A patient visited our office with back pain radiating into his leg that began a few years ago when he lifted his child. When he first injured his lower back, a local chiropractor helped him improve over four visits and he was very satisfied with the outcome. The chiropractor showed him his x-ray and said his problem was due to a pinched nerve. After therapeutic manipulation and some traction, he improved quickly. During a recent snowstorm, he shoveled and began to feel pain again, and then the pain worsened over the weekend.
For those of you who have shoveled snow, this previous storm was much heavier than normal, and you experienced back pain, as a result; it was far more likely if you were not careful.
During our history, the patient said that his lower back was very painful. Hee also began having knee problems about 5 years ago, prior to his first lower back problem and his doctors had had MRI and other tests to determine the source of his pain, however, these tests were negative. His wife also said that he is very stiff and tight all the time.
Upon looking at his x-rays, he mentioned that his chiropractor said his problem was a pinched nerve which was shown to him on the films. I showed him the films were negative for any problems other than some minor hip socket degeneration which usually means that there are biomechanical concerns that may be contributing to his chronic knee pain, back pain, and chronic stiffness.
Our evaluation showed guarded movement from the pain and his left side had severe restrictions of movement in multiple planes of motion, but his right side was moving well in comparison. His legs were extremely tight in both the front and the back. Tight fascia surrounding the legs will affect the knees and the lower back.
The patient also was asymmetrical in his body style. As described in the book Cheating Mother Nature, what you need to know to beat chronic pain, one foot turned out and the other falls affecting the way he moves and walks. These inherited traits will affect the way we learn to walk, move, and how the fascia that surrounds our musculature like an exoskeleton accommodates it.
The patient had difficulty squatting and his shoulders were very stiff as well, but he considered this normal, and it did not cause any pain.
After the assessment, his feet were taped in neutral to simulate how he would function with better symmetry. While he noticed his legs felt lighter, his back was still painful but he could squat without falling over. He also noticed better stability and his wife noticed his hips leveled out.
His neck ranges of motion that were restricted when we originally checked his overall mobility had also improved.
After performing some myofascial release on his core muscles and working on his legs to improve his mobility, he was able to move about better and a spinal adjustment was performed to improve his overall mobility.
One doctor’s pinched nerve is another doctor’s gait and movement problem
Most of us are not motivated by problems that “work themselves out” or self-resolve, but problems that remain painful or worsen are of concern to us. This patient had multiple problems due to issues that were developmental affecting the way he is built which affects the way he moves and walks, even when he does not experience symptoms.
Since he was stiff all the time, he believed this was normal since he was not in pain and it was all he had ever known since he was a child. When he developed back pain, he then realized this was not normal, yet his wife who knew him for many years understood that his lack of flexibility may be part of the problem and mentioned this during our evaluation.
Was his problem a pinched nerve, or a back strain, or perhaps a movement and gait issue? Most back and movement-related problems begin from the ground up. Had the other doctor looked at this patient more holistically, he may have diagnosed him differently and perhaps, realized that this inflexible patient needed more than just a spinal adjustment to his lower back.
Back, neck, shoulder, and knee problems are related
Problems affecting how we walk and move can affect us for years without marked symptoms, and will eventually result in many problems of the back, neck, shoulders, knees, and ankles that can even affect our hands, arms, and feet. Doctors are taught to evaluate the complaint but often forget that the patient may not tell them about other issues they consider normal unless they are hurt. Should we evaluate the symptoms, and the patient, or take the extra step and evaluate both to determine the true reason behind their complaint? Is it money well spent running expensive diagnostic tests such as an MRI when a more thorough exam may have resulted in treatment that was less costly than the test being ordered, as we saw in his history of knee pain?
While someone who is having acute back pain may not be able to be fully evaluated, most people can get a better diagnosis and more effective treatment by the doctor doing a more thorough holistic evaluation. In today’s environment of higher costs, it costs less to do it right the first time. Treating the area of symptoms may offer temporary relief which is the approach we use with medication, but several other problems or episodes are likely to occur over time to different areas of the body. This gentleman’s knee problems were likely part of his back problem which was being called a pinched nerve by his previous doctor. We currently have an Opioid problem that is partly due to the reliance on pain management methods, rather than problem resolution methods which can result in later problems being avoided entirely. Holistic care is better medicine.
Most back and knee problems are a result of the way we move and function as a unit. Treating the symptoms and ignoring the malfunction that causes them is mostly why our medical system has failed many back pain sufferers who have turned to opioids or had surgeries that cause irreversible damage after the area has been immobilized.
With the right treatment, retraining, and advice, in his later years, this patient is likely to have healthier spinal joints since most arthritis in the spine is due to how our body works over many years. Osteoarthritis is not the same for everyone, simply because we are built differently and use our bodies differently. It is a reasonable assumption that if our body mechanics improve, we are likely to have a healthier structure as we age.
What is the best course of treatment for a problem like this?
- Foot orthotics to level his hips and improve the symmetry of how he walks.
- Myofascial Release treatment to improve movement patterns and reduced restriction in his core, legs, and upper back region.
- Manipulation to the lower back and upper back to improve the movement of the joints in the spine and extremities.
- Corrective exercises to retrain poor movement patterns to prevent future problems.
Our office specializes in myofascial release treatment, active evaluation, and treatment methods and believes in holistic models of care for spinal and extremity problems. We look at patients first, and their symptoms second, and try to first understand their problem fully before we recommend treatment. If we cannot help, we will refer you to someone who can.
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