A new patient visited my office with back pain and stiffness. His former chiropractor had moved to a different town, and he had waited a few months to visit a new chiropractic physician. I am one of the few chiropractors with Sunday morning hours, and he had called to see if we were open during the holiday weekend. We weren’t, but I had another emergency and told him to come to our Scotch Plains office anyway. During our initial conversation, he mentioned that he was diagnosed with a herniated disc and as long as he saw his chiropractor every month or so, he felt ok. Upon further questioning, there was more going on than just his lower back, as his upper body was stiff. He rarely went to the gym anymore, as this aggravated his back, even though he was in his early 30s. He stated that a tens unit had helped reduce his lower back pain. My evaluation showed his shoes were a half size small, he had flat feet, and could barely squat. His upper body stability was poor, even though he seemed to have a muscular build. On my table, his legs were so tight I could not lift them off the table. His fascia, the connective tissue in the back and upper body into the legs, was very tight as well. Is the disc problem on the MRI the symptom or the problem? Many patients believe that the MRI is showing them why they hurt. While the MRI may offer a path to a diagnosis, it may not help you understand the reason your back hurts and may open the door to more interventions that are invasive, costly, and may not help you solve your back problems long term. Statistically, half of us may have herniated discs as we age, even in the absence of symptoms An MRI is part of your data, in addition to the history and evaluation. Often, what we see on the MRI is a history of malfunction. The question we should always ask ourselves as practitioners is why? In this patient’s history, he was tight and inflexible before injuring his back and was likely going to the gym to help himself feel better and more flexible. Often, trying to out-exercise tightness and poor mechanics ends badly as knee pain, plantar fasciitis, shoulder, or lower back injuries. His chiropractor had used mostly spinal manipulation; however, there was little other management to help his flexibility, strength, and core strength and stability. Sometimes another opinion can make a huge difference. As this was a weekend visit and the patient was in a significant amount of pain, my approach to treatment was to improve his flexibility using myofascial release, stabilize his pelvis with off-the-shelf foot orthotics, and give him basic McKenzie protocols to improve mobility and reduce his back pain. I explained to him that the MRI findings were old; however, his current lower back pains are a result of poor body mechanics and that these must be improved from the ground up. I had also advised him to expect pain to continue over the next day or so due to inflammation, and helped him understand why he was in pain. Why waiting until you require an emergency visit is a bad idea. Patients who have problems for weeks or months will eventually call for a Sunday emergency appointment when they are in moderate to severe pain. When an area is chronic and inflamed, it is unreasonable to assume that one chiropractic visit will resolve their long-term condition. On the other hand, I do my best to help the patient improve functionally and reduce the pain level. I often call this a Hail Mary Pass, which is when you throw a football as a last-ditch effort. In healthcare, it is when you do everything possible to help the patient feel better, with the possibility that you may never have another opportunity. If a doctor told you years ago that the MRI shows your problem is a disc problem in the lower back, your body has remarkable recuperative powers to recover on its own. You can usually improve the condition with chiropractic care, which can include myofascial release treatment, exercises, manipulation of the spine and extremities. Disc problems originate as problems with movement. Chiropractors naturally improve how you move and function. If you manage the problem well, you reduce the risk of a recurring problem. I advise patients to avoid blaming their pain on an old diagnosis from an MRI. Through a thorough evaluation, they will experience better care. In most cases, patients resolve or markedly improve and do not require another MRI, and many feel relief in as little as one visit. Resolving a long-standing problem requires a commitment beyond a Sunday emergency visit. A thorough evaluation will help you understand why you hurt. More importantly, different people are of different heights, body styles, as explained in my book Cheating Mother Nature, what you need to know to beat chiropractic care. Understanding this will lead to better care. Using one-size-fits-all protocols to your back is unfortunately all too common in our healthcare system, which leads to more costly tests, doctor visits, therapy that is not specific to our unique needs, and medical procedures that are non-cureative. Care for the lower back must be personalized to fit your unique needs and problems. Chiropractic sports physicians such as myself keep it simple. Holistic, thorough and personalized care for your back pain is what we are known for. Need help now? Book online today.