Radiculopathy Part 2

Caller: I have been suffering with lower back pain due to playing football for such a long time. The pain runs from my lower back down into the right side of my leg. Chiropractors worked on me for years but they say that basically there is nothing they can do for me with the discs as compressed as they are. I played in the NFL for 18 months.

Dr. Darrow: There are two things that run through my mind immediately when someone has leg pain, either it is a radiculopathy which means that there is some bone that is overgrown in the vertebrae that closes off the holes where the nerves come out or there is a piece of the disc that cushions the vertebrae that has broken loose or has become a herniated disc. If that is the case, then Prolotherapy sometimes can help because it stabilizes the vertebrae so there is not much shifting of the bones so it is not irritating the nerve.

We are differentiating between a referral pattern from a ligament in the low back or a radiculopathy which is an inflammation or a pinching around the nerve that comes out of the spinal cord that comes out of the vertebrae and goes down the leg. And unless we are able to put our thumbs in your back and check you out, we would not know for sure what is going on but we will be careful NOT to use an MRI to make our diagnosis for us because more than half the people with no back pain at all, if they get put in an MRI machine, half of them would have disc problems ON FILM, but no back pain.

Most of the surgeries that are done, in my opinion, is to cure the MRI than to cure the person. Our clinic is filled with these people who had the surgeries that have failed.

There is hope, even when people do have these flares of leg pain like you do, most of them go away on their own.

Caller: That is exactly right, I have been dealing with this for 20 years. It comes and goes.

Dr. Darrow: Back exercises can be a good idea. MedX is a big frame machine built by Arthur Jones who built Nautalis Equipment. This machine can strengthen up the muscles in the low back, which can be a good idea with someone with this type of problem. There is a lot of hope that you can deal with this without surgery. But if you have progressive neurological deficits like you can’t go to the bathroom, you can’t lift your leg, your leg is shrinking in size, things like that you need a surgical consult.

Radiculopathy Part 1

Caller: I have had an injury in my lower back since 1985, surgery has been recommended and strong medications have been recommended. I have been told that I needed spinal fusion. My MRI indicated I had a slippage in the vertebrae (Spondylolisthesis).

Dr. Darrow: That doesn’t necessarily mean you need surgery.

Caller: They found an arthritic condition.

Dr. Darrow: That doesn’t necessarily mean you need surgery.

Caller: And they found that I had Bulging Discs.

Dr. Darrow: That doesn’t necessarily mean you need surgery. Do you have pain down your legs?

Caller: Yes, radiating down both legs.

Dr. Darrow: Okay, that is an indication that a surgery may help you although I am not telling you to have a surgery or not. Here is the confusing part.

Pain that radiates down the legs is called a radiculopathy, pain that is referred down your legs by a nerve being pressed on by a bulging or herniated disc. Often I find that the radiating pain is not because of radiculopathy or pinched nerve but because of a ligament that is loose or injured because ligaments refer pain the same way. Before surgery explore conservative methods including Prolotherapy to see if its the ligaments.

Lower Back Pain Part 3

Unfortunately, the rate of success for second surgical operations in the case of “failed back syndrome” is no greater than it was for the initial operation, and declines with further attempts. In the words of a surgeon involved in such procedures, “In our extensive experience, satisfactory outcome is achieved about 60% of the time. Evidence indicates that many patients suffering from residual pain after multiple operations can benefit from an intensive rehabilitation program.

 

At the Chiropractor
Chiropractic care, although dreaded by the medical community, is desired more than any other therapy by the public. An excellent chiropractic methodology is called Applied Kinesiology (AK). The reason that it is often the best form of care post-surgically is that it does not involve “cracking” the vertebrae (although I must admit, I love to have my neck and back adjusted.)

A synergistic form of back strengthening for the muscles of the back and neck is MedX computerized exercise equipment. It was developed by Arthur Jones who also developed Nautilus.

With a combination of chiropractic care, Prolotherapy, MedX, and an intensive rehabilitation program that focuses on stretching, elimination of local inflammatory changes, spinal muscle strengthening, and general reconditioning, most patients improve by increasing function and mobility, and decreasing pain.

Prolotherapy to the Rescue
A study published in 1987—by which time the procedures of Prolotherapyy were fairly well established—offered dramatic support to proponents of the still basically unknown technique. In the first double-blind study on the effects of the treatment, two groups of carefully screened patients—with at least a one year history of back problems that hadn’t responded to other non-surgical treatments—were injected with either a true prolotherapy proliferant (a dextrose-glycerine-phenol solution originally developed to treat varicose veins), or with a saline-based placebo.

The test subjects had been thoroughly pre-screened, with full clinical evaluations, x-rays and lab tests, and the 82 patients accepted had arrived with painful conditions. 60% were currently using non-steroidal anti-inflammatory drugs. A half-dozen were experiencing such intense pain that they were taking narcotics for relief. A whopping 91% had difficulty sitting still for any length of time, and 65% had difficulty sleeping due to their pain. 17% had difficulty walking, sexual activity was down in 21%, and 4% were completely bed-ridden. (see video on Sleep and Detox)

Six months after the treatment, 35 of the 40 people who’d received the actual Prolotherapy treatment had experienced at least a 50% reduction in pain—a success rate of 88%. And 15 of them were completely pain free–compared to only 4 in the control group.

Other “pain score” indicators backed up the results of this data, confirming the success of the therapy. One thing was eminently clear:

Prolotherapy worked for the treatment of chronic low back pain.

Lower Back Pain Part 2

The sacrum at the base of the spine is the “keystone” bone, on which all of the most vital structures of the body rest. Besides the lower vertebrae and the rest of the spinal column that it supports, it bears the weight of the entire torso with all its major organs.

And since the core of the central nervous system is housed in the spinal cord, and the nerves affect not only the legs and other extremities, but also the glands and the organs, the importance of keeping this area healthy and properly aligned becomes readily apparent. It also explains why so much of the pain reported to physicians is rooted in the lower back.

Descriptions and diagnosis of common low back pain include:

 

Lumbrosacral strain or sprain indicates a soft tissue injury of the lower back, equivalent to a sprained ankle.

Discogenic syndrome is used to describe pain originating in the lumbar disk, due to tears in the annulus, release of chemical mediators, or micromotion.

Disc Herniation indicates a displacement of the nucleus pulposus from the intervertebral space into the spinal canal or foramen, or outside the foramen. This can “pinch” a nerve root and cause sciatica.

Facet syndrome describes pain originating in the zygapophyseal or “facet” joints between the vertebrae, characteristically localized in the back, aggravated by movement and alleviated by rest.

Spondylolisthesis is the slipping forward of one vertebral segment onto another. Retrolisthesis describes the inverse: the slipping backward of one vertebra onto another.

Spondylolysis indicates a defect in the structure of the pars interarticularis, while spondylosis is a catch-all phrase describing the changes that occur as a result of Degenerative Disc Disease, such as desiccation of the disk, narrowing of the interspace, inflammation, spurring or degeneration of the bone, and ligament hypertrophy.

Spinal stenosis is used to describe the narrowing, in part or in whole, of the spinal canal, either through spondylosis or a congenital defect.

Spinal instability is a very general term used when a more precise diagnosis eludes the physician. Specifically, it refers to excess motion of the vertebrae, and can be shown on flexion and extension x-rays. If instability is severe, it can cause spinal cord injury and paralysis.

Perhaps the most distressing is “failed back syndrome” — an official-sounding term to describe the pain of those poor patients whose surgical attempts have failed to correct their problem.

The most common cause of failed back syndrome is poor judgment on the part of the physician. Surgery prescribed as a last resort, with a hope and a prayer that it might alleviate the pain. In a future article we will also be discussing a rotator cuff tear and it’s various implications. A rotator cuff tear can be more complicated than initially thought.

Unfortunately, often times surgery does little to help, and in fact can make things worse. Frequently surgery results in post-operative scarring, which often exacerbates the initial problem or causes new pain syndromes.

Subsequent “corrective” surgery can help in some cases, particularly if the damage done by the first operation involves clearly observable physical complications like nerve root compression, massive scarring, bone spurring or foraminal compression.

Continue article on Lower back pain

Is Back Pain Genetic?

QUESTION FROM CALLER: My grandfather and my father both had chronic back pain, lower back pain. I seemed to have gotten that same gene. I do not know if it is genetic. I have a back spasm every month, what is the best approach to excise this from my life am I going to have this for the rest of my life?

Dr. Darrow: That is one of the greatest questions I have ever been asked. Genetically there are no studies that I know of that can correlate genetics and back pain. However, there can be sort of a structural genetic thing in the low back that can cause a lot of back pain. The arch in the lower back (can be severe) in a sense and that can cause pressure on the discs that can cause back pain and possibly disc herniation. Now this is theoretical as I say I have never done studies on it, but I have noticed that a lot of people that have this arch problem do have a lot of back pain. That particular part of the back where the arch is, right above the buttocks carries the most strain between the upper body and the lower body. More than 80% of the people on the planet have back pain at some point in their life and the fact that your grandfather has it, your father has it and you have pain episodically can just be that the fact that we are standing up when we are probably built to be on all fours and that extra stress from standing and putting the stress on the lumbar sacral area just causes a lot of back pain.

When you ask me what is the best way to prevent these back pain episodes that you have, the triad of healing in my office is chiropractor to align the spine and then MedX treatment which are big frame machines that were established by Arthur Jones who built Nautilus equipment. And these are big machines designed to exercise only the muscles that support the vertebrae, the paraspinal muscles. And most people have very weak paraspinal muscles, they can have very strong backs because their gluteus and hamstring muscles are very strong, these paraspinal muscles are weak. If we can strengthen these muscles up, they can save you from these spasms. Prolotherapy, the stimulation of the body to produce more collagen to strengthen the ligaments of the back. The low back especially is filled with the ligamentous type tissues.

We use a (multi-disciplinary approach in these problems) I do not know of another clinic in the world that does what we do or have the success that we have. The chances are that if you get the back good and strong and the muscles and ligaments strong this can help your problem.

Doctor Darrow’s Back Pain

Discussions from our Radio Show:

Doctor Darrow: I had Prolotherapy Injections on my back this morning, I fell down the stairs about six weeks ago and fell on the back of my ribs and the back of my pelvis and it sort of loosened everything up and it brought back an old injury that I had when I was a gymnast and fell on my tail bone. I had been healed with Prolotherapy once before and this is my third set of Prolotherapy injections for this injury and I am ready to go back out on the golf course.

I have had bad back pain that went down into my legs where I actually had to limp around for a couple of days and I never got an MRI. Now why didn’t I? Because I don’t believe in them, I believe that they are a useful backup but not as a primary diagnosis.

Now if I had a herniated disc, in my low back where the pain was, a surgeon would have told me to have a surgery to clean up the disc. But what we find in the people that come into our clinic is that they have sprains in the ligaments and this sprain can “pretend” that it is a herniated disc that the person has. Many people have disc problems, they have no pain, but if they get a sprain in their back and then they get and MRI, the doctors often think that it is the disc problem causing pain and they recommend surgery to fix it and it doesn’t work.

Dr. Darrow: There is pain that can come from the back down the legs, from the neck down the arms, that has absolutely nothing to do with the disc even if there is a disc problem. Most of the pain comes from trigger points, which was popularized by Dr. Travell and Simon who worked with Presidents Kennedy and Johnson. What we find is that the trigger point injections work very adequately when some one has an acute or new injury, to help relax the muscles. But what we find down the road the problem becomes chronic.

The other night we had a caller who said she had 25 years of back pain healed by prolotherapy, and she said she was healed after only eight treatments. We hear that everyday, people getting better, and it makes us excited and enthusiastic about this pain treatment.

In Prolotherapy, what the dextrose does is start a very small inflammatory response in the body. Inflammation kicks up the immune system, the immune system brings up fibroblasts which are small cells that produce collagen. Wherever we put that small needle, we will be stimulating collagen growth (Studies have shown ligaments actually get 50% thicker and their strength becomes 200-400% stronger.) Typically a person needs to get injected two to four times to show improvement, and if it is a really bad injury, we may have to inject up to eight times over a period of a couple of months as it does take collagen a couple of months to grow.

Prolotherapy helped me personally after numerous chronic injuries and a failed surgery. It is a valuable weapon that can help people with chronic pain.

Herniated Discs – Sciatica

Discussions from our radio show:

Caller: I am having a lot of problems with my L5 disc. Every now and then, and for no reason, I get a tremendous pain in that area, my back freezes up and I can’t do anything or straighten up. I wind up bent over in half, it goes on for several days.

I went and had an MRI and the radiologist says that I have a herniated disc. I would like to know about what causes it and what possibly could correct it other than surgery.

Dr. Darrow: Great Question. Do you know more than half the people walking around with “disc problems” don’t have any pain. What does that tell you? It tells you that even though you may have a 5 millimeter herniation in your disc, that may not be what is giving you pain.

From the history of what you are telling me that you cannot straighten up, this does not typically sound like a herniated disc problem, it sounds like something we call mechanical back pain. This is where yourligamentsmaybe stretched out or the covering of the muscle called the fascia which attaches all across your back muscles and attaches to the pelvis maybe stretched out.

Do you have pain running down your legs?

Caller: Yes I do, it runs down the sciatica nerve, it runs down my right leg and that will go on for a day or two days and then fades away.

Dr. Darrow: It is a very good thing that it fades away. That’s because maybe it is not sciatica nerve pain at all but a referral pain from the ligaments in your back.

We strengthen that whole area up we use MedX back exercises to strengthen the muscles around the vertebrae then we use chiropractor adjustments for alignment, then we use Prolotherapy to thicken and strengthen the ligaments.

Just because it looks like sciatica doesn’t mean it is sciatica. Sciatica means that the sciatic nerve is actually being impinged on.

Identifying Different Types of Back Pain

To review, there are many structures in the lower back that can cause severe pain. These include muscles, ligaments, tendons, bones, joints and discs. The outer rim of the disc can be a source of significant back pain due to its rich nerve supply and tendency towards injury.

During our development, there is a great deal of overlap of nerve supply to all of these structures. This makes it nearly impossible for the brain to distinguish between injury to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury. This is where an examination into the cause of the pain is important; each of these different structures may need a different type of treatment to resolve your pain.

Back pain can be divided into three large classifications. The most common condition is known as axial, or mechanical back pain. This pain can run the gamut from a very sharp to a dull ache. It may occur all the time, or it may come and go. It also varies in intensity from very mild to extremely severe. One patient may report that his/ her lower back is only sore when having been seated for a long time, or after working in the garden. Another patient may report severe, debilitating pain and need assistance to walk or stand, or even to get up from a sitting position. While one patient is perfectly straight, the other is bent over and locked in a crooked posture. The one thing that is common in these conditions is that the pain is restricted to the lower back area.

This most common type of problem, mechanical back pain, is completely non-specific with regards to the injured structure or structures. Generally, the pain gets worse with certain activities or positions. It is usually relieved by rest or changing positions. Note, extended bed rest may aggravate this type of problem.

This condition responds extremely well to conservative care. At times, spinal manipulation alone is the “miracle” affording immediate relief. More often, the injury involves more than just a misalignment of a vertebrae or of your pelvis. nerves, muscles, tendons, ligaments and skin can all have an influence on the degree of discomfort. And each of these may need to be addressed to attain relief.

Back pain can be divided into three large classifications – axial pain, referred pain and radicular pain.

If you have multiple episodes of this type of pain, you will want to engage yourself in a rehabilitation program to help resolve the underlying causes of the problem. Here, the diagnosis goes farther than just finding out what is causing the pain, but additionally centers on what weakness or restriction you have that ultimately causes you to have an episode. Here again, we function much like a “coach”, finding the cause(s) and helping to direct you towards ways of avoiding and limiting future bouts with pain.

The most common type of back pain is known as referred pain. Here, patients complain of having an achy, dull type of pain that seems to move around. The discomfort comes and goes and varies in intensity. This achy pain starts in the low back area and commonly spreads into the groin, buttocks and upper thighs.

The treatment options here are similar to those used in treating axial pain. Diagnostic and therapeutic measures are aimed at correcting abnormalities in the muscles, ligaments and small joints of the spine.

The last type of back pain is known as radicular pain. In this case, the pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.

The most common example of this type of problem is the sciatic pain that radiates along that sciatic nerve – down the back of the thigh and calf into the foot. This type of pain is caused by injury to a spinal nerve. Some of the possible causes of this are a disc protrusion or bulge, arthritic changes or a narrowing of the opening through which the nerve exits.

While a few of these cases will require surgery, most respond to conservative care. Here the care will consist of multiple therapies, all designed to reduce inflammation, balance your posture, strengthen supporting structures, attain normal motion and improve the health of the nerve that is involved.

In all types of back pain, your health habits play an important role. For example, there are certain foods that are high in the fats that cause more inflammation. Limiting intake of these animal fats and increasing your intake of the good fats that reduce inflammation may play an important role in your healing. Smoking is another health concern. Statistically, smokers are slow healers with respect to back pain.

An important part in prevention is keeping these back muscles active and in good tone.

One of the most important areas in chronic back pain management is the strength of your abdominal wall and your pelvic floor. There are three major abdominal muscles, each with small subdivisions. Any weakness in one of these sections can be the root cause of a chronic back problem. Weakness in these structures causes your back muscles to tighten and shorten. This adversely affects the lower back on the small joints and discs.

If you are interested in helping to prevent or at least limit your chances of having any of these types of back pain, talk to us about testing and setting up an exercise program for maintaining good support for your back.

Can Prolotherapy Really Fix a Back Problem Where Surgery Can Not?

Can Prolotherapy really fix a back problem where surgery can not? A study published in 1987-by which time the procedures of Prolotherapy were fairly well established-offered dramatic support to proponents of the still basically unknown technique. In the first double-blind study on the effects of Prolotherapy on back pain, two groups of carefully screened patients-with at least a one year history of back problems that hadn’t responded to other non- surgical treatments-were injected with either a true Prolotherapy proliferant(a dextrose-glycerine-phenol solution), or with a saline-based placebo.

The test subjects had been thoroughly pre-screened, with full clinical evaluations, x-rays and lab tests, and the 82 patients accepted had arrived with painful conditions. Sixty-percent were currently using non-steroidal anti-inflammatory drugs (NSAIDS). A half-dozen were experiencing such intense pain that they were taking narcotic pain-killers. A whopping 91% had difficulty sitting still for any length of time, and 65% had difficulty sleeping (see video on Sleep and Detox) due to their pain. Seventeen-percent had difficulty walking, 21% experienced decreased sexual activity, and 4% were completely bed-ridden.

Six months after the treatment, 35 of the 40 people who had received the actual Prolotherapy treatment had experienced at least a 50% reduction in pain-a success rate of 88%. And 15 of them were completely pain free-compared to only 4 in the control group.

1. Ongley M, Klein R, Dorman T, Eek B, Hubert L. A New Approach to the Treatment of Chronic Low Back Pain. Lancet 1987;2:143-146.

Discussions on Radiculopathy

 

 

 

 

 

 

Sciatica-Radicular Pain-MRI

Radicular pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.

Discussions on Radiculopathy from our Radio Show:

Lower Back Pain

Caller: I have had an injury in my lower back since 1985, surgery has been recommended and strong medications have been recommended. I have been told that I needed spinal fusion. My MRI indicated I had a slippage in the vertebrae (Spondylolisthesis).

Dr. Darrow: That doesn’t necessarily mean you need surgery.

Caller: They found an arthritic condition.

Dr. Darrow: That doesn’t necessarily mean you need surgery.

Caller: And they found that I had Bulging Discs.

Dr. Darrow: That doesn’t necessarily mean you need surgery. Do you have pain down your legs?

Caller: Yes, radiating down both legs.

Dr. Darrow: Okay, that is an indication that a surgery may help you although I am not telling you to have a surgery or not. Here is the confusing part.

Pain that radiates down the legs is called a radiculopathy, pain that is referred down your legs by a nerve being pressed on by a bulging or herniated disc. Often I find that the radiating pain is not because of radiculopathy or pinched nerve but because of a ligament that is loose or injured because ligaments refer pain the same way. Before surgery explore conservative methods including Prolotherapy to see if its the ligaments.

Car Accident

Caller: I was in a car accident, a roll over car accident on the freeway that resulted in Bulging Discs in my spine and a herniated disc in my neck. They cause me a great deal of pain.

Dr. Darrow: Do you have any pain that goes down your arms or legs?

Caller: Down my arms especially on one side, the left side

Dr. Darrow: (If it is a nerve problem) One of the first things I would try (even before Prolotherapy) is spinal decompression therapy. Spinal decompression therapy is like traction except it pulls you in different directions. What it does is pull on the spine and open up the foramen which are the holes in the spinal cord which the nerves pass through that go down the arm and very often with a series of decompressions, you can aleviate the problem by in essence, giving the nerve more room to breath.

The other thing is that there are trigger points often that can cause these radiating pains down the limbs and even though you say you a herniated disc, that doesn’t mean that that is causing your pain or the pain radiation, because there are trigger points that can create the referral pain patterns just as well as what we call radiculopathy or pinched nerve, so you need to go to someone who understands these different mechanisms and just doesn’t follow the allopathic medical model of “herniated disc – go to surgery.”

We find that most of the people that have these problems with radiating pain is that the radiating pain actually goes away by itself, even without doctors over a period of time, now it can be cyclical thing and come back but often times I have had patients who have fought me and gone to surgery and not only winding up with pain in one limb, but pain going down the other limb as well probably because of scar tissue that forms. Return to Radiculopathy main page

Football Injury

Caller: I have been suffering with lower back pain due to playing football for such a long time. The pain runs from my lower back down into the right side of my leg. Chiropractors worked on me for years but they say that basically there is nothing they can do for me with the discs as compressed as they are. I played in the NFL for 18 months.

Dr. Darrow: There are two things that run through my mind immediately when someone has leg pain, either it is a radiculopathy which means that there is some bone that is overgrown in the vertebrae that closes off the holes where the nerves come out or there is a piece of the disc that cushions the vertebrae that has broken loose or has become a herniated disc. If that is the case, then Prolotherapy sometimes can help because it stabilizes the vertebrae so there is not much shifting of the bones so it is not irritating the nerve.

We are differentiating between a referral pattern from a ligament in the low back or a radiculopathy which is an inflammation or a pinching around the nerve that comes out of the spinal cord that comes out of the vertebrae and goes down the leg. And unless we are able to put our thumbs in your back and check you out, we would not know for sure what is going on but we will be careful NOT to use an MRI to make our diagnosis for us because more than half the people with no back pain at all, if they get put in an MRI machine, half of them would have disc problems ON FILM, but no back pain.

Most of the surgeries that are done, in my opinion, is to cure the MRI than to cure the person. Our clinic is filled with these people who had the surgeries that have failed.

There is hope, even when people do have these flares of leg pain like you do, most of them go away on their own.

Caller: That is exactly right, I have been dealing with this for 20 years. It comes and goes.

Dr. Darrow: Back exercises can be a good idea. MedX is a big frame machine built by Arthur Jones who built Nautalis Equipment. This machine can strengthen up the muscles in the low back, which can be a good idea with someone with this type of problem. There is a lot of hope that you can deal with this without surgery. But if you have progressive neurological deficits like you can’t go to the bathroom, you can’t lift your leg, your leg is shrinking in size, things like that you need a surgical consult.

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