAP. Just like some people are more prone to dental issues and tooth decay, some people are more prone to spinal issues and spinal decay. It needs to be properly managed, though, so it doesn't manage her.

Good Luck!
Jeffrey Henry
Spinal decompression may be very beneficial for the disc protrusion. The doctor reviewing her history and MRI will be able to determine if she is a good candidate. She should know within 3-6 sessions that she is progressing. Sometimes a steroid may be advised depending on the severity of the inflammation and pain. THEN, once she is out of significant pain, she should seek out a chiropractor capable of spinal reshaping www.idealspine.com ...doctor locator) to restore the lumbar curvature. If the curve is not addressed she will recurrently have progressively worse outcomes.
Your wife's back pain is complicated but not impossible to resolve without surgery.

She is getting close to the point where the pain will become permanent if the problem is resolved soon.

The MRI findings mean that there is more than just the disc contributing to her pain,

so surgery would probably only have limited if any success in relieving her pain.

Your wife' condition needs finesse, a gentle and precise touch from a chiropractor that will look past the obvious, using various decompression techniques and measurably restoring spinal function.

Ask them in advance how they measure progress and ask for before and after studies.

Again this problem is about to become chronic if not resolved soon.