A 60-year-old patient is experiencing pain in the low back that radiates down the back of the leg. The pain is at times debilitating and inhibits the patient from many activities of daily living. The symptoms presented after going on a horse trail ride.
After a complete evaluation, it was determined a lumbar MRI was appropriate. The MRI revealed a significant lumbar protrusion that entrapped the L5 nerve root resulting in sciatica. The information was presented to the patient as well as our recommendations for treatment which included chiropractic treatments followed by non-surgical spinal decompression.
Spinal decompression is a unique treatment that our office alone offers in the Fremont Area. Decompression introduces negative pressure on the disc causing a vacuum gradient that draws the protruding disc back to the inner portion of the disc; taking pressure off of the nerve.
This patient opted to get an orthopedic spinal consult. While there, surgery was strongly suggested. The patient ultimately decided to try chiropractic. The surgeon reportedly slammed the files down on the table and stated that he would see the patient within six months for surgery (stating the decompression would not work).
However, the patient noticed relief after a week of chiropractic treatments with full resolution of complaint well within the treatment plan. The patient was given home exercises to strengthen and stabilize the core as a preventative measure. This case was 8 years ago. The patient has yet to experience a return of symptoms.
A study published in the Journal of Manipulative and Physiological Therapeutics (Vol.33, No. 8, pg. 626) revealed an increase in prevalence of lumbar protrusions detected using a load bearing MRI as opposed to a recumbent (laying down) MRI. Patients who complained of back pain and received a weight-bearing MRI had a 73.3% chance of detecting a lumbar herniated disc. Similar patients who utilized a recumbent MRI only had a 50.1% chance of detecting a lumbar herniated disc.
This is relevant research as correct diagnosis is imperative to getting the most appropriate care. Most patients report in the clinic that they experience their symptoms when doing activities of daily living. Activities are often load bearing, and when investigating potential bulging or protruding discs, it makes sense that the pressure exerted on the disc during a weight-bearing MRI will elicit a greater finding.
Taking this concept further, a typical medical lumbar x-ray is taken recumbent as well. A chiropractor will almost always take an x-ray with the patient standing. The load bearing position of the chiropractic x-ray allows the physician to better see what the spinal joint or spine alignment looks like when it is more functional (compared to laying down).
If you find yourself in need of a spinal MRI, be sure to ask your physician if he would recommend a (compression) weight-bearing MRI. Evaluating your complaint in a similar environment that elicits the complaint gives you the best opportunity to correctly diagnose your complaint and then determine the most appropriate treatment.
Photo Credit: www.sandhillswesternvacations.com