Back Pain

[sammie]

Hi

I had a Epidural steroid injections 5weeks ago, due to disc problems, had the injection's and still had bad back pain, i was told it could take a few weeks to feel better, 2weeks after the injections i found i had a pain in the middle of my back, if i pick anything up it feels like my back is breaking, like squashing down wards( sorry but cant describe it any different ),) i work in a hospital as a ward clerk, i am very careful on picking notes up but even one set feels like my back is breaking, last week the pain in my middle back got so bad that i couldn't breathe, pains were shooting all over, i lost the feeling in my right arm and left leg and could not move my neck, so i saw my doctor who said i had a spine inflammation caused by the injections,he has given me a slow release inflammatory tablet, but they have insisted i cant see a physio or chiropractor. any ideas why. i was told by fiends that they have got instant relief going to see a chiropractor, i feel like just going to one

thanks for reading this i would just like some relief

Similar Threads:

• Leg pain (hamstring, calve) and often lower back pain
• and internal rotation mainly hand behind back,otherwise no pain with ADL ,FROM shoulder joint,Can anyone suggest possible treatment or cause of pain?thx t
• low back pain with leg pain
• Lower back pain and ham string pain
• Re: Leg pain (hamstring, calve) and often lower back pain

[sammie]

Thanks for looking

[Canuck Physio]

Hello,

I personally think physiotherapy is the best bet. As for chiropractic I wouldn't suggest it except for high level athletes, because the grade 5 manipulations do not have significant amounts of evidence in treating slipped discs. What the manipulations can do however is release a large amount of endorphins giving you the sensation of a good feeling or 'buzz' from treatment. However, I think that managing your problem is the first step (alleviating aggravating factors), second is pain relief (either via meds or massage, or other), third is to begin a progressive exercise and movement program that will allow you to maintain a relative fit health status while the symptoms resolve.

Regards

[jonathan_PTRP]

you can have a physiotherapist now.. as a physical therapist, we have different techniques to treat our patients with different complications..
training would relieve te pain.. but if you have inflammation we have also a treatment plan about that..

[Judith Mollet]

"so bad that i couldn't breathe, pains were shooting all over, i lost the feeling in my right arm and left leg and could not move my neck...."
It sounds like a rather nasty reaction for whatever reason...I think it may be sensible to say no physio until this acute inflammatory reaction has calmed down. It hasn't helped and sounds as if it could have been a bit dangerous. Were you fully informed of how why and what they were doing with the epidural injections? Not knowing your case history I would say go for a good physio once it's calmed down. Manual Therapy may help, (not manipulation) Mid/longterm management with suitable exercises / ergonomics etc would also be appropriate.

[SPPAWA]

As a chiropractor, your symptoms following your injection do not sound like they would lend well to any manual therapy at this point... Whether it be chiro or physio. I'll make the following point: If you had no prior sensory loss or radiation in the arm or leg before the injection, I would be hesitant to say that these problems are the result of structural/physical findings. Some immune or infectious etiology would be more appropriate, especially considering the multiple dermatomal distribution of your symptoms. Have they ruled these out?
A comment was made about manipulation not being warrented in the treatment of a disc problem, allow me to argue this. Manipulation, as mentioned, does release endorphins but also has a direct reflex analgesic effect at the cord level. I would like to also give some other tips on how the mysterious manipulation works... We all know that movement inhibits pain (which is why you shake your hand when you touch a really hot hot plate). The brain pays more attention to movement than it does pain so you when you move the hand you don't feel the burn.

Typically, when a muscle is in spasm, we manual therapists provocate the bridged joint to be "restricted." Manipulation will position a muscle so that tension is drawn into the tendinous insertions which are rich in Golgi tendon organs which respond to fast stretch. The quick manipulation is just that, a fast stretch. Then, once stimulated, Type II nerve fibres from these tendons project directly back into the cord and through a series of interneurons inhibit the 1A afferent (ventral horn cell) which is keeping the muscle in spasm. This promotes it to relax and, if all goes well, restores the plane of restricted motion.

As I'm sure everyone on this form will agree the spine, discs in particular, require motion to feed through imhibition. Only the outer 1/3 of the annulus has a blood supply, thus if there is not motion to promote imhibition there is not going to be an ideal healing environment for a disc.

Most disc lesions also commence from the inner annular fibres which is why you don't feel them coming on (further compounding their nutritional healing issues) and it is usually some trivial event brings about an acute episode as the tear now progressed outwards to the highly innervated portion of the disc and now you CAN REALLY FEEL it. Here lies the crux of the issue and, I see it, where most cowboy chiros go wrong. Accurate diagnosis of the degree of the tear is crucial to appropriating treatment (MRI is useful here) but usually requires a comprehensive examination (fully sensory and power testing) and a great history, admittedly something that is tough to come in my profession filled with chiropractic "wellness practitioners" who don't take more than 10 minutes with a new patient before putting them on a table. Too often we forget that the spasm is protecting something unstable, however, it is also preventing healing... A true catch 22. Imaging is paramount, as is routine testing of sensation and power in the lower extremities and monitoring for changes in bowel and bladder function throughout a course of treatment for a lumbar compliant. An intense focus placed on modifying daily routines to minimize the stress an individual is now placing on an injured and freely moveable spinal joint that has been released through manipulation is paramount. It should also be advised that this can take 6-8 weeks to occur and longer in smokers and other nutritionally challenged individuals.

Once an acute episode has been stabilized, rehabilitation and neuromuscular coordination training is non negotiable for anyone serious about not having a reoccurrence. If you have ever broken a leg or sprained and ankle then had someone ask you "Are you limping?" long after it had healed you will understand my next point. The spine is controlled by reflex motor patterns which become interfered with when something goes wrong, as it did in your lower back. You alter these to suite your pain thresholds and not the intended optimal loading characteristics of the joints in the area. Resultantly, if you undergo treatment and your pain subsides you are likely still in the possession of altered motor patterns (bad habits for back muscles) which are going to place stress on tissues in your back that may not be able to withstand these loads making you more susceptible to injury. REHAB IS NECESSARY.
I'm new to practice in Sydney and located in Wahroonga on the northern beaches. I would like to work with in tandem with some local open-minded physio's who may be interested in working with a chiropractor.

[[email protected]]

I've had some experience with a chiro, I'd definitely recommend it. just ask if he can actually help with your situation.

[umerphysio]

hi,
You must go to a physiotherapist.if there is inflamation he will try to subside it first and will avoid exercises. ice packs and theraputic ultrasound may help to decrease inflamation.
best regards
umer physio

[robertcqu]

Hi All, Interesting points made by Sppawa. I agree that chiro is good but sometimes can cause more damage than help. Due to bad posture at work ,my desk was too far from my body and I was using laptop. I developed huge headaches. Felt like something was squeezing my brain. I was seen for MRi of a brain, naturally nothing was found. I then read about chiros and physio. I went for chiro and the headache was gone within a week. Of course I had to keep visiting chiro for another 3 months to maintain the healing process. I got a bit angry because I knew it was simply too long and did not believe that only adjustments are there to help me. After introducing physio, only one exercise, I managed to see chiro once per month. I learned that the problem was between my shoulders. It also affected my wrists, and my ganglion. All, including a ganglion was gone after some physiotherapy and a few weeks of regular massage and acupuncture. Acupuncture helped to manage the pain but the exercise given by physio took the weakness away from my wrists and muscles between the shoulders. Ok, that was the good part of my journey. Now it is time for the bad one. During the 3 months adjustment course , once twice per week, my smart chiro, for unknown reasons to me, adjusted my lower back. Mostly I was placed on a side but when I said I felt some pain in my heap he hit me from the top. I think he did it twice. After thesecond time I started feeling numbness in the lower back when laying on the floor. Numbness was gone after a few weeks and pain started when sitting. Of course chiro would not admit that it was him and for me it would be difficult to prove as I have sitting work type. I have a very strong body, no previous issues with my back in my life. I knew there was something wrong. I forced my doctor to do ct scan result, small disc protrusion which indents the anterior thecal sac but does not encroach into the lateral recess canals or exiting neural canals. I consider myself lucky,at least till now, as I do not feel pain when standing or walking only when sitting. Pain spreads around buttocks and coxic part. I took a week off and will try to stand at work for a while. I started physio who thinks that after two months of exercising I should be ok. I believe chiropractic is good but they still need to learn a lot. There are number of good chiros but also chiros who think they can treat you like a guinea pig. I am so angry with the guy and hope that one day someone will teach him a lesson For now what I can do is to tell you. be aware. I live in Ashfield NSW if you live around let me know I will tell you where not to go for chiropractic

[physiofixme]

The problem with epidurals is that they can cause damage to the dura. This is probably why you were advised not to see a physio or chiropractor at this point. I would press your Dr for a definitive diagnosis. If the symptoms you are experiencing are related to inflammation of your dura as a result of the epidural then no form of stretching, mobilisation or manipulation should be undertaken until these symptoms settle.

Your dura is like a protective sacking around your spinal cord and runs from your neck to your tailbone. Damage/inflammation of your dura can cause widespread symptoms - legs, arms, neck, etc. The pain is often quite intense. I'd proceed with caution at this point and focus on getting pain relief and your diagnosis sorted.

[markmiller]

Hi-

Sorry to hear about your injury. I would not recommend a chiropractor. I had a very bad experience with my back with one of them. They do manipulations that can make it feel better or much, much worse (as in my case). I would recommend doing some hip stretches and a few simple exercises, like the superman, plank, bridges and clams. You should be able to find all of these online. Improving posture and strengthening the core is the way to go for the back.

Best,
Mark

[SPPAWA]

Hi-

Sorry to hear about your injury. I would not recommend a chiropractor. I had a very bad experience with my back with one of them. They do manipulations that can make it feel better or much, much worse (as in my case). I would recommend doing some hip stretches and a few simple exercises, like the superman, plank, bridges and clams. You should be able to find all of these online. Improving posture and strengthening the core is the way to go for the back.

Best,
Mark

Sorry to hear you were hurt by a manipulation, this, unfortunately sometimes happens. In fact, it is referred to as iatrogenic injury and happens in medicine much more often as seen with side effects to drug reactions. In your case, your manipulative therapist did not likely perform the needed tests to asses the type of injury and unfortunately you responded negatively. As a manipulative therapist, I must admit, this has happened to me on some, although, few occasions. Much more often people get up feeling immediately better. I will also tell you that first hand some of the exercises I have perscribed have also hurt patients more than any of the manipulations I performed! Without examining and diagnosing a condition you really should not be recommending any treatment. I would encourage anyone reading here to undergo a proper examination by someone qualified in managing musculoskeltal complaints. Physiotherapists and Chiropractors would be excellent choices, unfortunately GP's here in Australia are just not given adequate training anymore (I have taught for a medical school). As a hot tip, when you find one who is good (ie a chiropractor or physiotherapist) they will support and work well with each other. It likely means they have both been reading the same research which shows that both manipulative therapy and exercise are beneficial to various rehabilitative circumstances overall... again depending on the diagnosis... go and see someone who is qualified and ask them some good questions!

SPPAWA

[Petero]

I had back and neck pain and find sitting at my office chair for long periods of time quite uncomfortable. My back particularly aches in the morning when I get out of bed as I'm stiff from the nights rest. Also I get sciatic pain during the evening especially which can be very painful. I've gone to the doc and physio before but to no avail. Its very debilitating living with back pain and I sympathise with anyone who has to suffer with it like I have.




orthopedic pillow

[Laura Jayne Physiotherapy]

Hi

It is really common for back pain to occur while sitting at the office. It is likely that when your back is curved sitting down the disc will start to bulge slightly, you'll need to see a physio to advise the best releif but it is likely that extended your back the opposite direction will move the disc into the correct place and stop the pain. If you are aitting down for long periods of time get up and move around so the pressure is off your curved back. A physio may be able to mobilise or manipulate this to help.

Hope you get your back pain resolved soon.

Thanks, Laura

Laura Jayne Physiotherapy

[pauljackson]

hey guys why dont you see a chiropractor chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues in general it is safe when employed skillfully and appropriately. Posture Exercise designed for your body to retrain poor patterns of body motion.if you encounter any problems with these poses, you should consult an expert.


Chiropractor Lawrenceville GA

[yelufem]

Hello everybody.I think more than enough reports have revealed the danger of visiting a chiro for solution to spinal problems.A profession that lack a body of knowledge rooted in scientific evidence should not be trusted.Chiro does things that work,fine,but are those maneuvre based on evidence.In twenty first century,medical practice must be driven by evidence world over and the remotest part of africa for the betterment of all and expansion of the body of knowledge.Chiro need a lot to do in this direction if they want other health professionals and pts to take them serious.It is safer for LBP sufferer to see physios.We possess adequate knowledge ,base that is rooted in grand empirical evidence to handle your case with little or no adverse effect.With love to both physio and chiro guys out there.yelufem.BMR(PT).

[Dr Damien]

Yelufem

Thank you for your views on the above topic. I do not think its fair to run down an entire profession based on mistakes of one or two professionals. physiotherapy can very well be considered a dangerous profession in the hands of the wrong practitioner as well. I know several patients that have sworn to never see a physiotherapist again. Physiotherapy is not very well supported in terms of evidence for the practice generally anyway. Infact, what is becoming more evident is the condemnation of many of our modalities (most researches do not support these modalities anyway) wherein we are left with more of our manual therapy skills now. So if anything, we should fortify the use of our manual skills and build some evidence for it. A field that is the forte of the Chiropractor. I know a very good chiropractor who has done very well for his patients over here, even in instances when the physios have never been able to help.

My opinion is that every professional should have respect for the other. We are not in allied health for no reason...as the key word is Allied.

I strongly agree with you about evidence based practice. I am all for evidenced based practice and If you read many of my previous posts, you would realise that i advocate the use of mainly evidence based practice. However, new methods of carrying out treatments often do not come out of research, they are born from lateral thinkers who influence research. The reality is, it is very difficult to extrapolate findings from research into practice mainly because the patients studied are never like your patients. This in essence flaws the concept of evidence based practice in general.

And yes, spinal adjustments are strongly evidenced based. Infact there have been several papers written on how to predict when these sdjustments are most likely to work. It all depends on patient selection. If the evidence has pointed that these patients are more likely to respond to manipulation, and the chiro/physio decides to select inappropriately, then it is not the professions fault...but an individual professionals problem.

We physiotherapists should not see ourselves as the know-ers of all, we can learn from a variety of disciplines...an example is the use of acupuncture...this was never a physiotherapy modality until a few years ago...it is not strongly evidenced based however it is now a recognised adjunct for treating low back pain in the UK. It was not us that figured this modality could be helpful, however we showed ability to change and adapt. Thats what we should all preach.

Remember that chiros/osteopaths are building their profession as well, if it was such a quack profession we would not have institutions dishing out degrees for these skills.
I dont see Chiros/Osteopaths/physios...what I see are manual therapists....and this is beginning to emerge as a field on its own...

cheers

[yelufem]

Dr demien.
Thank u for your post and comments on the subject matter.I think i am being misunderstood here.My comment is a reflection of my concern for the chiro profession's stand on many issues in health care. Giving the time of its existence and early training available,chiro as a profession is expected to lead the manual therapy world with other msk professionals to deliver the enormous benefits of manual therapy in a way that is consistent,scientific and reliable.What we get is continue deviation from general medical belief system and self imposed isolation from regular health team.Physiotherapy has emerged to play this role and playing it well at the moment.
Yes,some physio theories and treatment procedures have been challenged by clinical research and their use no more clinically permisible.This is quiet good for the profession and for the pt and the third payer .This is common in all medical field and not unusual.Research helps to determine clinical procedure that add value for money or are just wasting of tax payers money.Therapeutic ultrasound quickly comes to mind here.I stand to be corrected, physio as a profession has done far more than chiro in validating or discarding its treatment procedure in modern practice.Clinical evidencies are far superior to philosophy.The popular GallilioGallili gravitational force quickly come to mind here.When a profession holds on to 18 century philosophy in the face of numerous evidences pointing in the contrary,it may be consumed by the revelations it failed to embrace.
My sincrere appeal to our colleaques in chiro is to embrace modern clinical practices shaped by scientific evidence to win health professionals and pts confidence.yelufem.

[Dr Damien]

Cheers yelufem

We know you didnt mean to put down any profession and we ( and I should say myself personally) appeciate your ideals for scientific evidence.