What is my problem?
By Robert A. Leach, DC, MS, FICC, CHES
Generally patients come to our office with back or neck pain. Occasionally we see patients that complain of pain in or around other joints throughout the body, including even the jaw and tailbone area. The question most patients want answered first is, “What is my problem?”
In order to answer that question, we will take a thorough history and do a complete physical examination. Sometimes we will need x-rays, or refer you for other tests like a magnetic resonance image (MRI). Basically this is so we can be sure that you do not have a “medical” problem, such as a disease, space occupying tumor or cyst, or other referred pain. When we are able to rule out disease and fractures, for example, then we can assume that you have a so-called “soft tissue” problem that may still involve muscles, joints, discs, and even nerves. In these cases, for the average person, we think the pain is due to inflammation that can be very successfully managed by chiropractic, and sometimes with both chiropractic and medicine. We'll talk more about that in a moment.
In a few cases, even after an examination, we're still not sure what is causing your pain. For example, you may have several indicators that you're having a chiropractic problem, such as back pain that worsens after sitting, or back pain that is better after a little bit of walking. However, if you also have a so-called “red flag” such as pain at night that is worse than pain during the day, then Dr. Leach will emphasize to you the importance of following through with all treatments and referrals to other doctors that he recommends. It is important for you to ask questions if you do not understand completely why care or more tests are being prescribed, so that you can follow through and get well.
Vertebral Subluxation Complex (VSC) is the chiropractic term for the theory that postural stresses, trauma and aging can lead to inflammation and other changes in the nerves, muscles, ligaments, discs and other soft tissues around the spine, resulting in pain.
Chiropractors generally believe that spinal problems respond well to treatment using adjustment, or spinal manipulation. Many chiropractors believe and some promising research supports the premise that adjustments help more than spinal pain and headaches, helping even the whole body to be healthy. Beyond this, today chiropractors also generally agree that regular exercise and a good diet are also extremely important ways to help our overall health, as well as the health of our joints and muscles.
This first signs of spinal problems include stiff or tight joints, tight muscles or spasms, and unusual tenderness in the muscles to each side of the spine. Left untreated, as the inflammation increases and you feel more pain, stronger muscle spasms or a “stiff joint” develop as the body attempts to keep weight off of the inflamed joint and/or disc. These early spinal problems are referred to in the literature as segmental dysfunction (SDF). In chiropractic theory, we call these VSC phase 1 lesions. These are the easiest of the 3 phases of subluxation complex to correct, and it is the phase of VSC most likely to be permanently resolved through periodic chiropractic checkups, exercise and lifestyle modification.
Phase 2 Instability
With Continued stress on the spine from abnormal postures, repeated injuries, and aging, cartilage and ligaments gradually wear out, allowing the spinal joints to slip. We see these type problems typically after whiplash or sporting injuries, especially involving the neck, since it is most vulnerable to trauma. Serious problems show up on special x -rays called “stress” views. Not all spinal problems develop into instability, but these VSC Phase 2 lesions cause pain, disability, and promote arthritis. Aggressive chiropractic intervention will include exercise and lifestyle modifications, after initial chiropractic care.
Phase 3 Stabilization
The human body is always trying to heal itself, whether the problem is a spinal joint problem or a germ. In the case of germs of course white blood cells trigger a massive counter attack. In the case of spinal joint problems calcium deposits in the weakened ligaments eventually form spurs that will attempt to stabilize the injury. Other calcium deposits and fibrous tissues and adhesions develop in and around spinal joints and other structures. We term these and associated changes that are an attempt by the body to stabilize the spine, osteoarthritis, and these are considered by scientists to be the 3rd phase of VSC. Unfortunately, these deposits, adhesions, along with worn out, bulging and herniated discs, cause stiffness and may make it more likely to develop pain and disability, or even more serious problems with the spinal cord itself. VSC Phase 3 spinal lesions may develop even in the absence of Phase 2 changes. Careful chiropractic intervention has been shown to benefit patients with more chronic and serious pain, including even pain associated with so-called “herniated discs” and “pinched nerves,” and the doctor of chiropractic will recommend exercise and lifestyle modification in addition to adjustments, and any other medical co-management sometimes required.
Earlier this decade, the World Health Organization proclaimed that this is the Decade of Bone and Joint Health, to emphasize that musculoskeletal problems are the leading cause of all worldwide disability. Further, it is known that low back pain is the leading cause of musculoskeletal disability. As long ago as 1994, the U.S. Agency for Healthcare Policy and Research proclaimed that spinal manipulation was “safe and effective” for acute low back pain. These and other developments and evidence suggest that chiropractic care should be an essential component of care for spinal lesions, for prevention of recurrence, and for education in maintenance of optimal spinal health.
©2008 by Robert A. Leach