The other day a new patient visited our office who had sciatic pain for two years and recently, has experienced “my sciatica” and back pain that has not gone away.
Upon questioning the patient, we found out that she already had an MRI which showed that there were some significant problems that have continued to develop over the years.
There are two ways to evaluate x rays and an MRI, the first being pathology which may be related to the pain the person has been experiencing and a second which looks at the test as a history of malfunction that has resulted in what we are now seeing. While we all want to know what the cause is, the point of view a doctor views the test can determine what happens next and how the problem is managed in the future. From a chiropractic holistic perspective, we look at both and use the test as part of our data to understand the person we are evaluating so a non invasive approach to care will diagnose and correctly treat the patient.
While the patient left feeling better, the patient did not tell us about a epidural injection she was going to have two days later.
Medical data shows us that whom you see first for lower back pain will determine your experience and how it is treated. Since she explored the medical route first, she was sent for an MRI which is usually used to get procedures approved that are invasive. Often people are immediately sent for rehabilitation which usually includes strengthening protocols that are given to everyone.
Physicians are now beginning to send these patients to chiropractors more frequently. Some insurers such as Optum health are recognizing that non pharmacologic care is the future and are making it less costly to see a chiropractor. A bill has also been introduced in the Congress to modernize the chiropractic coverage that has been restrictive since the 1970’s to fully cover chiropractic services under Medicare, a move that can help prevent another Opioid crisis. In the VA, chiropractic use is growing as a valued service to help service men and women and the integration is saving the armed forces millions while helping troops avoid opioids and other drugs.
The Annals of Internal Medicine published its guidelines in 2017 based on many years lower back pain treatment data. They concluded that you should use one of many methods which include manipulation from a chiropractor, exercises, tai chi, massage and other approaches and see a physician or a surgeon last for more invasive approaches. Chiropractors are the only profession that uses a number of things off this list to treat the problem and have the highest levels of satisfaction for back pain treatment.
What is did not say but implied was that back pain responds to treatments that improve movement first. This patient did this in reverse and was scheduled for an injection which increases risk and is often sold to patients using an MRI that is often used to sell the procedure. The injection may relieve the pain, but the mechanism that developed the problem will continue to worsen.
Healthcare for the lower back is actually healthcare of the human frame and the way we move. While we do have choices, we also must be better healthcare consumers even though they have a buffet of choices and choose wisely. Most healthcare consumers know more about the television they are about to purchase than the healthcare problem they are exploring when they are in pain.
Is my sciatica and back pain a lower back problem?
If a healthcare practitioner takes a brief history and evaluates the patients lower back only, and then issues a failed therapy treatment to the lower back, the protocols then suggest either an MRI or a referral or both to someone who will take a more aggressive approach.
If a chiropractic sports physician sees that patient, they will ask about the knees, the feet, the back, the neck and look at the person, as well as the back. Who is more likely to understand why the patient is in pain? Perhaps this is why patients who find a chiropractic physician they trust continue to use chiropractors in the future.
In the case of the patient above, there were a number of things they would never have revealed about themselves unless they were asked such as occasional knee, foot, neck and shoulder problems. Often these problems are inter related and are caused by postural adaptations the patient considers normal and unrelated. It is not unusual to meet a patient with multiple joint problems being managed by multiple specialists that are merely a postural problem that can be improved with the use of a chiropractor.
In this patients case, the “my sciatica” the patient referred to was caused by asymmetrical body mechanics and their normally stiff neck due to age was due to a distorted pelvis and the way she adapted to it from a very young age.
For most patients, normal is what they are used to since there is no other parameter for normal. So it may be “my normal stiffness”, “my normal stress headaches” or “my normal poor sense of balance.” Their normal is usually what they are used to however, is it normal or will an MRI many years later show us a poor history of function?
Why see a chiropractor first for back pain and “my sciatica”.
A multi faceted approach is needed to improve how we move and function. Improved body mechanics are going to help us a enjoy a healthier and more pain free life without the use of drugs or surgery. The right approach can also help us keep our joints healthy so they last as long as we do. Chiropractors are often the one stop shop for most painful problems in the musculoskeletal system.
Our chiropractic approach may include the use of
2. Myofascial release
3. Corrective exercises
4. Foot orthotics
5. Gait retraining.
Who should you see first? All roads lead to the chiropractor.