How do chiropractors diagnose what went wrong?
What has happened to our poor accountant who now is experiencing acute back and leg pain? Apparently the cracks and fissures in his disc, the dehydration, the poor mechanics, the lifting - and perhaps even the sneeze - has caused the disc to slip just enough to press against the nerve that exits next to the disc. This has caused inflammation of the nerve, which can then cause pain along the path of the nerve into the leg.How does the chiropractor determine whether this is a "slipped disc"?
Careful history taking, vital signs, and orthopedic and neurological testing are standards of practice in chiropractic offices. Are the reflexes intact? Is there loss of muscle strength or signs of muscle wasting? Is there loss of sensation along an area supplied by a particular nerve? These are vital questions that the orthopaedic and neurological exam can help answer.
Chiropractors utilize other diagnostic procedures that are unique to chiropractic and establish the foundation for a program of care. Chiropractors look carefully at posture and perform a postural analysis of the patient. They use techniques such as motion and static palpation to determine exact areas of restrictions in spinal joint motion. They palpate muscles and perform muscle testing, as well as perform tests for pelvic balance and determine whether there is a "short leg".
X-rays of the low back are taken, or the chiropractor might send the patient to an x-ray facility for these films. Depending on the findings, the chiropractor may call for an MRI or other imaging study of the back.Chiropractic Care of Low Back Disc Conditions
After analyzing this information, the chiropractor determines if the patient has suffered a disc injury. The crucial diagnostic question is, "what type of disc injury has occurred?" It is the answer to this question that will determine the chiropractic approach to treatment or referral.
There are some patients who are not good candidates for conservative chiropractic care. For example, if there is suspicion of a cauda equina syndrome in which loss of bladder control accompanies a disc injury, this is a medical emergency not treated by chiropractic.
If there are unusual neurological findings with advanced loss of strength, sensation, and reflexes, the chiropractor will refer the patient to a spine surgeon (spine specialist) prior to initiating conservative care
Most disc conditions do not fall into these more extreme categories. The great majority of disc injuries involve some degree of bulging of the disc. The "slipped" disc can be a slight, even temporary, push against the nerve or the spinal cord, or it can be a more definite mild, moderate, or marked bulge. Frank herniated discs occur when a fragment from the central part of the disc breaks completely through the fibrous rings.
Whatever the category of disc bulge, the low back pain, leg pain, and muscle spasms require examination and, in most cases, a period of conservative, non-surgical care prior to any consideration of surgical intervention.What is the chiropractic approach to conservative care of the disc?
First we should address a misconception. Chiropractors do not attempt to "pop a disc back in place" with forceful adjusting or manipulative techniques. There is a form of disc insult to a nerve with low back instability, often resulting in a quite dramatic lean of the low back with spasm that responds well to traditional chiropractic adjusting. However, all other disc conditions are treated in chiropractic with a gentle program of low-force techniques.
Another misconception is that chiropractic care involves a few quick treatments, again usually seen as popping the back, which will fix the disc. Instead, chiropractors who treat disc conditions integrate their low force adjusting techniques in an organized protocol of evaluation and treatment.
Throughout a program of chiropractic care for disc conditions, patients are asked questions regarding their progress. Evaluation of progress using neurological and chiropractic tests based on comparison with the initial findings are essential aspects of this chiropractic protocol.
If a patient is not responding to conservative care using this protocol, the chiropractor will refer the patient for imaging studies and spine specialist consultation.