Case of the Month June 2011

The Patient

• 52 year old female with a history of lower back pain, mid back pain, sleep difficulties, and digestive troubles
• Patient is overweight by 30 pounds
• The patient had a traumatic spinal injury from a slip and fall 3 years ago, that was corrected by spinal surgery

The Patient’s Complaints

• Moderate to severe lower back pain, hip pain bilaterally, and pain down the back of the thighs
• The patient has difficulty walking normally and must use a cane due to her disturbed gait and balance

Snapshot of My Examination Findings

• Past surgical reports, X-ray evaluations, and MRIs were reviewed and revealed moderate to severe degenerative disc disease of the lumbar spine and showed the site of the surgery at L5S1.
• Patient demonstrates a loss of balance while standing and walking
• Guarding (protective movement and positioning) of the lower back and lower extremity
• Multiple areas of spinal subluxations (jammed spinal bones that irritate the nervous system) with focal tenderness to the lumbar vertebrae when pressed
• Painful range of motion of the lumbar spine in flexion and extension (worse in extension)
• Painful muscular fibers and trigger point activity around the lumbosacral spine and the hip areas bilaterally
• Positive orthopedic test for sciatic nerve irritation

My Diagnosis

• Lumbar Spine and Disc Degeneration
• Pain and Instability of the Lumbosacral Spine
• Subluxations of the Spine and Hip area, dysfunction and pain
• Sciatica

My Recommendations

• A course of 12 visits of integrative care to include the following:
• Chirporactic adjustments of the spine, and hip areas
• Myofascial release to the lower back, hips, and lower extremity areas performed by massage therapist
• Progressive therapeutic exercises targeting the lower back and core, with a focus on restoring normal balance
• Ice the lower lumbar spine at home as needed for 15 minutes per hour

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.  It was the joints, muscles, and nerves that were involved.

Post-surgical cases can be the most difficult, due to internal weakness at and around the prior site of the surgery.  In this case, the weakness centered in the patient’s lumbosacral spine and in her core.  Following surgery she had rehabilitation, but the exercises she had learned were not continued. In time, she became de-conditioned, overweight, and developed a weak and unstable core.  This resulted in chronic back pain that is marked by episodes of aggravations and 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, this patient has had an approximate 50% improvement in 4 weeks of care, with less pain,  improved balance, and increased range of motion.  She has had moments where she was able to walk without limping, but she still has a way to go.

Our Approach To Post-Surgical Chronic Lower Back Pain

If you were a new patient visiting our office, we always start with a thorough case history, consultation, and examination.  I may recommend diagnostic studies (x-ray or MRI) if I need more information. At this point, if I determine that care is appropriate and you decide to begin care, 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.

We follow a very effective  treatment strategy based on the letters ASR.  They stand for:

• A – Adjust (whole-body adjustment techniques)
• S – Support (spinal pelvic stabilizers and other joint supports)
• R – Rehabilitate (targeted exercise therapy/physical rehab)

Our Wellness Program Options

• Relief Care – We offer short-term plans for fast pain relief and recovery.  When many people seek care in our office they have one goal… relief.  So that’s where we start!  During this initial stage of intensive care, we have the following obligations: 1) To uncover the underlying cause of the health problem.  2) To suggest a care plan to produce the fastest results possible.  3) To offer ways patients can participate in their recovery.  4) To explain the value of exercise, nutrition and other aspects of wellness.

• Rehabilitative Care – We offer comprehensive plans for optimal recovery following injury.  Many of our clients want to continue corrective care into the next phase of care – the rehabilitative phase. Wisdom has taught us that long-lasting pain relief can be achieved only when complete healing occurs and your body returns to optimal function. This part of the healing process usually involves therapeutic exercises. We provide one-on-one coaching through this phase of care and focus on flexibility, strength, endurance, balance, and core-conditioning.

• Supportive/Wellness Care - We offer ongoing plans to help keep you active and feeling great.  Many of our clients enjoy regular chiropractic “checkups” and/or massage because they have found that they feel better, have more energy, and enjoy life more.

• Weight Loss & Detox Programs – our 30-day “Quick-Start” program can help you lose weight fast, detoxify, regain your energy, and enjoy life again!  Experience one-on-one counseling and personal attention from our holistic nutritionist, Stephanie Brabazon.  We may also use laser auriculotherapy to help you lose weight.  Laser therapy is non-invasive, requires no needles, and is painless. We see many overweight people that have tried diets but have failed because they have difficulty curbing their appetite and cravings. Our program helps to curb your appetite, depress hunger cravings, stimulate your metabolism to burn off extra calories, and correct internal body hormonal imbalances.

Our Passion

It’s our passion to help you feel great and be your best!

After meeting with Dr. Ken Goldman and discussing your heal goals, we will put together aspecific treatment plan just for you.  We have many natural therapies to consider – chiropractic, massage, exercise, nutritional counseling, and laser therapy techniques.  This strategy sets us apart from many other health practitioners, and gives our patients the best opportunity to achieve superior health.

We will do our best to find the cause of your problem and correct it.  If at any time we discover something beyond the scope of our practice, we won’t hesitate to refer you to another healthcare professional.

We accept most health insurance plans and provide a variety of affordable payment options (even for those without health insurance coverage).  We also accept car accident cases, work injuries, personal injuries, and sports injuries.

We don’t want you to have to resort to dangerous medicines, injections, or surgery.  Our approach is to use chiropractic care and other natural therapies (such as massage, rehab exercises, or nutrition) to correct your back pain quickly and  naturally.