Expert: Dr. J. Shawn Leatherman - 10/31/2006

Question
My chiropractor advised that I had a herniated disk (C5, C6)and the pain zinged to my upper left arm and area around my shoulder blade. Initially I could only sleep in a recliner, and now it is still painful to lie down on my left side, and stomach. My right side is okay, my back so-so. I have been going for treatments for a month. At this point, I understand the herniation and inflammation is gone but I still have muscle spasms/cramping around my scapula (shoulder blade) and upper arm that are pretty bad. I am now undergoing massage therapy as the knots in that area are noticeable and pretty tight. I don't remember what it is to be pain free at this point. My doctor keeps saying hang in there. How much longer does this last and should we be trying something more?

Answer
Dear Lynn,

Disk problems can have long reaching effects, especially when they are pressing on the spinal cord or the spinal nerve roots. This is where much of the pain comes from. You had said that the herniation was "gone", according to your doctor, how does he know, was there a follow-up MRI to confirm or deny that statement?  Was there an MRI performed at all to make the initial diagnosis?  These are questions that should be answered.

Concerning treatment, do you still have the radicular symptoms in the arm/shoulder blade?  IF so then disk derangement, nerve root compression, and cord compression are still suspect.  Now if the pain is only present when you press into the muscle tissue, then it is more likely to be from that source.  Doing massage will continue to be therapeutic to reduce muscle spasm and myofascial problems, but will not solve the problem if the disk is the actual offending tissue.  Chiropractic adjustments will also help to alleviate pressure on the disk itself and the associated joint space, but will also only address part of the problem.  You need to be under some active form of care such as physical therapy and specifically active traction which should have been recommended from your Chiropractor after the initial diagnosis.  Many chiropractic physicians offer physical, functional and structural rehabilitation in there offices.  If you are not doing this, then you are compromising the healing effect by limiting the formation of proper scar formation in the disk and/or surrounding tissues.  If you are not doing this, I would recommend that you find a better chiropractor.

Specifically, you should be undergoing active axial traction (pulling upward)of the neck to alleviate the gravitational stress and compression of the disk tissue.  When the pain levels decrease structural traction to create a proper curve in the neck should be initiated to reduce the chance of re-injury.  To find a Chiropractic Physician who has the training, qualifications and certifications to implement this type of program check out, www.idealspine.com

I also want you to check out two specific pages on my website that explain the spinal anatomy in detail as well as what a bugling disk actually is.  this way you will have a complete understanding of the tissues and how they may cause problems when injured.  The links are listed below:

http://www.suncoasthealthcare.net/sa.htm
http://www.suncoasthealthcare.net/dsc.htm

If you have any further comments or questions get back to me at your leisure, and good luck with treatment.

Respectfully,
Dr. J. Shawn Leatherman