What is Sciatica?

What is Sciatica?

As many of my blog followers can attest, I spend a fair amount of time talking about injuries sustained in Baltimore auto accidents. Today I will talk about a different condition that is generally not traumatically induced, although it can be.  Many people have heard of the term sciatica, but what exactly is it?

Sciatica refers to a set of symptoms associated with compression of one of the five spinal nerves that combine to form the sciatic nerve.

Symptoms of sciatica include lower back pain along with radiation of the back pain typically down a leg or into the buttock. Sciatica may cause numbness and/or tingling and/or weakness down an extremity. Or, it may just be back pain with some dull pain down a leg.

Technically speaking, true sciatica is compression of the sciatic nerve. In clinical practice most presentations of sciatica are not sciatica, but instead are a combination of other causes of back pain that cause radiating leg pain. In fact, sciatica is NOT a diagnosis, but rather a series of symptoms that describe back pain with radiating leg pain. If a patient tells me they have sciatica what it really means is “I have leg pain associated with back pain and I’m not sure why.”

The typical causes of sciatica include: disc herniation, spinal stenosis, facet joint irritation, piriformis syndrome and in some extremely rare cases other space occupying lesions such as cancer that can mimick the condition. Patients that carry extra abdominal weight such as obese and/or pregnant patients can get sciatica as well.

Most patients that present with sciatica will have an x-ray to rule out nefarious causes of the sciatica. Once cleared for therapy they undergo a series of physical therapy modalities along with chiropractic spinal manipulation to help alleviate the symptoms causing the nerve compression. Most patients respond fairly quickly to therapy and their peripheral (leg) symptoms resolve.

Patients that have no response or negative response to care are often referred for MRIs and/or to a specialist to consider pain management/injections. These approaches, although more invasive, are often effective in alleviating symptoms where chiropractic care has not been able to help.

If you, or anyone you know suffers from sciatica in Baltimore please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Important Tips to Avoid Injury While Shoveling Snow

In light of the recent monstrous amounts of snow we have been receiving in Baltimore it occurred to me that I should mention some basic ways to avoid neck pain and back pain while shoveling.

First tip: Make sure you are physically capable of a work out. A recent article by the Baltimore Sun found here details the death of several men in Howard County who died of apparent heart attacks while shoveling. No one really ever plans on having a heart attack, but it speaks to the bigger issue that shoveling is really a work out. With any work out, make sure you are physically fit enough to do it before you begin. Consult your physician if you are not sure.

Second Tip: Warm up. As with any other work out you want to make sure that you are ready for exertion. Make sure to stretch your back before beginning any work out so you do not strain a muscle. Even a few jumping jacks will get you appropriately warmed up quickly.

Third Tip: Use the right tool. For light dustings of snow I prefer a push broom which avoids repetitive bending or lifting. If you need to use a shovel to pick up snow, make sure you have a sturdy but light weight shovel. Often the big, heavy, industrial shovels are way more than is necessary to clear snow, resulting in increased weight to carry and often times increased back pain as a result.

Fourth Tip: Use Proper Biomechanics. As with any dreaded tasks there is a desire to rush through it and “just get it done.” The problem with taking this approach while shoveling is that it is often the cause of increased back pain and visits to my chiropractic office. As with all heavy lifting, make sure to bend your knees and lift with your legs, not your back. If you have to move snow to one location make sure that you turn your entire body (avoid twisting at the waist). Typically, if you throw the snow over your shoulder the increased twisting at your waist while carrying a heavy load will cause an increase in lower back pain.

Fifth Tip: Find a friend with a Snow Blower. In the best case scenario you may have a friend or relative with a snow blower. This will allow a machine to do all the heavy lifting and help save your back. If you are a friend that has a snow blower, please remember to help out the elderly and less fortunate by clearing their sidewalks and driveways.

While most of these tips are straightforward and probably pretty obvious, you might be surprised how often my phone rings with patients who did not take proper precautions and now have acute lower back or neck pain from shoveling.

If you, or anyone you know has suffered from back pain or neck pain while shoveling, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Undiagnosed Shoulder Pain Following Baltimore Auto Accidents

Some of my faithful blog followers might be asking why I would blog about shoulder pain following a Baltimore auto accident, when I am, in fact, a chiropractor. Traditionally chiropractors focus strictly on the diagnosis and treatment of spinal complaints including headaches, neck pain, and back pain. In many states, including Maryland where I practice, chiropractors can apply for physical therapy privileges, giving them the ability to diagnose and treat non-spinal musculoskeletal complaints.

Due to the successful “click it or ticket” campaigns there are more and more shoulder complaints following Baltimore auto accidents than you might otherwise expect. The shoulder harness can restrain a shoulder and cause an injury to an occupant.

Typically shoulder pain is treated like any other injury that I treat in my office following a Baltimore auto accident. I use a combination of physical therapy modalities (heat/ice, electric muscle stimulation, ultrasound, etc) and then progress to passive stretching and active therapeutic exercises. In the majority of cases the shoulder pain resolves within a few months.

In some cases shoulder pain persists past 6-8 weeks. This makes sense as everyone is different and not everyone responds the same to therapy. For shoulder pain that does not improve quickly, I typically order an MRI to rule out ligament tearing and rotator cuff pathology. Interestingly, MRIs do not catch all shoulder pathology on their own. That is, there are additional testing that I use on occasion to diagnose “tricky” shoulder problems that do not display pathology on traditional MRIs.

For patients that have failed conservative rehab of shoulder pain and have negative MRIs, I usually recommend an arthrogram. An arthrogram is a special application of radiography in which a dye is injected into the shoulder and then the shoulder is imaged in various different positions. It can be combined with MRI or CT scan to give a better understanding of underlying pathology such as partial thickness muscle tears and labral tears.

Once appropriately diagnosed the patient is referred to a shoulder orthopedist for (typically) shoulder surgical intervention. While I do not promote unnecessary surgery and as a chiropractor I personally think that it should be the last resort, I am in favor of surgery when it is the only remedy for an injured patient.

If you, or someone you know has been injured in a Baltimore auto accident and have shoulder pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

More on Croft Guidelines for Whiplash Treatment in Baltimore, MD

In my last blog post I referenced the Croft Guidelines. These are industry accepted guidelines for the length of treatment usually required by people involved in auto accidents that are injured and require auto accident treatment (in Baltimore and across the country). Dr. Croft notes that no two people are the same, so it is acceptable to deviate from these guidelines if need be, but in general they should be adhered to. Once patients begin requiring treatment in excess of the Croft Guidelines it is generally a good idea to get a medical specialist on board to co-treat the patient.

Dr. Croft classifies injury severity into 5 different categories and then gives treatment guidelines depending upon which category a patient falls into:

1. Grade 1: Minimal Severity. No limitation in ROM, no ligamentous injury, no neuro findings

2. Grade 2: Slight Severity. Slight limitation in ROM, no ligamentous injury, no neuro findings

3. Grade 3: Moderate Severity. Moderate limitation in ROM, some ligamentous injury, possible neuro findings

4. Grade 4: Moderate-to-Severe. Limitation in ROM, some ligamentous injury, neurological findings present, probable hard tissue damage (fracture) and/or disc derangement

5. Grade 5: Severe. Requires surgical management/stabilization.

Of note, I would say that the vast majority of Baltimore auto accident injuries present with severity grades 1-3, with grade 2 being the most common.

Using these grading classifications Baltimore auto accident chiropractors such as myself can put together an effective treatment plan for recovery and can keep in mind how much time and treatment may be required.

If you look at table 12.3 here you will see that even patients with grade 1 injuries that have No ROM limitation, no ligamentous injury and no neurological findings still fall into the category of allowing for daily care for a week, 3x/week for 1-2 weeks, 2x/week for 2-3 weeks, 1x/week for less than 4 weeks for a total treatment duration of less than 11 weeks with 21 or fewer total treatments.

Although the research by Dr. Croft and his colleagues dictate that even grade 1 patients may require treatment of around 11 weeks duration, it is interesting to note that most third party payers (insurance companies) generally look to disallow care following 12 weeks, thinking that “everyone is healed by then.” I can tell you from my 5 years experience treating auto accident patients (of which I have seen more than 1000 different cases) in Baltimore and Las Vegas that it is not the case. Often the Croft Guidelines are a useful tool to reference to justify to insurance companies the need for continued care for my patients.

If you, or someone you know, has suffered from a Baltimore auto accident and has experienced whiplash and want help to recover, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Croft Guidelines for Whiplash Treatment in Baltimore, MD

As a Chiropractor that spends many hours a week treating patients involved in Baltimore car accidents resulting in whiplash, I often get asked how long any given patient should expect to take to recover from their injuries. Asked another way, patients often want to know how long they should expect to need treatment for their injuries. It is a fair question, since many patients end of missing time from work and leisure activities in order to present for treatment. Unfortunately there is no simple answer to that question. As we have seen in past blog posts, every patient undergoes unique loading mechanisms during Baltimore auto accidents and has different relative risks of injury. As such, it should stand to reason that some patients might not get hurt at all, while others can suffer with debilitating injuries that take weeks or months to heal, while others never fully heal.

Fortunately there is a professionally accepted standard for treatment of whiplash patients that helps to grade the severity of the patient’s presentation. These guidelines are then useful in predicting how long a patient should be under care in order to reach maximum therapeutic benefit (or referred to as maximum medical improvement, MMI).

Keep in mind a few things here:

1) A patient’s ability to return to work, depending on what they do for a living, can occur prior to their being “healed.” I often release patients to work at either light duty or even full duty even while they are having pain.

2) Patients that feel better and have no pain are still healing even after I dismiss them from care. The healing process takes months to years for new connective tissue to effectively replace old, torn, injured tissue. This is why we see patients involved in multiple auto accidents often having more severe symptoms if their second crash occurs in quick succession to the first.

3) Not every patient fits into this guideline. Some patients can be outliers to this guidelines and may require MORE or LESS care, depending on their specific health characteristics and comorbid conditions.

For a link to the croft guidelines, click here.

In future blog posts I will discuss more in depth the different classifications associated with the croft guidelines and which classifications usually present in a chiropractic office.

If you, or someone you know, has suffered whiplash injuries as a result of a Baltimore auto accident please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz