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 at
www.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.