Leg Pain & Groin Pain with NO Back Pain

Problem: Today I had a man present with groin pain and leg pain to the foot worse on sitting and lying down and better with standing and walking. He has had similar groin pain in the past over the years but he has had no similar leg pain. He thinks he hurt himself lifting something heavy a week ago. Today, he had no back pain to speak of. In fact on examination, the low back had very little tenderness or spasms. He had a little edema over the sacrum. His groin and leg pain however he rated at a 9. During the exam his pain was so intense he could hardly carry on a conversation. My exam revealed several things. First, I could make the pain worse by having him sit on the table and raise a leg to 90 degrees. Secondly, with him lying on the table, when I lifted his uninvolved leg up to 35 degrees, pain shot down his leg and into the groin. Third when I tested his lower extremity sensory nerves (dermatomes) he had moderate hypersensitivity (too much) in one area of the involved leg followed by moderate hyposensitivity (too little) of the along the outside of the foot (S1) dermatome. Forth, his muscle strengths were somewhat diminished with some loss of strength at the involved leg quad and hamstring muscles both rated a 4/5. He had a negative heel walk and toe walk and denied any change to bowel. Finally he had a negative braggard's ruling out simple sciatica. Treatment: He had a defibrillator so e-stimulation was out. So I went with moist heat followed by laser to the sacrum and lateral/posterior leg along the nerve route and ultrasound to the upper lumbar para spinal muscles at T12 -L3 on the side of involvement. I did some manual therapy on his low back and sent him for X-rays at the local hospital as I want a radiologist to read these films. I think he has two things going on. First I think he has stenosis (narrowing of the central spinal canal) and secondly I think he has superimposed a bulging disc at L5. He also may have one at L4. I think he has neuroforaminal encroachment (disc pressing on the nerve root) causing inflammation. I will order an MRI after I get the x-rays back. I talked to him about anti inflammatory meds but he was already on Mobic. Discussion: Diagnosis is the key. If a doctor does not know what is causing the problem he can't fix it. God gives us the right to have more than one thing going on at a time. Most people have multiple pain generators. I talk everyday to patients that tell me that the doctor did not touch them in the examination. That means the doctor is guessing and that's why we have so many failures in low back pain treatment. Greg Millar DC CCEP




Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Simple Neck Pain

Problem: Today, I had a patient with simple neck pain. I know from his perspective, no neck pain worth going to the doctor is just simple. However, after examination and x-rays, he had neck spasms and pain with no radiation and no x-ray underlying pathology. He had no prior history of neck pain and had no trauma. He just woke up today with pain worse on turning his head to the left. We in Chiropractic call this condition "torticollis" or neck spasms. Patients often call this a "crick". In this case, his condition was classic. He slept last night with the window open and the cold air blowing in the room. This caused his neck muscles to spasm.

Have you ever woken up in the morning and for some unknown reason have a painful, stiff neck that allows you to barely be able to move your head? If you answered yes, then you are certainly not alone. Neck pain or torticollis neck discomfort is a very common reason for people to seek Chiropractic care. Most neck pain is caused by muscle strain or tension, and although some individuals experience this chronically (can be worse), neck pain is usually not serious. The first step is to identify what activities may be causing this neck pain, such as poor posture, work, sleeping in an uncomfortable position, or specific life activities such as sports or exercise.

While most cases of neck pain do not have serious medical implications and can be often corrected with Chiropractic manipulation, some neck pain could be the sign of an underlying condition or problem that requires prompt attention. Often this type of problem requires an MRI for further imaging. Treatment: Patient was put on ice for 12 minutes along with premod e-stimulation. Patient's SCM, Traps and neck muscles were massaged. Patient was adjusted and sent home with home care of ice tonight and heat tomorrow. Patient stated that he was 75-80% better after today's treatment. He will return on Thurs for another Chiropractic treatment. Results: good.

Greg Millar DC CCEP

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Failed Cervical & Failed Low Back Surgery

Today is Wednesday February 11th, 2009. Problem: I had a lady see me in the Decatur Disc Treatment Center today that had four previous surgeries with the last two being fusions. She had her first neck surgery in 1993 and her last low back surgery in 2007. She was in intense pain all the time. She described the pain as 9/10. She had neck pain with radicular symptoms into her hands bilaterally. She had low back pain radiating down her left leg to the inside of the left foot. Her left thumb and first two fingers were numb on the right and her great toe was numb on the left. She came to my office in tears. I first saw her in December 08 and told her she needed pain control; two new MRIs; and a Nerve Conduction study of the upper and lower extremities. I told her pain control was going to take sometime but she wanted a quick fix. She left in December and went to a pain doctor who did exactly what I said and ordered new MRi's of the cervical and lumbar spine an NCV of the upper and lower extremities. After looking over the studies the pain doctor decided to put her on heavy meds and see her for monthly for refills. She did not want to take large quantities of meds and came back to see me for treatment. Yes she has recurrent bulges and adjacent segment syndrome. The MRI's were ordered without contrast so it's nearly impossible to see if any adhesion of scar tissues have occurred. Treatment Plan: I am starting her on conservative chiropractic care (Activator only no manual adjustments) and the disc pump for the cervical and lumbar spine. I will do some Cox Flex/Dist work on her. I am also consulting with UAB Dept of Neurosurgery as I think she is a candidate for Pulsed Radio Frequency treatments to the lumbar facets or perhaps an internal cord stimulator. I will start her on modality treatments including IFC and Short Wave Diathermy for deep heating. We will have to do some trigger point and deep tissue work to help her heal. I am consulting in Gary Cohen, DO Physical Medicine for IMS/NMS dry needling of the lumbar paraspinal muscles, SI Joints and traps. And I'm consulting in Michael Dick MD for treatment of the OA and Bursitis. I put her on vitamins, fish oil, glucosamine sulfate, Boswella and B-6 vitamin. I see pool therapy in her near future. I told her today It's going to take a year to get feeling better. Results: Too New to rate, I will let you know.



Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Fibromyalgia and Multiple Herniated Disc

Today Monday Feb 9th was a most interesting day of practice. CASE: I had a middle aged female patient in the Decatur Disc Treatment Center office who had multi level degenerative disc disease with stenosis and neuroforaminal encroachment with 2 herniations and 2 bulges in the lower cervical spine; 2 prolapsed disc in the thoracic spine at T7-8 and T8-9; and 2 herniations in the lumbar spine at L4-5 and L5-S1. She also has Rheumatoid arthritis. I have treated her for several years. She has been through several rounds of DTS decompression traction with good success particularly in the lumbar spine. She has also had several rounds of physical therapy again to good success particularly in core stabilization and in making her stronger and more vital. What made today so different was that she has for some time been experience mild fibromyalgia like symptoms. Today her FMS (fibromyalgia) was flairing and was setting off her neck and low back radiating pain. FMS is normally considered a non- inflammatory disease and her SED rate was a 2 on the 0-20 scale meaning that she had little or inflammation. However she stated that her fibro fog and fibro pain was at it's highest ever today. She also stated that the FMS pain (pain evenly divided in all 4 quadrants) was always there as background pain then as the day progressed her radicular or discogenic pain would break through and progress. Treatment: I treated the FMS by helping her to get to sleep and stay asleep. I put her on Fibromalic brand of magnesium with malic acid. I asked her to control her sleep time and make changes in her going to sleep patterns. I told her to use breath right strips at night. I ask her to take warm Epsom salt baths. I put her on (krill) fish oil 3000mg a day. I measured her anti-occident scan and it was under 12000 where it should be a min of 35-40,000. I put her on physician grade multi vitamins and water as her serum Co2 was in the 30's. I consulted in Dr. Gary Cohen Do physical medicine/rehabilitation and he suggested Gogi juice as well. We are going to repeat her NCV to make sure that no radiculopathy changes have taken place and were starting her on a round of conservative chiropractic care along with physical therapy core stablization. Results: Too new to rate. I will revisit this case in two weeks.

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Hello and Welcome

Welcome to the Millar Chiropractic "BackTalk" blog. The Doctors of Millar Chiropractic will openly share patient problems, treatment and results. We do this for two reasons. First, if you have the same or a similar problem then you may be helped by our discussion. Secondly, you can see the results of treatment of others and dispel any fear or uneasy feelings you may have about trying Chiropractic. Each day a different doctor will share a case and his treatment. Please join us in our quest to empower the people of Northern Alabama and Southern Tennessee to exchange ordinary healthcare for extraordinary wellness through discovering and implementing Chiropractic, Nutritional, and Whole Body Prevention, leading to a Wellness Lifestyle and longer life. Visit us online at www.millarchiro.com.
Thanks
Dr Greg

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.