Expert: Dr. J. Shawn Leatherman - 9/6/2006

Question
Dr. Leatherman, I hope you can gie me some advice. I have been having trouble with my left sciatic nerve since March. No accident. It just started hurting.a month ago I went to a chiropractor for a free evaluation for his treatment on the DXL-9000 machine. All he did was tell me to bend down as far as I could without bending my knees and bend backwards as far as I could. He said I needed an MRI before I could start treatment. The problem is my insurance won't cover this test....or any for that matter. I went to my Dr. She put me on a round of prenozone to see if that would help. I'm half through and no progress. I read that most of the time the body reasorbs the fluid that is leaked out of the disc. Is this possible? If so what kind of vitamins and nutrition can I use to possibly heal this problem. Also I walk for excercise. Should i continue to do this. Any other advice would be appreciated. Sorry this is so lenghty. Thanks for you time. Marlene

Answer
Dear Marlene,

Disk problems and sciatic type pain can be a very frustrating problem, and I can understand your concern with the MRI.

First of all, the "FREE" evaluation was not an evaluation at all...more like a gimmic to get you in the office, and I am thoroughly disappointed that you were subjected to that marketing ploy!  Although I do very much like the technology of intervertebral decompression therapy with the DRX 900, the free evaluation was intended to get you in the office.  The chiropractor you saw should have at least given you a rudimentary examination including orthopedic testing, neurological testing, a posture examination, and a focused history on your current problem.  Obviously that was not performed.

An MRI is the best diagnostic imaging tool for visualization of the disk, but a comprehensive examination including x-rays of the area of complaint should have been the first course of action.  You see many times patients with disk problems get better with taditional chiropractic treatment (adjustments and physical rehab) quickly (2-3 weeks).  In that case the entire examination, x-rays, and treatment would be less expensive than the MRI test. Also many asymptomatic patients have disk bulges without a true herniation on MRI. That is not a diagnosis, just a finding. If there is a herniation, then you have a visualized disk injury. To learn more about the four types of disk herniation please visit the page on my website>>  www.suncoasthealthcare.net/dsc.htm

Now, concerning the actual disk, it works like a hydrolic system (fluid contained for support and strength).  The inner part of the disk, the nucleus pulposus is a gelatenous liquid substance that is normally contained by the outer tough part of the disc called the annulus fibrosus.  In this normal configuration, the inner part is not displaced.  With injury or degeneration the nucleus can leak out which can cause pain and problems.  

There are other problems that can mimic sciatic pain such as "piriformis syndrome" (a muscle constricting the sciatic nerve), "sacroilliac dysfunction" (joint problems in the pelvis), and "nerve root encroachment" (spinal nerve being inflammed or constricted which sends pain down the leg).  All of these conditions should be considered as well as disk disruption.  It is also possible to have a degenerated disk not a herniated disk.  Again the only way to document your diagnostic picture is with a history, examination and x-ray of the low back/area of complaint. (MRI to follow if necessary)

I would recommend that you continue your walking.  Controlled movement is good for disk and spinal health.  You need to limit any lifting, bending and twisting until you have the area fully examined and addressed.  Also sitting postures greatly increase the pressure on the disk, so prolonged sitting should be avoided.  You can also lay on your back and pull your knees up to your chest to help stretch the low back, and this should be a pain free exercise. Use ice for pain relief and to reduce inflammation.

Considering you question on nutrition, vitamin c and zinc are important for disc health as well as plenty of clean water intake. Drink two thirds of your body weight in ounces of water daily. I would also recommend increasing your antioxidants (fruits and vegetables) to reduce the oxidative stress on the cells, and I would recommend taking omega three fatty acids, (EPA and DHA), a minimum of 4000mg per day.  The omega three fatty acids must be pharmaceutical grade and mollecularly distilled.  In addition reduce intake of sugar, coffee, carbonated beverages, and refined grains...these all promote inflammation in the body, and increase pain levels.

Marlene, I hope I have not overwhelmed you with information, but I could go on and on with more.  This is a good start.  Do not get discouraged, and do not give up on chiropractic either.  The doctor you saw may be a great chiropractor, but got caught up in technology.  You may want to further discuss treatment with him, or find another local chiropractor who will perform an evaluation before making decisions about your case. Feel free to follow-up with any further comments or questions.

Respectfully,
Dr. J. Shawn Leatherman