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

27 reasons you SHOULD get an x-ray…

First of all, we do not have an x-ray machine in our chiropractic office.  I generally send patients out for needed films or studies, and only for the most obvious reasons (the ones I have listed below).

Having an x-ray is a great idea, you get the ‘inside’ info.  There is a lot one can tell just from an x-ray.  Of course an MRI or CT scan is better for some problems.  If you have recent x-rays (any in the past year or so) you do not need new ones unless things worsen or don’t get better as expected.   I always suggest that people immediately get a copy of their study so they can keep it in their own file.  Do not rely on the office you had the films done to have the time or interest in getting you copies at a later date.  That is too much of a hassle.  Bring them to me, I will go over them WITH you… answer all your questions and explain it all… (I used to teach and tutor x-ray evaluation in Chiropractic College)

Reasons that YOU should want to see an x-ray are:

1. Abnormal posture- you are bent over, in pain, cant move well… a good idea to see what is ‘twisted’ or ‘off kilter’
2. Partial dislocation/subluxation of spine-(or any joint)
3. Spinal deformity/ posture- this is upon closer inspection, lumps bumps, etc…
4. Trauma- possible fracture or dislocation.
5. Birth trauma…(a whole new blog is coming on this)
6. Restricted or abnormal range of motion-
7. Abnormal gait- if you are limping significantly, and don’t have a good reason why.
8. Axial pain (pain along the mid line of the body.)
9. Radiating pain-Pain that starts somewhere and travels down an arm or leg, could be something in the spine.
10. Headache- not just any headache… usually from trauma, or one that is ‘the worst you have ever had’
11. Short leg/ pelvis imbalance- see gait,
12. Spinal instability-when your spine clunks or clicks a lot… even with just normal movement.
13. Follow up of deformity-If you HAD a deformity and it went away…
14. Suspected osteoporosis- age, gender, race, activity level, and other factors determine this.
15. Facial pain- deep pain
16. Systemic health problems-diabetes, asthma.
17. Neurological conditions-numbness tingling, ache, inability to move, weakness…
18. Delayed developmental conditions
19. Eye or vision problems-related to a headache, neck pain, etc. not from strain or too much time at a computer.
20. Hearing disorders-related to trauma, headache, neck pain.
21. Spasm, tenderness- that will not go away.
22. Abnormal pelvic morphology- If your hips are messed up, we need to see this area…
23. post surgical evaluation- we want to see exactly what was done and what scar tissue there is.
24. spinal degeneration and arthritis- (also other areas) see OLD fractures too…
25. Congenital anomalies-a thing or problem you were born with.
26. Pain upon spinal movement-
27 Red flag conditions. Pain that wakes you at night, cough that won’t go away, etc… we have to check and make sure there are no tumors, infections, cancer, etc.

Now, not to scare the heck out of people but fracture is not the first thing you are looking for, sometimes we look for infection, tumors and other things.

Live well, be well… Remember motion is life!  so get moving.

Dr. Sean H. Thompson, Chiropractor, Acupuncturist

Natural BodyWorks Treatment Director

Parker Colorado

Working with neck fusion, post operative massage

This is a 56 year old female that had anterior neck fusion surgery about 9 months prior. Muscle pain, spasm and weakness are considered normal and generally treatable under Physical Therapy. Unfortunately PT did not help and she came to us for help… this is her story.

Well, for months now we have had a large influx of people that have had surgeries with implants and all kinds of screws and plates too!

This is a story of a woman that had an accident which really damaged her neck so bad that traditional care did not really help.  By traditional care I do mean medicine, physical therapy, massage, and chiropractic.

This is not a ‘bag on’ any of the providers that helped this woman.  This is a discussion after the end treatment option has been given, (surgery).  In my opinion, I do think some changes in her previous care would have saved her from surgical repair, but I was not there.  She did have all the signs that would have made surgery applicable: pain that did not go away with NSAIDs, or physical therapy, nerve problems such as tingling, numbness, and weakness, as well as chiropractic care.

Now she has permanent limitations in range of motion, permanent nerve damage, and permanent weakness.  For her there is also tightness and pain that just does not go away.  There is so much pain that she cannot sleep.  She has medications that make her too sleepy to drive and they keep her from working more than a few hours a day.  Her life has changed and she had lost hope, a little at least…

When she came in I had to be honest with her and tell her that her neck could not move in that area ever again (obviously) and that chiropractic is not a good idea for that part of the neck (very specific adjustments above and below the surgery area would be OK, but lots of attention to detail needs to be done.) , but may help her upper back from being so tight.  The muscles in the back of her neck were ropey and tight as banjo strings.  She got recurrent headaches and had trigger points all along her upper back and shoulders.    She was also suffering from bone loss around the titanium screws in her neck.  The base of each screw was not showing any bone growth around it and she was given an electrical stimulation machine to help stimulate bone growth, but it was not working.

We had decided to work with her and focus on the muscles and pain.  We did discuss nutritional changes she should make to promote any bone growth as well as some supplements she could get to help with muscle tightness.  The treatment we offered was mindfulness meditation training for pain as well as massage.

I have used massage as a therapy since before I even became a doctor of Chiropractic some 17 years ago.  I also taught massage therapy for over 5 years at the college level and got to really perfect my own work and teach many how to really do deep work.

Her first few treatments were to see what we could find and how much we can get into the muscles without causing too much post treatment pain.  I used a thick oil and did all the work with her breathing into each movement so that we could train the muscles to relax.  There has been great results, we have seen about 20% decrease in reported pain and much more relaxation, I write the thickness of the muscles in the neck and there has been a softening of those muscles in the back of the neck near the surgery site.  If course no change in range of motion of the neck, but the motion is much more pain free.

We are still working on her, the main goal was pain relief. We achieved some, and with upkeep she should be able to maintain and gradually decrease her medications (they are prescribed by her MD as PRN, take as needed).  This way we save her stomach some stress and her poor liver the cleaning work too.

She was able to reduce her frequency of massages to about one each three weeks with some home self care and a great little secret of Salon Pas…

She is currently under care still, we are waiting for news on the bone growth in a month or so.  We are requesting new x-rays to see if her nutritional changes have helped at all.  I will write an update in a few months.

I welcome any questions and comments regarding post surgical care with massage, chiropractic and acupuncture.  Next time, the Quantum Touch connection.

Yours in mindful health and wellness

Dr. Sean H. Thompson, Chiropractor