Expert: Dr. Victor Dolan, DC, DACBSP - 4/19/2010

Question
hi there.  i suffer from spinal stenosis.  have had 5 surgeries on my lower back L5/S1 discectomy's, fusions, and finally a few screws and plates inserted. in July 2009 i suffered a set back once again but this time it took the cervical.  Surgery  performed and 4 screws and two plates later, my headaches ceased and neck/arm/shoulder pain dissappeared.  However only for a few brief months because 3 weeks ago i had the nerves on the entire left hand side of my body blocked.  this seemed to have worked in the 1st week after the surgery, however i am feeling more and more pain on my right hand side as well as the left.  i am also on a daily basis struggling with my muscles in my legs/ thighs/ shoulders and back.  I have such bad cramps and muscle spasm that i fear ending up in a wheelchair in the not too distant future.

what can i do to relieve the pain in my muscles?  I am terrified of what can happen to these muscles if i allow the cramps to settle in completely.  i am tired of fighting this.  pleas can you help???

much appreciated.

Virginia Erasmus
Cape Town, South Africa

Answer
Spinal Stenosis, Spinal Discectomy, HNP, Herniated Disc, Herniated nucleus pulposis, Spinal Block, Staten Island Spinal Stenosis, Staten Island Herniated Disc, Staten Island Chiropractic,



Hello Virginia,

Wow, what a complicated history.  I am sorry to hear of your conditions and repeated surgeries.

Usually chiropractic can be of help and head off surgeries such as this.  I am sure your Doctor of Chiropractic tried his(her) best to conservatively and non-invasively treat you before the procedure(s).

At this point, with all of the invasive surgical procedures, the chiropractic treatment options may be very limited.  Activator technique, S.O.T. chiropractic technique, perhaps mild non-surgical spinal decompression could be tried.

With all of these invasive surgical procedures, your surgeon should be your best friend and confidant.   What does your surgeon say?- all of these procedures and still hurting?- maybe something else needs to be done?

Many DCs (Doctors of Chiropractic) would not even take on a case like this.  All of the work on your spine makes the spinal biomechanics unpredictable and prone to aggravation, exacerbation, altered biomechanics and resultant degeneration.  Perhaps your original doctor will take you back and utilize some gentle forms of chiropractic.  Certainly only a 'hands- on', in- person chiropractic examination could determine what could be done conservatively and non-invasively in the office for you.  

I recommend returning to your initial DC, hopefully he(she) will work with your case.

I recommend speaking with the surgeon(s) who have done all of this to you.

Perhaps you can find a Doctor of Chiropractic who works with gentle activator technique, applied kinesiology, S.O.T., chiropractic spinal decompressive therapy.  I recommend these approaches in your case.

In my Staten Island Chiropractic office I utilize patient handout information sheets, perhaps this one with nutritional recommendation could be helpful to you:



“Pinched  Nerve”   ,  nerve pain:

( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )
“pinched nerve” – is only ½ a diagnosis,  WHAT is causing the ‘pinch’? Your Doctor of Chiropractic will examine and evaluate you to make sure you are not showing signs of neurological damage or disease, tumors, cancers,  severe pathology, perhaps a Herniated Disc, or a Vertebral Subluxation Complex.

Sometimes  we  can  wake  up  with  a  ‘pinched nerve’,  or  a  muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a ‘pinched nerve’.  Very often -  the true    c a u s e   of  the pinched nerve, painor numbness  in the:    neck and/ or  shoulder  and/ or  arm  and/ or  hand;   pain in the back and/ or   buttock/ hip/ leg/ knee/ foot -  is a misalignment,  a  ‘kink’ in the neck or back - more properly termed a Vertebral Subluxation.

              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:
         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.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          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.    For good health-
Treat   the   Cause,  not just the Symptoms.


“Pinched  Nerve”   ( Also Known As-  neuritis, neuralgia, brachial-neuritis, sciatica )
“pinched nerve” – is only ½ a diagnosis,  WHAT is causing the ‘pinch’? – That “pinch” has to be taken care of FIRST!

As the “pinch” – the MECHANICAL component of the problem, the CAUSE of the problem is being taken care of  through Chiropractic treatment,   perhaps additional help would speed your return to health:

Nerve Health Support:
-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support.  High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.
-----B-6 is lower in patients with neuropathy.  Vitamin B-6 reduces the glycosylation that can cause nerve damage.  Amounts greater than 200mg/day can cause neuropathy symptoms.
-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.
-----A multi-vitamin/mineral supplement is suggested for comprehensive support.
-----Essential fatty acids are necessary for nerve health.  Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.
-----Lecithin aids in nerve support.
-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.
-----Eat a healthy diet.  Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.
-----Drink plenty of filtered water.
-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity.  Glucosamine is effective in relieving joint pain associated with osteoarthritis.  Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties.  These disease-modifying effects are not seen with simple analgesics and are of particular benefit.
-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness.  Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.
-----White willow is an antiinflammatory and analgesic agent.  White willow was used as far back as the Middle Ages to reduce pain and fevers.  The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects.  Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs.  Curcumin may have similar action to aspirin.
-----


Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, 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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Perhaps some of those supplements could be of help in your aches and pains.

Be careful of pain medications; here is another informative handout I use in my Staten Island Chiropractic Office:


PAIN           

Pain  is a  ‘red light on the dashboard’.   

RED  LIGHT  =   Trouble !!

Pain  is  your  body  telling  you  that  something  is  wrong.   
Think  you  should  listen??

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?

Pain  Killing  medication???  =    16,000  deaths   ( probably  under-reported )
                         DEATH ! ? ! ?    better   watch  out  on  those  medications!!!


                             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) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468   Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001)  Motrin, Advil = NSAIDS

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 realizing these drugs may make the underlying condition worse.   These medications  cover  up  the  pain,  and  cause  the  problem  to   worsen.

Pain  can  often  be  the  result  of  the  Vertebral  Subluxation  Complex.

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.
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;   Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, 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 ; Invited to Colorado Springs (Olympic Training Center) to  Care for USA Olympic Athletes 2010

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Looking through my office paperwork, I also see some information on Spinal Stenosis.
    I know you have had your surgeries already, but many people with similar questions, similar conditions come to AllExperts.com for information-- I think this following information could be helpful, not so much to you, but to others asking similar questions- prior to surgery.


Spinal Stenosis  : Spinal Stenosis is a highly VARIABLE condition.  Some people run marathons and lift weights with stenosis.  Some people cannot get out of bed with stenosis.  Stenosis is a narrowing of the spinal canal. There is not a lot of room in the spinal canal.  Take a nickel coin and a dime coin, place the dime upon the nickel- if the nickel is the canal (the space that the spinal cord/ spinal nerves have to run through), the dime is the spinal cord/ spinal nerves.  There is not a lot of space left in reserve,,, not a lot of space to ‘play with’   (note difference:  spinal  CANAL  vs. spinal  CORD ).
    A condition due to narrowing of the spinal canal which can cause nerve pinching which can lead to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity (to avoid the pain).
    The Silent Epidemic
The most common indication for surgery in persons aged over 60 in the United States is Lumbar Spinal Stenosis (LSS). Currently, it is estimated that as many as 400,000 Americans, most over the age of 60, may already be suffering from the symptoms of lumbar spinal stenosis [The American Association of Neurological Surgeons (AANS) and The Congress of Neurological Surgeons (CNS)] and this number is expected to grow as members of the baby boom generation begin to reach their 60s over the next decade.
According to the U.S. Census Bureau, people over 60 will account for 18.7% of the domestic population in 2010 versus 16.6% in 1999. According to the United Nations' Population Division, Department of Economic and Social Affairs, the trend is global with the number of persons aged 60 years or older estimated to be nearly 600 million in 1999 and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14 years) for the first time in human history. The majority of the world's older persons reside in Asia (53 per cent), while Europe has the next largest share (25%).

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Exercise: The Miracle Cure
It seems the more options you give people, the more they demand. Exercise, for example, is well known for its dramatic and wide-reaching physiological effects. Yet when you counsel a patient to exercise, they generally say something like, "Yeah, doc, I know all about exercise and diet, but what can I really do to help?" Often it appears that things with which you are very familiar are automatically either ignored or discounted (married people understand this concept well). Among the many benefits of exercise that have been scientifically documented:
•   exercising three days a week raises basal metabolic rate so that even on the days you don't            exercise, you are burning 300 more calories each day;
•   Finnish study found exercise relieves knee pain more than anti-inflammatory drugs or rest;9
•   provides long-term relief of  spinal stenosis symptoms
•   lowers cholesterol levels;
•   improves balance and coordination, even in the elderly;
•   strengthens bones;
•   fights insomnia;
•   reduces the effects of mental stress;
•   relieves depression;
•   helps control type II diabetes;
•   dissolves or prevents blot clots,11 possibly explaining exercise's protective effect against heart attacks;
•   decreases breast cancer risk by up to 60 percent
•   cuts the risk of gastrointestinal bleeding in the elderly in half
•   postpones many effects of aging;
•   increases resistance to infections.

Spinal Stenosis  is a narrowing of the spinal canal.  This can create irritation of the spinal cord or the spinal nerves.  Stenosis can come about from many different causes.  Just saying “…stenosis…” does not say much.  Stenosis can be due to big bad things like a cancer or a tumor that irritates or puts pressure on the spinal cord.  Stenosis can be due to a bulging or herniated disc.  Tests should include MRI, Xray, perhaps CT scan to visualize the stenosis and the cause of the stenosis.  Many times stenosis can be handled through noninvasive conservative care such as Chiropractic.  Unfortunately, sometimes after conservative care has been tried unsuccessfully, more invasive treatments must be tried: medications (with attendant side effects), injections (with inherent risks), all the way up to invasive surgery.
One of the common causes of Spinal Stenosis is Degenerative Joint Disease (also known as Degenerative Disc Disease, Spondylitis, Spondylosis, or OsteoArthritis).
Degenerative    Disk     Disease
DDD = Degenerative Disc Disease; DJD = Degenerative Joint Disease; = similar/ same OsteoArthritis.
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, and can ‘pinch’ the space available for our nerves.

         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.
          Certainly;  safe, effective, cost effective, noninvasive, conservative Chiropractic care should be utilized, if even for a few weeks- before proceeding to risky medication or risky, invasive  surgery.  Visit your local family Doctor of Chiropractic for an evaluation and treatment which may be necessary.

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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I hope all of this information helps your directly, and perhaps the readers of this website with similar questions.

If you need further information, do not hesitate to recontact me here at AllExperts.com.

I recommend returning to your surgeon(s) who have worked on your spine.  If you can find a Doctor of Chiropractic willing to take on your complicated case, I recommend conservative, non-invasive, gentle chiropractic care (as described above).  I recommend nutritional supplements such as those mentioned above.

I wish you good luck and Good Health, Naturally!

Thank You,

Dr. Victor Dolan, DC