Expert: Dr. J. Shawn Leatherman - 1/29/2007

Question
Hi, hope you can help me.  Let me start off  by letting you know that -I am a fitness instructor. I have a pinched nerve that radiates excrutiating pain down my left leg-right now mainly my lower calf.  MRI showed L4,L5 disc degeneration.  I have had 3 epidural steroid injections in my lower back in the past 4 months-helped with pain in my upper leg, hamstrings, quads-none in lower. I have recently been treated by a chiropractor who uses the activator method ( I did not want the standard cracking so to say of the spine) Pain seemed to have diminished my first treatment-then pain came back within a day or so- second treament -no dimished pain and 3rd treatment no dimished pain.  When will this begin to work and/or will this work?? Do you have any suggestions? It is obviously effecting my work. Thanks in advance for your quick response.  

Answer
Dear Angela,

Sorry to hear about your situation.  The first thing I have to do is play devil's advocate...how do you know you have a pinched nerve?  A confirmation of disc degeneration does not necessarily equate to a pinched nerve.  However, if the disks in question are also bulging into the nerve roots, if they are so degenerated that disk height has been significantly affected or there is also degeneration of the vertebra with arthritic changes, this can "pinch" the nerve.  The neuroforamen (hole in which the spinal nerves exit the spinal cord) can become smaller and cause inflammation of the nerve roots which will cause pain such as you have described.  But, the sacroiliac joints frequently cause lower back pain that radiates over the entire leg, and can be mistaken for "nerve pain".  Lastly, the sciatic nerve can also be impinged in the muscles of the buttock, specifically the piriformis muscle is contributory.  

Now, the sciatic nerve's sensory branches are really located below the knee where the nerve becomes more superficial.  Above that, the nerve has sensory and motor functions, but is deep in the leg and considered to be more motor than sensory. If the disks are moderately to severely degenerated, they can easily cause irritation to the nerve roots that form the sciatic nerve. The bottom line is you need to make sure that you know what anatomical structure is causing the pain to adequately address the problem.

Concerning the activator method, I do not practice Activator and I am not an expert in that technique, but I can offer you a few bits of information. Activator stimulation will increase the neurological input to the spine and brain, and help to reduce pain transmission and perception, but it is not going to correct the problem. Activator is based on the stimulation and vibration of the joint capsules and to some point the surrounding tissue such as the muscle, ligaments, and disks, but it will not offer any rehabilitative measures...only active exercise and stabilization protocols will do that. I do think that activator can offer you a measure of relief, but how much relief you will obtain, I would not be able to ascertain.

I would suggest that you have a discussion with your chiropractor and specifically address your diagnosis, how it was rendered and the exact wording of the MRI report to obtain a more thorough understanding of your current status and treatment. Also any x-ray findings, if they were taken. In addition, check out the Activator website:  www.activator.com.

Angela, in my practice, you would be adjusted (we also use instruments, just not the activator instrument or protocol), but specific exercises and stretches would be utilized as well. Either for the facet joints, the disk, or the myofascial system...maybe all of the above depending on what was found on examination. You may also want to discuss the usage of a TENS unit for pain control while not in the office...this is a non-therapeutic (offers no healing benefit), but many times will give significant pain reductions.  

If you do not see further improvement with the chiropractic care you are receiving after 6 visits, then it is not likely that you are going to have any further benefit. Patients typically see improvements in 3-6 visits, which will continue until an ultimate plateau is reached, or they become pain free.  In my experience patients with your type of described pain patterns generally require 6-18 visits to get it under control and learn how to utilize corrective exercise protocols at home for further stabilization.  

If current treatment is not offering you continued gains in pain reduction and increased function, you may need a different chiropractic technique, or a more aggressive pain management procedure such as nerve ablation, or diskectomy.  

Don't be afraid to ask your chiropractor for a referral if his treatment plan is not producing results, your case may need a different approach.  I just referred a patient out of my office after four visits to another chiropractor because I did not have the right type of equipment to effectively manage her care and he did.  Ultimately she is treated on a special table at his office, and does rehab at mine, and is getting much better results now.  Your chiropractor should be able to recognize not only his strengths, but also his weaknesses and when it is appropriate to refer you for care he does not provide.

Angela, I hope this helps you in your decision making processes.  If you have any further comments or questions, or need any clarification of diagnoses or reports that have not been explained, feel free to write back.

Respectfully,
Dr. J. Shawn Leatherman
Director of Clinical Rehabilitation
WWW.SUNCOASTHEALTHCARE.NET