CF 024: They Laughed When I Said I Could Still Help After Back Surgery

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

They Laughed When I Said I Could Still Help After Back Surgery

Today, we’re going to talk about people coming into our office after having had back surgery wanting us to perform miracles. Well, why didn’t they come to us BEFORE the surgery would be my big question. We’ll toss all that stuff around today on the Chiropractic Forward Podcast.

But first, here’s that bumper music!

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

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We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal

You have done the electric slide right into Episode #24 and that’s exciting

Now, as I mentioned previously, how many times do chiropractors have new patients come through the doors but they’ve already had back surgery? They’ve had back surgery they hoped would be a quick fix usually. But it wasn’t.

Now, they’re sitting in your office, looking at you with a very scared and concerned face, and it’s up to you to lead the way and, hopefully, be able to provide them some sort of relief with your magical abilities.

I can tell you from 20 plus years of experience that it happens all of the time. At least a time or two per month for a busy practice. That’s what I would guess.

The truth is, sometimes we can help these back surgery people and sometimes we just can’t. I tell patients that surgery, many times, is permanent and anything we do toward trying to get some relief can be a little bit like pushing a wheelbarrow uphill. Depending on the weight in the wheelbarrow, we may get it to the top and we may not get it to the top but we’re sure as hell going to try while making sure we keep them safe from further damage.

At first glance, when you’re looking at an x-ray of a post-surgical patient, many times I find myself thinking, “What in the heck can I possibly do with this trainwreck.” I’m sure I’m not the only one to ever feel like that. It’s a little bit of a helpless feeling sometimes. Especially when you see parts missing like you’ll see in a laminectomy. Or when you see parts added like boney fusions or fusions with hardware. I get a sinking feeling in my stomach for patients like that. Back surgery is no joke.

At first glance, when you’re looking at an x-ray of a post-surgical patient, many times I find myself thinking, “What in the heck can I possibly do with this trainwreck.” I’m sure I’m not the only one to ever feel like that.

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Especially when we know for a researched-fact that these patients most likely did not have to endure those procedures. For any reason. If you aren’t sure about that statement, please review our podcast episodes we did no The Lancet low back series. Episodes #16, #17, and #18 dealt with this very issue.

Back surgery is gaining in popularity while the outcomes show no change. They are no longer recommending surgery for acute or chronic low back pain. Period. Sure, cauda equina syndrome, foot drop, and severe symptoms like that may indicate surgical intervention but, otherwise, they say no shots, no surgery, no bed rest, and no medications.

Surgeries are gaining in popularity while the outcomes show no change. They are no longer recommending surgery for acute or chronic low back pain. Period.

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We will be hammering these things consistently until we start seeing some change. I can guarantee it.

OK, but…..what if nobody listened to the experts and they just did the surgery with no relief? Can we do anything about it?

Let’s look at a couple of possiblities:

1. The spine was fused years ago and now, due to the immobilization and increased workload on the segments above and below, the segments above and/or below begin to show signs of wear and tear.
2. The spine was not fused but the complaint never improved. This may be the case in people that have the microdiscectomies or epidural spinal injections.

Of course there are a lot of different, very specific outcomes that don’t fit in those two categories but I’d say these are the ones I commonly see.

Let’s take the first one: a fusion that caused issues above and below the fused segment. If you go through nonsurgical spinal decompression certification through the Kennedy Decompression Technique, you’ll be taught that a fusion with hardware is a hard contraindication. At least it was 6 years ago.

Assuming these people develop disc issues above or below the fusion, that would mean you can’t do any decompression on the site. An orthopedic surgeon that is familiar with non-surgical decompression however, may tell you that the segment is more solid after the fusion than it ever was before and decompression won’t cause any issues with the fusion itself.

OK, so, we’re stuck between two worlds on that and, honestly, if you’re an expert on this and you’re listening, email me at [e-mail] and tell me your experience and understanding.

After bouncing the problem off of several highly trusted colleagues, I think a light pull on decompression is tolerated just fine and does in fact provide relief to fusion patients. No, you cannot pull them at 1/3 or 1/2 of their body weight. We’re talking a LIGHT pull. This combined with gentle McKenzie and Core exercises as well as self-management recommendations at home will go toward getting them back on their feet and getting back after it.

If any of you disagree, I’d love to talk about it. My first question would be, “What would the alternative be?”

I am by no means the final and ultimate opinion on this. We have to depend on trusted advice and clinical experience, don’t we? That’s just what I do and what I’ve found is that about 80% of patients just get better. There’s about 10% that gets better but not quite what we hoped for. Then there’s that 10% that …”Hey, we tried and it looks like I’m not your homey on this deal.”

Now, what about the second option? Let’s say that they had a discetomy back surgery but it was a failure (surprise surprise) and now it’s up to us to help the patient and attempt to keep them from enduring any more back surgery or shots. What do you do? Maybe I should say, “What do WE do?”

I say adjust them!! After a certain healing time has passed, of course.

I say we do all the other stuff I mentioned previously for them as well. We may do decmopression. We may do laser. We certainly do McKenzies, Core Building, McGill’s Big Three, no bed rest, and home self-management.

If you have paid much attention to our previous episodes then you know the American College of Physicians and the global panel of experts on low back pain that published the low back pain papers in The Lancet back in March of 2018 say that spinal mobilization is a researched and recommended first-line therapy for acute and chronic low back pain.

In my opinion, a discetomy doesn’t change these recommendations much. Sometimes, cases are so specific, that they just don’t get researched in depth for that certain instance.

However, I CAN offer a case study if you’re willing to listen.

It was titled, “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report” and was published in the Journal of Chiropractic Medicine in the Summer edition of 2004(Estadt G 2004).

Why They Did It

To explore management of lumbar disc herniation following sugery using a regimen of chiropractic manipulation and exercise/rehab.

How They Did It

• The patient was a 54 yr old male
• The patient had a history of acute low back pain with left sciatic pain down the left posterior thigh and lateral calf as well as numbness inthe bottom of the left foot.
• The patient previously had steroid anti-inflammatory drugs and lumbar microdiscectomy surgery.
• The patient did not recover completely.
• The patient couldn’t walk without hurting and was unable to return to activities of daily living.
• He was antalgic in flexion.
• His lumbar range of motion was restricted in flexion as well as in extension.
• He had a positive SLR as well as foot drop on the left.
• Intervention consisted of patient education on posture, bending, and lifting.
• Exercise/Rehab was started in-office progressing to at-home based exercise/rehab.
• Active rehab was continued after early improvement (7 visits) in order to return lumbar spinal extensor strength.
• The patient was ultimately released to home therapy and supportive chiropractic care and continued to show improvement.

Wrap It Up

The author concluded, “Management of postsurgical lumbar disc herniation with chiropractic and active rehabilitation is discussed. Spinal deconditioning and weakness of the lumbar spinal extensor muscles appeared to be related to the patient’s symptoms. Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.”

OK, a case study with one subject. What does that tell us as far as research goes? Very little. What is the impact of the Journal of Chiropractic Medicine? It’s peer-reviewed and it has an impact factor of 0.74 and has climbed significantly since 0.36 in 2011.

Although this case study is only one patient’s experience, from my own anecdotal evidence, I would come very close to guaranteeing you and betting the farm that these post back surgery results can be repeated time and time again.

Although this case study is only one patient’s experience, from my own anecdotal evidence, I would come very close to guaranteeing you and betting the farm that these results can be repeated time and time again.

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I’ve seen it time and time again. My experience tells me we can help these people. YOU can help these people. Back surgery doesn’t always mean we are helpless to pull out the power of chiropractic.

I want you to know with absolute certainty that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.

We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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Bibliography

Estadt G (2004). “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report.” Journal of Chiropractic Medicine 3(3): 108-115.

CF 020: Chiropractic Evolution or Extinction?

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

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