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Case of the Month July 2012

The Patient

  • 42 year old male with a history of severe chronic pains (of around 6 years) in the lower back, mid back, neck, shoulders and hips.
  • The patient history revealed high levels of emotional stress, headaches, depression and difficulty sleeping, lifting, traveling, and sitting for long periods.
  • Patient is overweight by 22 pounds.
  • The patient related that the pains began from no known cause (insidious onset).
  • The patient has had multiple diagnostics tests (MRI and Bone Scan), which revealed mild degenerative joint disease in the spinal areas and mild arthritic changes in the shoulders, elbows, and wrists.
  • The patient has been under several medical doctors care over the course of 6 years and has been treated with pain medications and was prescribed a lumbar support orthosis (back brace).

Snapshot of My Examination Findings

  • Past diagnostic films and reports were reviewed and findings were confirmed.
  • Joint dysfunction and tenderness was found in the left sacroiliac joint, and at two lumbar vertebrae – L3 and L5.
  • Joint dysfunction, stiffness, and point tenderness of the hips on the left and right.
  • Patient demonstrates a loss of balance while standing and walking.
  • Guarding (protective movement and positioning) of the lower back.
  • Painful range of motion of the cervical and lumbar spine.
  • Painful muscular fibers and trigger point activity in the following muscles: quadratus lumborum, trapezius, rhomboid, and hip areas.

My Diagnosis

  • Multiple levels of Spine and Disc Degeneration.
  • Pain and Stiffness of the hip joints.
  • Segmental Dysfunction the Spine and Hip areas, with associated myofascial pain (abnormal muscle tension and trigger points).

My Recommendations

  • A course of conservative care for pain relief to include the following:
  • Chirporactic adjustments of the spine, sacroiliac joint, and hip areas.
  • Myofascial release to the muscles of the lower back, hips, upper back, and shoulders performed by massage therapist.
  • TENS unit (home electrotherapy device) for pain management.
  • The patient will progress to core stabilization/balancing exercises ASAP performed in-office and at home

The Prognosis

  • Fair

Discussion

Lower back pain can be caused by many different things.  Causes range from simple joint dysfunction or sprain/strains, to joint degeneration or even internal organ disease.  My exam was critical in determining that this patient’s pain had a biomechanical cause.  In this case, I was able to firmly conclude that the patient’s pain was originating from the joints, muscles, and nerves that were involved.

Chronic cases that have not improved with medical intervention can be the most difficult, due to internal weakness and developed dependence on pain medications.  In this case, the weakness centered in the patient’s lumbar spine, sacroiliac joint, and in her core.  This was in part due to her inactivity, dependence on medications, and constant reliance on a back brace for support.  This resulted in 6 years of chronic back pain that was marked by episodes of aggravations and partial recovery.

One of the best solutions for chronic lower back pain, is chiropractic care with core stabilization exercises.  This combination can help keep the spine healthy and prevent repeated relapses.

Upon following our advice and treatment schedule, in only 3 visits this patient has had over 50% improvement, with less pain, increased range of motion, and improved energy.  The intensity of the pain and the muscle tension in his neck, back, and hips has decreased considerably.  The patient still has several months of healing and rehab to achieve a full recovery, but the outlook is excellent.

Our Approach To Chronic Spinal and Hip Pain

If you were a new patient visiting our office, we always start with a thorough case history, consultation, and examination.  I will review any past diagnostic films that were taken.  I may recommend new diagnostic studies (x-ray or MRI) if I need more information. At this point, if I determine that you are a good candidate for care at our office, I will design a treatment plan for you.  If at any time I discover something beyond the scope of my practice, I won’t hesitate to contact your primary care provider to discuss a possible referral to another healthcare provider.

I specialize in providing short-term care for neck and back pain relief, and am fully licensed and certified to adjust the spine and extremities (arms, hands, legs, feet, etc.).  I am a certified instrument adjuster and use the Impulse iQ – a special adjusting instrument that allows me to perform adjustments without the typical twisting, turning, or popping as in traditional techniques.

If you are experiencing neck and/or back pain, we invite you to come in for a quick no-obligation consultation & examination.  Call us at 215-938-8500 for more information.

It would be an honor and a privilege to provide you with natural pain relief and to help your body heal and maintain the health you deserve.

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