Post Surgical Chiropractic Treatment?

Most of my practice as a chiropractor over the past 17 years has been to keep people from getting surgery.  I have to say, I have been pretty successful with that.   I have had only three patients that had low back pain so bad that conservative care did not help.   All three worked very hard at educating themselves, sticking to their protocols and schedules and really attempted to beat the odds of having the operation.  Although I did not feel like a failure for ‘letting’ them get the operations, I did feel responsible for their well being and helped them research different options to find the right surgical procedure for them.

This of course consisted of advice on which questions to ask the surgeon and whether they should have a neurologist or an orthopedist do the job.  In my opinion, I would always have them go for the neurologist surgeon.  They are far more ‘dainty’ in their work and are interested in the details of the operation.

Now that the ‘Silver Tsunami’ has begun, I find many patients come to me with back pain, forget they had surgery 35 years ago and want treatment.  When they are on the table, I see scar tissue on their lower back and, well, the whole plan changes.   Not that I turn them away, but a whole new list of questions begins, reviews of x-rays, detailed history and real detailed functional capacity evaluations begin.  I want to know if I could even help them at all.  I can improve range of motion with training, adjustments to the spine and extremities where there was no surgical changes.  I can teach them stretches and modifications of their work stations/situations that help etc…

What I cannot do is change the surgical area.

What can be done to a post surgical patient depends on the type, extent, and age of the surgery, the scar tissue that has inevitably built up, the current level of flexibility and general health of the patient and more…

There are a couple scenarios I have come across in my practice that deserve review and explanation to get the point across.

1. Let’s call him ‘John Q’.  John had surgery for lumbar scoliosis in his early 20s, a Harrington rod on each side of his spine was surgically bolted to the vertebrae in his lumbar and thoracic spines and a keloid  scar went from between his shoulder blades to his sacrum.  His spine was as straight as an arrow!  (better have been).  He had good range of motion and could almost touch the ground with forward bending but rotation and side bending were reduced.  His complaint was upper back pain, ache in his thoracic and lumbar areas as well as pain in the rump on the right.  After sending him for his full physical and new x-rays to see if the rods had broken (yes, it happens…) we got to work.  Hmmmm… Cannot adjust where the rods are… but can work on the Sacrum, Ilium, neck and upper thoracic spine.  OK, ok, wait a minute… why the neck?  Let’s leave that for a whole other time, but the quick and dirty is that the whole body wants to and has to work together to get you easily through space and time.  The neck will try to loosen to make up for differences elsewhere etc…

So what did we do?

This is what worked…

1. Massage to the muscles of the whole spine, including trigger point work and work on the keloid scar on his back with Arnica extract oil.

2. Chiropractic adjustments to the Sacro-iliac joints with S.O.T. blocking and Full-Spine style hands on adjustments.

3. Chiropractic adjustments and therapies to the neck to improve (His unique) alignment, and reduce muscle tension.

4. Stretches and exercises to improve over all flexibility, strength and stability.

This took only a couple weeks to see real subjective improvement.  His neck regained stability and motion, his scar softened and did not hurt, his back no longer ached.

There is no possibility of ‘correcting’ the curve of  someone that has had this type of surgery, and trying to go for that ‘text book’ range of motion and alignment would only make John much worse.  He was released from any ‘active care’ and was taught that when his own ‘tricks’ and exercises do not give relief, he should seek massage and chiropractic care.  It works for him quite well.  His quality of life is maintained and stress is reduced, his whole outlook got better because there WAS HOPE and someone to LOOK and figure out what could work.  He was told his life would be painful and that he should just accept it.   Nahhhhh… c’mon.  We did it…

The next case example…

Sue, we’ll call her.  A 50 something exec, lots of travel for work.  History of laminectomy one year prior.  Scars almost invisible (great arthroscopic work!)  Pain comes and goes, very tight quads, back muscles as well as rump muscles.  Good range of motion overall.  Pain gets so bad she must frequently get up from sitting, lying down, has to take muscle relaxants and pain pills to get through the day.  Other providers were more than happy to supply her with great drugs, and tell her ‘that’s the way it’s going to be, so take your meds.  Imagine how bad it would have been without the surgery?!’  (Her pain levels and patterns were very close to those from before surgery*)

OK, this one was easy, we had no hardware to deal with and adjusting her lower spine was easy in the prone position, pain was usually relieved immediately.  We gave her stretches for her hips, back, knees, and helped her learn to lift again with her back care in mind.  She required visits after or before most trips and occasional care here and there to keep her pain free and mobile.

SO, what did we do with both of these people?

We did not use special machines, lasers, muscle stim, ultrasound, gizmos, gadgets, elixirs, potions, medications or anything like that… we used TLC, hands on care, and Education.

There are simple stretches for the low back that have worked in 10 of 11 cases when done, there are simple and easy

*Failed Back Surgery (see more) http://www.ncbi.nlm.nih.gov/pubmed/21463472

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