Low Back Pain! OMG!

My long-time friend and buddy, Tito, sent me a text this morning asking for help. T lives in the Denver area. We've had a celebratory history of ups and downs and mostly ups over the course of almost thirty years now. Tito is one of less than five who I call my closest friends. We've had parties together, fights together, worked out together, shared weddings and his second-born is partially named after me.

I guess Tito's wife, Sandi, has come up with a severe lower back complaint and it sounds like it is a problem stemming from the L5/S1 nerve root which some commonly call a sciatic problem. The sciatic distribution of the problem is somewhat accurate, at times, but most of the time the root and source of the lesion is from the L5/S1 nerve root coming out of the intervertebral foramen. Its actually a radiculopathic problem most of the time versus what is termed a peripheral neuropathy. I mostly find that this is actually a sign of facet syndrome instead of inflamed disc. Sometimes ilio-sacral ligaments can elicit the same signs/symptoms of the lesion. Usual physical findings are tight/spasm supporting lumbars, iliopsoas, TFL, gluteus medius and piriformis. Neurologic decrease in achilles DTR, lack of sensation rear thigh/leg/foot. Sometimes a patient cannot tip-toe walk. Subjective is rear thigh/leg pain sometimes down to foot, numbness and tingling/shooting pain. Sometimes, one does not even feel the lower back pain. If this problem is not caused by traumatic circumstance, then you generally find a history of an insidious onset with off/on signs/symptoms occurring over extended period of time. Repetitive motioning and micro-injury are usually the culprits. The patient finally presents after the idea that "It will go away" does not happen this time. The reason it "does not go away" is because episode after episode has finally caught up to the patient and the body has finally had enough. The patient would have been much better off had they been checked and treated on the previous milder episodes. Rarely does this ever happen. So it goes.

Key indicators of the nerve root problem when I see this patient filling out their paperwork are the following: They usually lean to one side, have slip-on shoes instead of tie-ups, no socks and shorts or easy to put on sweats. These four indicators are dead give-aways to a radiating low back victim.

I talked to Tito, told him what he needed to do with Sandi and this is what I said:

Print this thing out for reference.

Make sure she has good shoes. Asics or New Balance are my preferences for patients. Higher the number the better for proper anti-pronation. Throw away anything older than one year. No flip-flops. Shoes are the foundation and, basically, your back care is from the feet on up.

At health food store/vitamin store - Emergen-C by Alacer with glucosamine/chondroitin sulfate and Emergen-C with MSM. They are two different boxes with 36 packets each. I only recommend the Emergen-C b/c its in salt form and over 90% assimilated in body. Any pills, whatever, in any other form, you are throwing away over 50% of your purchase b/c of lack of assimilation. Thats not my opinion, its fact. The C in the Alacer product is also vitally important to collagen synthesis and joint structure (as well as anti-oxidant properties) in body. Take 3 to 6 packets per day in water. Would be good for you also as well as your whole family. Don't pay more than $12-13 per box. Any more than that and you're being ripped off. I usually pay about $11. The regular Emergen-C is around $8-9. Multi your doing is probably okay (as long as it is multi-pack versus all-in-one), but quit that calcium - its for crap to do that and a waste of money. You build and maintain your bones with load bearing activity and hormones do the rest of conversions.

Maintain chiropractic correction and therapies. Any heat on low back follow with cold/ice. Like spa/jacuzzi follow with cold shower or cold pool.

Stretch, stretch, stretch. Especially your hamstrings/glutes/piriformis. Maintain proper lifting techniques (No rotation of torso with load and also knees bent while lifting). If that chiro does active/release, then make him do it - otherwise, anyone else can do it with you. Tight hams are number one with low back. You may have disc bulge, but over 50% of population has this and its asymptomatic - its a chance finding anymore. Stretch those hams with a belt around the foot and pull on the belt. Cross one leg in front of the other to get that glute medius/piriformis. Hope you know what I'm talking about. If not, look it up online. Common yoga stretches. Oh, yoga is also great for everything.

If any drugs OTC, try getting rid of IB and go with aspirin/excedrin, aleve. If script, I prefer naprosyn, celebrex. Don't mess with muscle relaxants and oxycodone like stuff - they don't do crap and only put you on headtrip and dehydrate you.

Food - fruits, veg, fish, light chicken, rice - up to 5-6 small meals per day. Decrease breads, dairy, candies, cakes, cookies. Increase water intake. Make yourself exercise. Low impact.

Inversion table is good idea. You may be able to find them in sports stores. I prefer ebay or other auction sites. Full inversion is best versus just hanging from torso. Teeter brand is best and most expensive. My table at the moment is Lifegear and I think its just as good. Probably in the $150 range. Be careful of shipping cost if buy on ebay. This is usually where great profit is made by selling.

Depending on degeneration, contributing factors, previous injury and extenuating circumstance, a good trial for severe low back is four months solid at least three times per week treatment in first two months and then minimum two times per week last two months. Within first one month, results should be evident and things should get better. Expect brief relapse after about six weeks which is very painful for a few days and then its downhill from there. If you have no relapse, then God is with you! Ha. Within that four month mark, do not stop treatment no matter how good you may be feeling. Its not worth it to start from scratch again, at anytime. This didn't happen overnight, you will not be able to control it into submission overnight. After full recession of symptoms, you must maintain. You have a weak link and it will always be a weak link. It depends on the person, but ongoing maintenance of your weak links is anywhere from once per week on up to one month. If this schedule is abbreviated by any doc, then treatment time is extended as then there is just a lot of patch, patch, patch per visit. You can't leave a lot of time between treats and expect the structure to maintain proper position when it has been compromised and in bad position for great length of time prior.

When you're dealing with such a problem, this is my best recommendation for your best result. Often cost must be taken into account and you can always ask for point of service discount when you know that forty visits over a four month period of time can get quite costly. You have to figure out how much your health is worth to you. I can tell you this: You're health is something you've always got, good or bad. Its up to you to live for the best. Without your health, where would you be? Its a small expense to making sure of a happy, productive mom, dad and kids. I offer a discount at start of a problem for multiple visits paid ahead of time and I do charge full price until base problem is taken care of. Thereafter I offer maintenance office visit fees as these visits are not as time consuming.

Something I also do in my office with families is offer an unlimited care plan for the entire family at only $169 per month. This saves me an insurance headache as well as makes it easy on a family to get care they desire and need. The kids end up being better and more coordinated in the sports, takes stress off the parents and makes life 20% better with well taken care of nervous systems. Also keeps from getting sick with properly working immune systems. When you think about it, my average insurance copay is now $30. If I used a family of five's insurance just once per month, the cost would be a total of $150 just for that one visit - not to mention deductible cost. My family plan is a total deal. All you have to do is ask your chiro about the possibility. Its a win-win. The patient gets care they need and the chiro ends up not paying for filing insurance and also waiting the month or two for pay. The chiro also ends up with less stress b/c of maintaining happy patients instead of dead and dying patients.