and neither do their Health Care Professionals.
Chapter 1
Chapter 2
Chapter 3
When a patient comes in for a first visit, I always ask for the main complaint. The patient will often answer with a diagnosis instead of what the symptoms are. For example, the patient will say, "I have a bulging disk between L4 and L5. Can you help me?" Another person may answer, "I have degenerative arthritis in my lower back causing pain. Can you help degenerative arthritis?" The patient will frequently bring x-rays or special studies, such as a CAT scan or an MRI scan, which demonstrate such and such a diagnosis, and the patient will ask me if I can treat that diagnosis successfully. This happens quite often for the following reasons:
- Many of my patients have already been to several other physicians and have been given one or more diagnoses.
- The patients were told that the diagnosis is the cause of the problem.
- The patients may have tried many different therapies in the hope of getting better and they want to know immediately if I can successfully treat that particular diagnosis.
A patient comes into my office with a five-year history of low back pain. The patient has been examined by the primary care physician and is diagnosed with degenerative disk disease and arthritis of the lumbar spine. For purposes of explanation, let me briefly describe degenerative disk disease. Between each of the vertebrae is a disk, which can be likened to a cushion that acts as a shock absorber between the vertebrae (Fig. 3.1).
Fig. 3.1 - Side view of a skeleton model showing the vertebrae and intervertebral disks of a normal lumbar spine.
This intervertebral disk is similar to a shoe insert that is filled with gel that you might have seen advertised in magazines or on television. When we walk or run or jump, these disks provide a protective buffer layer between the vertebrae and prevent bone from rubbing against bone. As we grow older, the gel-like substance may harden and become brittle. The disk may also become thinner from the wear and tear of years of weight bearing and, as a result, the space between the vertebrae may become narrower. The disk then provides less cushion effect between the vertebrae. The end result is that weight bearing and other normal activities begin to cause pain. This is degenerative disk disease
Fig. 3.2 - Side view of an x-ray of the lumbar spine showing thinning of the intervertebral disks (narrower spaces between the vertebrae) and "wear and tear" degeneration of some of the vertebrae (bone spurs). (Fig. 3.2). Arthritis of the spine, of course, is a condition in which the joints that connect the vertebrae with each other begin to deteriorate. The vertebrae themselves may also begin to show wear and tear. On the x-ray, bony spurs may also be seen on various parts of the vertebrae as an indication of the wear and tear (review Fig. 3.2).
Returning to our example, suppose that the patient’s primary complaint is left-sided low back pain, which occasionally goes down into the left leg. Let us also suppose that x-rays have been taken and that they do, indeed, show lumbar degenerative disk disease and arthritis of the lumbar spine. Let’s also suppose that an orthopedic surgeon examined the patient and the x-rays and has agreed with the diagnosis. Physical therapy was tried, anti-inflammatory medication was prescribed but both were of little help. The patient was then told that there was nothing more that could be done.
Now, let us also suppose that the patient does not want to accept the fact that nothing more can be done and comes into my office with x-rays in hand and says, "I have degenerative disk disease and arthritis in my lumbar spine. Can you help me?" I examine the patient and the x-rays and I discover that there are some things that are definitely treatable, so I proceed.
Let’s say that after six or eight treatments, the patient begins to feel significant improvement. After 10 or 12 treatments, the pain is gone and I discharge the patient from my care with instructions to return as needed. If we were to repeat the x-rays when finished with the treatments, would the x-rays have changed? No.
The x-rays would remain the same, showing the same degenerative disk disease and spinal arthritis that had been present before we started treatment. What does all this mean? It means that, yes, the degenerative disk disease and the arthritis in the lumbar spine are definitely there, but they are not the cause of the chronic low back pain. It’s as simple as that. Are you beginning to get the picture?
A man walks into a doctor’s office. He has a carrot sticking in one ear, a banana in the other ear, and a piece of celery sticking out of each nostril.
He says to the doctor, "You’re my last hope, Doc. What’s wrong with me?"
The doctor looks at him and says, "It’s obvious. You’re not eating right!"
The point of this bit of humor is to illustrate that although it may be "obvious" that the patient is "not eating right," don’t you also get the feeling that there just might be something else going on here? Something that is not quite so "obvious" that is causing him to not eat right? Similarly, with regard to you and your chronic low back pain, isn’t there a possibility that there just might be something else going on in your lower back? Something that’s not quite so obvious, something in addition to the diagnosis that you have been given, that’s causing your lower back pain? Well, there just might be! In fact, that’s what this book is about. So, please read on.
