Expert: Gerald Anzalone, D.C. - 9/3/2009

Question
Hi, I am 59years old. I have a problem with my lower back going out about 2 times a year. It recently went out, so I visited a chiropractor. He took X-rays and said my spine is out of adjustment, and my 2 lower disks are deteriorating. He has put me on a 4 month program, 3 visits first 6 weeks, then 2 visit remaining of 4 months. first he adjusts me, then some type of machine to stimulate the muscles. He has 10 yrs of experience.Is this 4 month period to long ? Then he wants me in 1 a month. Thank you !

Answer
Thank you for your question.

While I cannot provide you with specific advice related to treatment, I can offer you some general comments about the nature of the treatment program that you have described.

First, x-rays really only indicate whether or not there is a pathology present (i.e., fracture, dislocation, osteoporosis, tumor, infection, etc). Determinations of spinal "misalignment" based solely on x-ray analysis are not consistent with evidence-based guidelines for radiographic analysis in low back pain patients.

However, while x-ray cannot visualize the disc (since the disc is not made up of bone, but a fibrous/cartilagenous composition with a gel-like interior), it does show the disc spaces, and a finding of thinning disc spaces might indicate that your symptoms are more disc-related. Has your chiropractor discussed a diagnosis with you?

Electrical muscle stimulation as an adjunctive therapy oten bring temporary relief to patients suffering from "tight" (the correct term is 'hypertonic') muscless that may be contributing to their pain.

The 4-month treatment protocol that you describe, however, seems to me to be an arbitrary time frame. Has your chiropractor discussed performing home rehabilitative exercises to facilitate your recovery? If not, then you can be almost certain that the treatment approach discussed emphasizes only passive care; the research to date clearly shows that patients who combine appropriate home exercises with their physical therapy or chiropractic care (this is called 'active care') get better quicker and tend to stay better longer.

I would recommend a thin and very affordable book called "Treat Your Own Back" by the Australian physical therapist Robin McKenzie. Written for the lay person, it's a self-help manual that provides an excellent source of information for patients suffering from low back pain.

It's also important to gauge whether or not you are responding to the spinal manipulation that you are receiving. There are different techniques of manual spinal therapy that can be employed for treating lower back pain, and depending on the patient and their condition, certain techniques may work better than others for disc problems vs. muscle problems vs. joint problems.

I hope that this helps to answer your question.