Jon presented to our clinic on recommendation from a family member after having suffered with years of chronic lower back pain. He had seen numerous therapists and specialists over the years many of whom had told him his hips / pelvis were “out of alignment”. However, manipulation (clicking) to realign his spine was delivering ever decreasing results and he had got to the point where is was no longer helping a constant ache in his lower back as well as spasms and episodes of his back “locking up” which were becoming more and more frequent.
Jon did not have shootings pains down his legs and clinical signs did not indicate any “trapped nerves” (radiculopathy). Despite this we suspected Jon was suffering from one or two degenerative discs in lower spine. He had never before been for an MRI scan, so this seemed the obvious thing to do in such a longer term problem, in order to “look under the bonnet” as well as testing his function in the clinic. Jon’s MRI scan did indeed confirm our suspicions, this is an extract from his report “…Extensive Modic type 1 change L5-S1. Lower three motion segments show facet OA. Left paracentral annular tear L4-5 and right paracentral annular tear L5-S1. (No significant nerve root impingement)”. In addition, on review of the images ourselves, we noticed slight signs of instability (dynamic retrolisthesis) of his L5 vertebra.
This correlated exactly with the clinical palpatory findings of (relatively) hypermobile L4/5 and L5/S1 segments with a very stiff / rigid spine at higher segments i.e. most of Jon’s movement (shear and torsional) stress was occurring through his L4/5 and L5/S1, hence the degenerative changes seen on MRI and perpetual irritation of his lower most discs.
The initial aim was to reduce alleviate pain from Jon’s degenerative and inflamed load bearing structures. We chose (IDD) spinal decompression therapy for this task (and advanced form of targeted, computer controlled, oscillatory traction). Immediately following his initial sessions, Jon reported that for the first time in a long while he had experienced significant symptomatic relief from the IDD Therapy. Thereafter and, in addition we used dry needling (medical acupuncture) to help ease the reactive tension, spasm and contracture in Jon’s deep spinal muscles.
We explained to Jon that in his case it was not a good idea to repeatedly have his back “clicked”, at least not in the area of the worn discs. Whilst this may have the potential to produced temporary, reflex relaxation of the local muscle spasm, this was unlikely to provide a long term fix. Worse still this might of been making the situation worse as repeated manipulation (joint clicking) would likely make his ligaments even more lax, thereby making his degenerative discs even more unstable.
We instructed Jon on the need for him to improve muscular stabilisation (core and multifidus etc.) specifically in his lower most segments and to improve mobility higher up in his spine.
We further added to this theme by referring Jon to a well known sports doctor, who was very experienced in spinal (P2G) prolotherapy (P2G = Phenol, Glycerol and Dextrose) and an excellent reputation working with top athletes and sports people. Prolotherapy is associated with upregulation of fibroblast growth factors resulting in the formation of stronger (stiffer) ligament tissue.
It took time and patience (12 – 24 months) for the delegate balance of muscle and movement balance / symmetry to properly swing in Jon’s favour but he even made it back on to a football pitch without suffering from back spasms and eliminated thoughts of needing spinal surgery.
