If you have had neck and arm pain (cervical radiculopathy) or low back and leg pain (sciatica), you know that it can be debilitating. I see patients with these conditions often and here are some observations I’ve had over the years when treating them.
-It’s not as simple as a vertebra being out of place and causing a pinched nerve. The nerves in your arms and legs originate from the spinal cord at the level of your neck and your lower back, or lumbar spine. Those nerves exit the spinal column through gaps between each vertebrae, and that is where they can become pinched by either bulging discs or bone spurs. Disc bulges and bone spurs are much more complicated problems than a theoretical bone slipping out of place and pinching a nerve. In that scenario, the bone could be put back into place to take pressure off of the nerve and the pain would resolve quite rapidly. Don’t get me wrong, we do get some people better quite quickly. In the case of cervical radiculopathy or sciatica, though, it isn’t often that simple. Some people give up on treatment too soon because they want it to be that simple.
-Even though it is not just a bone out of place, a chiropractor can still help. Adjustments do more than just move bones. Adjustments can decrease the pressure inside the discs, which are soft and squishy and made mostly of water. Chiropractic adjustments can also relieve pressure on the pinched nerve by temporarily opening up the space where it passes between the vertebrae. Perhaps most importantly, adjustments affect the communication of pain signals from your arm or leg to your brain. In essence, getting adjusted can turn the volume down on the pain signal. Adjustments are just one tool in a chiropractor’s tool box. While they might not cure sciatica or radiating arm pain alone, they can help make the rest of your rehab more effective.
-If you end up needing surgery, doing it later rather than sooner shouldn’t affect your outcome. I’ve had patients give up after not seeing results after 1 or 2 treatments, only to consult with a surgeon and move forward with surgery. If the pain is caused by a bulging disc, and it is bearable and you aren’t progressively losing function in your arms or legs, it is safe to wait for surgery while you give conservative care a real chance at helping you. This study shows that even 1 and 2 years after the onset of symptoms, patients have a relatively equal chance of good surgical outcomes as those undergoing early surgical intervention. So when I recommend a trial of care lasting 4 weeks with 2 visits/week, I’m not doing it to pad my pocket book. In my experience, that is giving conservative treatment a fair chance before considering more invasive options. It’s enough time and enough visits to make a change, but not too much time that it could affect your surgical outcome if it comes to that.
If you or a loved one are suffering from cervical radiculopathy or sciatica, give conservative treatment a chance before doing anything more invasive. Contact us with any questions or to schedule a visit. (503) 526-8782
I remember several years ago I was watching Sports Center and the anchor reported that Sammy Sosa was not going to play that day due to back pain caused by a sneeze. It was reported in a way that made light of the subject, and I even got a good chuckle out of it. You may have laughed as well if this had never happened to you, but whether they make the headlines or not, sneezes often result in back or neck pain. As a chiropractor, I see this frequently and my patients are often embarrassed when they tell me how it happened. I believe sneezing is risky for two reasons:
1. When you sneeze you often turn your head in order to aim it away from people near you and to cover it with your arm or hand. Sneezing causes a very violent contraction of the diaphragm and many of the muscles that support the neck and spine. When creating such a violent contraction with your neck twisted, it is easy to see how a muscle could be pulled or even a joint in the spine sprained as the tissues are put under such intense stress.
2. Sneezing causes a rapid rise in intra-abdominal pressure. The pressure builds as all the air taken in during the “ahh” part of the sneeze gets restricted momentarily before the “choo” part. Raising intra-abdominal pressure also causes an increase in intra-thecal pressure, or the pressure inside the spinal canal, as well as the pressure inside the intervertebral discs, the soft cushions between each of your vertebrae. A sudden spike in pressure in these areas can cause a disc injury and/or a pinched nerve sensation in the back or neck.
One way to avoid injury when sneezing is to reduce the stress on your spine by slightly extending your neck and your lower back. As I discuss in the video below, we tend to bend forward when we cough or sneeze. Bending forward can place more pressure on the spine even when not sneezing, so it is best to avoid that position then next time you feel a tickle in your nose. See the video for more details. Until next time, take care and sneeze safely 🙂
In this month’s research update we review a study that compares the success of spinal manipulation (chiropractic adjustments) vs that of surgery for sciatic pain. Sciatic pain is nerve pain that courses down the back of your leg due to a pinched nerve in your low back. The nerve is often pinched by a bulging or herniated disc and can cause severe pain, numbness, tingling, and weakness in your leg. If you have any of these symptoms and show up at your doctor’s office, you could end up undergoing a whole spectrum of treatments and tests. A common protocol is to treat a problem like this with conservative care first, unless immediate surgery is warranted. Then consider surgery as a last option if all else fails. As this study demonstrates, “conservative care” can mean any number of things. From the medical perspective, a course of conservative care can go as follows: Oral pain medications, muscle relaxants, and a physical therapy referral. If this fails, steroid injections may be ordered as a final “conservative” approach prior to surgery.
The beauty of this study is that the group that underwent chiropractic treatment had already received at least three months of other conservative treatments that had failed to resolve their pain. After all was said and done, chiropractic care out performed the other non-operative treatments and showed very similar results as surgery, as shown in the graph above. This demonstrates that, while not the only option, chiropractic care should be considered as a valid first option in the treatment of sciatica. Surgery can be quite effective, but one should note the potential risks and failure rate associated with surgery. If there is another option, it should be taken, especially if it is natural and has fewer potential risks and side effects. Be an educated consumer and patient. Advocate for yourself and ask your doctor what other options there are besides drugs and surgery. If those are necessary options, then ask what the risks and side effects are so you are clear about what you can expect.
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