Expert: Dr. Victor Dolan, DC, DACBSP - 12/6/2008

Question
i recently injured my lower back picking up an item at work. i am a mover. the injury is in the lower back area. at time i feel as if my legs are going to give out. i went to the E.R. and they prescribed oxycodone pain medication. i was asked to rest. do i need a chiroprator or more rest

Answer
Workers Compensation, Hurt at work, Lower Back Pain, back pain, neck pain, low back pain, sciatica, herniated disc, HNP, slipped disc, sprain/ strain, muscle spasm, rest, absolute rest, relative rest, medication risks

Hello Robert,

Sorry to hear of your injury.  Low back pain (with or without Sciatica (pain down the leg from the lower back) ), is right up the chiropractor's alley.  

From a health perspective; I recommend a visit to your local Doctor of Chiropractic for an evaluation.  Appropriate examination should be performed to rule out:  'slipped disc'= possible herniated disc (HNP), disc protrusion, sprain/ strain, vertebral subluxation complex (more on that later), sciatica, 'pinched nerves', muscle spasm.

The low back holds the Lumbar Spine.  The lumbar spine is composed of bones, discs, ligaments, cartilage, discs, muscles, nerves.  The low back is very complicated, and a problem there is usually multi-factorial.  I have never found 'just a pulled muscle'- to be JUST a muscle.  The low back works like a symphony orchestra- all the pieces have to be in synch to give the wonderful harmony of life's movement.
'Just a pulled muscle' will alter nerve firing, joint movement, joint alignment, place additional stress upon disc structures, etc.

Chiropractic approaches ALL of the factors in the complaint.

A chiropractic evaluation is needed to fully appreciate and rule out serious problems like the herniated disc (HNP), sciatica, degenerative joint disease, vertebral subluxation.

Your legs feel as though they may give out because of the mechanical changes in the sprained/ strained tissues, AND the nerve irritation.  The nerves from your low back control your legs, bowel, bladder.  If you have pain in your back, extending into the legs; you need that local Doctor of Chiropractic.  IF you have problems controlling your legs, bowel, bladder- problems with bathroom duties- you may even need surgery.  As I said earlier- the low back is a complicated place.

Q) Do you need MORE rest?  
A) Probably not; but let us define rest.  Research shows that ABSOLUTE rest---- bed rest---- is RARELY needed, and if utilized as a treatment approach, ABSOLUTE rest should be used for only the shortest amount of time: hours, a day or two.  Absolute rest allows quick atrophy of the tissues.  RELATIVE rest is a different story.  IF you have a physical job, and as a mover I would call that physical- relative rest would allow you to walk about, drive, perhaps even go to the store (but do not carry heavy bags!).

'Relative rest' may allow you to go to work and do desk duty- answer a phone.  If we are used to running a marathon every day; walking to the store is relative rest.  

I do recommend 'relative rest' for you, and I recommend a chiropractic evaluation.  I do not recommend 'absolute rest'.  If there is no 'light' or 'limited duty' at work, then perhaps you do have to stay home for a few more days (or a few weeks depending upon your severity).  If you are hurting,,,, you cannot return to the very same activity that caused the hurt!  You do have to heal.

When you do return to work, to the same activity that hurt you in the first place,,,,, think.  Think about your posture habits, think about your movement patterns.  Look at your lifting techniques; protect yourself, protect your body, think about the item, think about the lift before your do it.  If you need additional hands, get help.  If you are in a tight spot, think about your plan of attack before lifting.  Of course; bend your knees, lift with your legs, keep the item in close to your body, have secure handholds, keep the item in front of your body (rather then twisting for it).

The lower back is a wonderful piece of Mother Nature's engineering.  It allows tremendous movement!, But this movement allows problems such as yours to occur.

A full 80% of Americans will have Low Back Pain at least once in their lives.  Unfortunately, for 1/2 of those people, about 40% of Americans do have CHRONIC low back pain.  Now, chronic does not mean that it hurts all day, every day.  But, many, many people have to be conscious of their backs, and their posture and movement patterns; or their 'weak back' will go "out" on them.

Is this the FIRST time this has happened to you? - Then you have an excellent chance of treating this properly, returning to full health sooner, and preventing recurrence.  Get to your local Doctor of Chiropractic for appropriate evaluation, treatment if necessary, posture advice, movement instruction.

Is this something that has happened before? - Then you should get to the local Doctor of Chiropractic to evaluate your mechanically unstable back. Get to your local Doctor of Chiropractic for appropriate evaluation, treatment if necessary, posture advice, movement instruction.

Staten Island Workers Compensation patients come to my chiropractic practice every day.  Injury at work is common, back injury the most common complaint.  Chiropractic is safe, effective and cost effective for spinal complaints, particularly low back injury.

In my Staten Island Chiropractic office I utilize informational handouts, I hope this information will be helpful to you:

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Lower  Back  Pain  (LBP):          

Low  Back  Pain  can be caused by many different things.  Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).  

Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).  Bad things, like  - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic.  LBP can come from a motor vehicle accident, sport injury, slip, trip, fall, arthritis, lifting improperly, or even bad posture in standing, sitting or sleeping.  All of these things often have a Lumbar (Low Back) Vertebral Subluxation involved.

              Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems. A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

This is a serious condition identified by its five parts:

    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.



The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.

         Workers Compensation Injury, Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.

ONLY a Doctor of Chiropractic evaluates for the Vertebral Subluxation Complex as well as other pathology.

          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical-  problem requires a mechanical   correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine
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PAIN MEDICATION may relieve the pain, but also may 'cover up', 'mask' the seriousness of the problem, mask the CAUSE of the problem.  If you 'feel better' while taking drugs,,,, you may not really BE better.

PAIN     Pain  is a  ‘red light on the dashboard’.  
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car- -- do you ignore it until the car breaks down, or do you get it checked and correct the problem?  Pain, pain in your body- -- do you ignore it until your body breaks down, or do you get it checked and correct the problem?   Pain,  do you cover up the pain by taking a painkiller?  Take a painkiller, mask the pain, and allow a problem to progress in your body?

       NOTICE  ON  PAIN  RELIEVERS:
 
Label changes ORDERED by FDA;  the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news  206- 207;  12-9-06) ;
   
The  American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement  2-26-07);

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982;
9: 3- 5 ).  Many times people take NSAIDS for the pain of Arthritis, not knowing it may make the underlying condition worse.


Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.  If you take a drug to turn off the pain, you are NOT treating the CAUSE of the pain.


Vertebral  Subluxation           (  ‘VSC’ ,    ‘subluxation’   )
Vertebral Subluxation  is  actually  a  quite  common  condition.   Doctors of Chiropractic look for pathological conditions which may require referral to other specialties,   and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system  (the master control system- ALL health disciplines learn this).  VSC- ‘Subluxation’ – can be the cause of many symptoms and conditions.

Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.

The course of VSC is highly variable.   Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights.    Some patients immediately develop symptoms related to the VSC,  some patients take years to develop symptoms.  Some people suffer for only a few days with pain and symptoms, some people suffer for months.  Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


Subluxation  is  a  serious  condition  identified  by  its  five  parts:
            Spinal Kinesiopathology:        This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
            Neuropathophysiology:         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
            Myopathology:           Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
            Histopathology:       A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
            Pathophysiology:     The VSC contributes to OsteoArthritic degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
       Vertebral  Subluxation   cannot   be corrected through chemicals (medicine), stretching,  yoga,  vitamins  or  physical  therapy  alone.       Subluxation- a neuro/skeletal/muscular-    mechanical-    problem  requires  a    mechanical correction-  -  -    a manipulation,         best  performed  with  the  chiropractic  adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine
++++++++++++++

INITIAL TREATMENT RECOMMENDATIONS

P.R.I.C.E. =   P  protection.   R rest.   I  ice.   C  compression.   E  elevation.

Hurt  yourself ??  injury/ trauma/  bruise/ not even sure - - a broken bone ??

You should certainly get to the Doctor or trained health professional to be examined  if you think it  is  bad  enough.     BUT  in  the  meantime,  some  simple  steps  may  help.   PRICE.

The  PRICE  protocol will usually help just about any musculoskeletal injury.

P = Protection;  protect the area from further injury- stop what you are doing, can you pad  or bandage the area ? Tape the area? Do something to protect the area !

R = Rest;  rest the area as much as possible, if a part is damaged, give the body time to repair the area

I = Ice;  ice is a potent anti-inflammatory; it will slow swelling, help with pain control (ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the injured area for 30 minutes; then back on again

C = Compression;  to help prevent swelling compression may be helpful- for example if it is an ankle, wrap the ankle with an ace bandage and ice the area.  Many body parts may not be applicable to compression.

E = Elevation; again to fight swelling and pain, raising the injured body part above the heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part


PRICE  may  help :    Sprains,  Strains,  musculo-skeletal injury,  bruise,  contusion

Sometimes  a slip, trip, fall, heavy lift, Workers Compensation injury, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain.  Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction).  In the spine, a sprain/strain  is a misalignment,  a ‘kink’ in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation.   Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!

         Spinal = Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)  ;   ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.

A  subluxation  interferes with the proper functioning of the nervous system  (the master system  which controls and coordinates all function within the body)  and may cause various other conditions, symptoms and problems.
+++++++++++++

Degenerative    Disk     Disease
DDD = Degenerative Disc Disease; DJD = Degenerative Joint Disease; = similar/ same OsteoArthritis.

Joint degeneration, joint deterioration is HASTENED when the joint is NOT properly aligned, NOT moving properly.  Chiropractic restores more proper alignment, more proper movement to the joints.

Degenerative Disc Disease  (old term =  DJD) is  actually  a  quite  common  condition.   However,  the course of the condition   is  highly variable.   Some patients with DJD literally cannot walk, yet other patients with similar X-ray/ MRI findings may be able to run marathons or lift heavy weights.   Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow:  Ice the area when painful-  10/ 15minutes on, 30/ 45 minutes off;  avoid certain postures and movements;  bend the knees when coughing or sneezing;  bend the knees when lifting anything;  do not extend legs straight out when sitting, laying down, lifting, or driving.   Avoiding certain movements and postures will prevent aggravation of the condition.   Practicing good postures and movement patterns will help the condition heal and be less painful.  DDD, DJD,  OsteoArthritis, -  deteriorating discs (disk)   is/ are  often caused by,  or often  concurrent with the Vertebral Subluxation Complex.  VSC is a misalignment which hastens deterioration of the joints involved.

         Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of joints, and can cause osteo-arthritic degeneration, Degenerative Disk Disease, degenerative joint disease, etc.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

Subluxation  is  a  serious  condition  identified  by  its  five  parts:
    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve  system  dysfunction  can  cause  symptoms  elsewhere  in  the  body.
    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The  resulting  scar  tissue  changes  muscle  tone,  requiring  repeated  spinal  adjustments.
    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation.   Inflammed  Discs can easily bulge,  herniate,  tear,  or  degenerate.   Other  soft tissues  may  also  suffer  permanent  damage.
    Pathophysiology:
         The VSC contributes to  OsteoArthritic  degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term  nerve  dysfunction  can  cause  other  systems  of  the  body  to  malfunction.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, Disk Degeneration,  or aggravate such conditions.   
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.     Subluxation- a neuro/skeletal/muscular-   mechanical-   problem  requires  a   mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.

Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine
++++++++++++++++++++




In my Staten Island Chiropractic office, Workers Compensation injury patients are recommended to Work Comp LAWYERS.  The Doctor of Chiropractic is concerned with restoration and maintenenace of HEALTH. The Lawyer is concerned with the legal and financial (getting paid if you are out of work, getting treatment) aspects of an injury sustained at work.

My Staten Island Work Comp patients do get this little bit of information-- but remember I am not a lawyer- this is just general advice, and this is applicable to  New York Workers Compensation, perhaps not as applicable in your locale:




Work   Comp   INFO   for  the   newly   injured

I  am  NOT  a  Lawyer,  and  this  is  not  legal advice,  not  a  legal  opinion,   this  is  just  general  information,
Questions ?  - call  your  attorney.

If  you  are  hurt  at  work,  BY  STATE  LAW  YOU  ARE  COVERED  BY  WORKERS   COMPENSATION   INSURANCE.     There  is  no  choice.

If  you  are  hurt  at  work,  your  private  health  insurance  IS  NOT  responsible
to pay for your treatment (whether that may be Chiropractic,  Surgery, Medical, Dental, Physical  Therapy,  Psychological, etc.).


YOU  DO  NOT  HAVE  TO  MISS  WORK   to  be  covered by compensation.
Some  people  have  open  comp  cases  for  many, many years- 10, 20 years.....
IF   YOU   ARE   HURT   AT   WORK,    BY   STATE   LAW    WORKERS  COMPENSATION  HAS  TO  PAY  FOR  YOUR  TREATMENT.... WHETHER
YOU  ARE  WORKING  OR  NOT,,,  WHETHER  YOU  MISS  ZERO  DAYS,
ONE DAY,  ONE  WEEK,  OR  ONE  YEAR .

If  you  inform  your  doctor  that  you  were  hurt  at  work.....
BY   STATE   LAW   THE  DOCTOR   HAS  TO  NOTIFY/ GO  THRU  WORKERS  COMPENSATION.

If  you  inform  your  doctor  that  you  were  NOT  hurt  at  work......
BY   STATE   LAW   THE  DOCTOR  CANNOT   GO  THRU/ NOTIFY  WORKERS
COMPENSATION.

The  above  is  a  brief  explanation  of  WORKERS  COMPENSATION.  This  explanation  is  not  prepared  by  an  attorney  or  the  Workers  Comp  Board,  is  not  legally  binding,  but  is  an  attempt  at  a  brief,  general  explanation  of  workers  comp.   For  further  or  more  detailed  explanation,  contact  your  Work  Comp  Attorney.
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,




To summarize your Question/ Answer:
You injured your lower back -  See your local Doctor of Chiropractic.
Injury ocurred at work - Workers Compensation covers your injury, treatment, and salary if you are out of work.  Work Comp covers treatment even if you are not out of work.
Leg symptoms- from the nerves of the low back that supply the legs, and/or mechanical instability in the lumbar spine.
Pain meds- see above- certainly helpful when hurting a lot, but not really treating the CAUSE of the problem.
Rest?- relative rest, yes, recommended; absolute rest- no, counterproductive.
More rest vs. the Doctor of Chiropractic,,,,,, see the DC for at least an evaluation of the problem, do it now, before the problem becomes more chronic, more severe.



I hope all this information helps you.  Do not hesitate to re-contact me here at ALLEXPERTS.com  ( http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm ).



I wish you Good Luck, and
Good Health Naturally !


Dr. Victor Dolan, DC

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http://www.SIworkcomp.com           work comp injury info

 Blog article on Workers Compensation:  
http://www.merchantcircle.com/blogs/Dr.Victor.Dolan.Chiropractor.718-981-9755/20...