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Posted on 10-02-2016

Some Patients Fail To Improve With Chiropractic Care

By now I am sure that my avid blog followers are aware that I am a Baltimore Chiropractor that treats patients in Baltimore, MD with headaches, neck pain, mid back pain, and lower back pain. These aches and pains can be from overuse injuries, chronic pain from a lifetime of hard work, or they can be acute injuries suffering from Baltimore auto accidents, Baltimore slip and fall injuries, and Baltimore worker's compensation injuries. Like all business owners I like to highlight my "wins" and showcase the patients who have had favorable outcomes and resolutions with treatment in this office. I had a patient recently who came to the office and asked me about my "losses" - that is, the patients that fail to improve with chiropractic therapy. This patient wanted to know what happens to them? Do they live with their pain? Do they need surgery? I thought that this was an interesting blog topic so I decided to showcase two recent losses, that ended up with positive outcomes.

The first "loss" was a friend of mine who came to see me with neck pain and radiating right arm pain. He is an avid weight lifter and had been having neck pain and radiating right arm pain for about six months off and on. I treated him like I would any other patient - I performed a history and physical examination. Based upon my findings we took an x-ray of his neck to rule out instability and to look for neuroforaminal narrowing. Everything looked good so we began treatment. I saw him twice the first week for therapy. He felt a bit better after the first visit and then worse after the second visit. I told him to come back the next week. His condition had progressively gotten worse over the weekend, so we decided to discontinue further treatment until he got an MRI. At this point he had some grip strength weakness and increased arm pain - all of which we had discussed could possibly happen. After we got his MRI about a week later the bad news was revealed. The patient had a large extruded disc herniation in his neck. Although chiropractic care has a good history of helping patients with disc herniations, this particular herniation due to its size and the fact that it was encroaching his spinal cord was likely a surgical candidate. This was heartbreaking for both me and my friend. I referred him to a local orthopedist for a consultation. About a week later, with understandable concern for his health and well being, he underwent a successful anterior surgical decompression surgery with fusion. This means that the herniated disc was removed and the two bones that it was separating were fused with a metal cage to prevent them from slipping. I followed up with my friend about a week later and he was so relieved. All of his arm symptoms had resolved and his neck pain had decreased by about 80 percent. So did Chiropractic care fail him? No - while it is true that he did not respond favorably to my treatment, part of Chiropractic care is to continually re-assess a patient's condition and to make changes to the treatment plan based on a patient's response to therapy. In this man's case he required an MRI and ultimately surgery to fix his condition. He could not have been more thankful for the treatment and referrals we gave him and made on his behalf, because left to his own devices, he likely would have done nothing for six or more months, and he could have potentially re-injured himself worse at the gym moving forward.

The second "loss" was a few months prior to the above example. A young woman who was about 40 presented for care with lower back pain and left and foot numbness. She was a fairly active woman who liked to do yoga and go to the gym, but had stopped recently due to back and leg issues. I told her that we would try two weeks of treatment and re-assess her condition. She was doing well for about 3-4 visits and then her condition worsened. She felt increased back pain and increased leg numbness. These "red flags" made it clear to me that a lower back MRI would be in order. So, we ordered her an MRI. Similar to the example above, the patient had a sizable disc extrusion with lower back nerve root compression. We discussed that it was likely that the disc herniation was compression the nerves going to her left leg and foot. She had a family friend who was a spinal orthopedist so I encouraged her to take her MRI findings to him for an evaluation. As expected based on her response to treatment and her MRI findings, he recommended surgery. Given her age and response to treatment before chiropractic care and after chiropractic care, she elected for surgical intervention. She had a lumbar laminectomy with discectomy. That means that they shaved a hole in her lower back vertebrae and shaved down the offending disc. Less than a week later she came in to "catch me up" on her progress. She was about 75 percent relieved in terms of back pain and 100 percent of her leg numbness had resolved. She admits that it was the best she had felt in almost a year. She was very appreciative of the fact that we had tried to help her with conservative chiropractic therapy and that we referred her to another provider when her clinical condition worsened.

Both of these examples demonstrate how, despite what most chiropractors would like you to believe, we are not magicians or mystical healers. We are neuromusculoskeletal practitioners that are limited in scope, but experts in what we do. In both instances the above patients were referred for MRI imaging and ultimately had to undergo decompressive spinal surgeries. Although surgery and anesthesia are not without risk, both patients ultimately did well with their procedures and their symptoms have improved considerably. When I asked both patients what they thought about the therapy they received, rather than being upset with the fact that chiropractic care could not "fix" them, they were very appreciative that they were referred "downstream" to providers who could ultimately tackle the underlying problems. In fact, both patients who failed with conservative chiropractic therapy have since continued to refer their family and friends to the practice, since they so appreciated the care that we provided to them in their times of need.

I tell all of my new patients that we will begin with a few conservative treatments to see how they will respond to care. Ideally if patients respond favorably as expected, we reduce their treatment moving forward. If they worsen, as in the examples above, we make timely referrals for imaging or to other specialists. To me, chiropractic care is limited in scope. But rather than this being a negative, I look at this is a positive. It means that we can focus on what we do well and we can refer patients to where they need to be quickly so that they can ultimately improve their condition quickly.

If you, or someone you know, has headaches, neck pain, or back pain and are interested to learn if Chiropractic care could benefit you, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

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