Presentation
All moves shown in this report are done on the segmental drop table using the Thompson technique, and analysis is based on the Thompson protocol.

The patient, a 36-year-old male, had been injured in an auto accident and continued to work at his truck-driving job. His complaints included cervical, mid-dorsal, and low-back problems that interfered with his ability to perform his tasks as owner-operator and mechanic of a trucking business. His progress was altered by his inability to be patient with the healing process and his antagonizing his condition, which resulted in his pain worsening. He also found that the pain medications were not making him well enough to do his job from day to day.

The patient saw a medical doctor because of severe coughing and the heavy pain he was experiencing. He was given Guaifen-PSE. The patient went to another doctor about a week later, and he was put back on muscle relaxants and pain relievers. He then asked the doctor if going to a chiropractor would be helpful. The medical doctor told him that it couldn’t hurt, since the patient had not been getting any better under his present care.

The patient, on his initial visit to my office, noted on his intake form and verbal family history that he was having low-back pain, neck pain, and stiffness, as well as problems with his hips, legs, and knees. He had great difficulty in getting up from a seated position, which also hampered his ability to do his job from day to day. Because of his pain, a friend of his who I had been adjusting for several years encouraged him to come to see me. The patient told me that the medical model was not helping, even with the use of pain medication and muscle relaxants. He said that since his friend was doing better, he would give chiropractic a try.

The patient had been injured in an auto accident 5 months earlier and for the next 5 months he was treated in the medical model with pain pills, physical therapy, and over-the-counter medications; he was put on light duty.

After x-rays and an MRI, the patient was informed he had a herniated disk at L4 to L5. He was reviewed by a neurologist, and he was ordered to discontinue any aggravating activity and informed he may need an operation.  

Prior to seeing the chiropractor, the medical doctor referred him to physical therapy, where he was given several tests and evaluations to determine the type of treatment and to plot his progress. The doctor ordered him to continue using muscle relaxants and pain relievers. The patient said that the physical therapy actually aggravated his condition and did not reduce the pain to any notable degree.

The medical doctor ordered a diskography, which revealed a significant annular disruption with a relatively broad-based posterior tear at L5, S1. The disk was pressurized to approximately 80 mm Hg that reduced the pain to a 7 on 10 scale.

The assessment of this patient shows a negative diskogram based on the inability to separate an abnormal disk at L4 to L5 from a normal-appearing nucleus at L3 to L4.

The doctor gave the following plan in his report: “I do not believe that we should want to proceed with any interventional care and instead, stay conservative with this gentleman in the management of his pain.”  The patient said the doctor told him to go back to his chiropractor.

Treatment
We had been taking care of the patient prior to the diskogram and had problems with the patient following instructions. His driving trucks and working on those same vehicles as a mechanic was the basis of his aggravation of this pain. There were a few incidents in his history of him playing flag football.

We used the inversion table for a short period of time that did relieve some of the pain, but found that adjusting the psoas muscles made a greater difference in further reducing his lumbar pain. We also fitted the patient with a Velcro lumbar wraparound brace while he was active during the day.

A series of exercises were prescribed, including cervical and shoulder exercises, and scissors motion of the lower legs. Abdominal and leg crunches for the abdominal and pelvic region greatly helped stabilize the muscles in that region. These were to be done at least two times daily with eight to 10 repetitions and two to three sets. If pain was elevated, then the exercises were to be cut down for 2 to 3 days. Ice was also used for the prescribed treatment plan, 20 minutes on and 40 minutes off at least two to three times per day and twice per day during increased pain periods. The patient also used a pain-relief lotion during the first 5 to 10 months.

Because the patient got some relief from the inversion table, I decided to refer him to another chiropractor who specializes in  and teaches flexion distraction. That made a big difference in relieving more of his pain, from a five or six on a 10 scale down to a four on a 10 scale. Occasional spikes occurred when he would aggravate the condition by doing things that aggravated the low back. The pain in the hips and legs has receded somewhat as well after the flexion-distraction treatment. The patient was now following the chiropractors’ suggestions and to some extent was following the instructions of the medical staff that he would visit on occasion for a checkup.

Because of the injury to the disk, I felt that being conservative and enlisting the cooperation of the patient was the only way this problem could be resolved. The body will heal the injured area if it is in the right climate and chiropractic adjusting, exercise, and therapy are used following the rule of 20/40. That’s ice, 20 minutes on and 40 minutes off before starting the next treatment schedule or exercises.

Limited walking is very good for the low-back disk after receiving a chiropractic adjustment and ice for 20 minutes. Start off by walking down the block at first.

Around the block is the next step, and progressively walk more as each week goes by. This is based on the patient’s progress related to the pain scale. The higher the pain scale, the shorter the walk. Of course, as the patient improves, the longer the walk.

Adjusting a patient while monitoring the progress, and numerically keeping track of any changes related by the patient, served as a measurement of his progress. The tracking shows how his progress was hampered by his lack of early cooperation to follow the chiropractor’s health plan. The tracking clarifies that the plan was basically sound from its inception. It shows how the chiropractic model served as a more likely plan than the medical model. The medical doctor’s decision not to operate played a large part in the positive progress exhibited by the patient.

The patient was in the other day for a follow-up visit, and guess what? He had been playing flag football. At his age and condition, there was no need to lecture him because he knew who was responsible. That’s why he came in to get his back adjusted. He’s really learning how to take better care of himself.

Wayne Henry Zemelka, DC, is CEO of a chiropractic clinic in Davenport, Iowa. Contact him at drwayne@netins.net.