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Not all advice on the Internet is worth taking…

On the Internet, such as on About.com, you can read advice from professionals, experts, and even people who have no idea what they are even talking about. This is good or bad depending on what the advice is. If it’s about your health it is important to focus on good advice and avoid taking bad advice.

On the About.com page a Medical Doctor advises on what you should and shouldn’t be treated by a chiropractor for. Things NOT to go to a chiropractor with include:

  • Back pain with associated leg pain
  • Numbness or tingling in the legs
  • Weakness of the muscles of the legs

Now…some of that may be potentially good advice, but much of it isn’t good advice. Let’s take it from the top:

Back pain with associated leg pain, commonly called sciatica, can be caused by much more than just nerve pressure from some sort of scary spinal problem. Back pain with associated leg pain can be caused by piriformis muscle spasm, SI joint fixation, lumbar or sacral sprain, lumbar spine misalignment, prolonged slouched or seated posture, actual sciatica caused by either arthritis/bone spur OR disc deformity/herniation or multifidus muscle strain, or annular fiber inflammation, or vertebral subluxation, or hip dysfunction, or PLL microtears, etc etc…I can list probably ten more things but you get the point.

All of those painful sounding things I just listed are things that can cause back pain with associated leg pain. All of those things are issues that an interested chiropractor can treat. Some of them may require co-management with other doctors, maybe consultation with other specialists like a neurologist, physical therapist, or an orthopedist. But nearly all those conditions I listed above are capable of being self-limiting (meaning, essentially, that the patient will “get better” without treatment of any kind as long as re-injury or exacerbation is avoided). Not treating isn’t advised, but I use that point to illustrate that these aren’t conditions you should be NOT seeing a chiropractor because of. Heck, many of them will seem to “go away” on their own. Not all of them, but many.

People who heed About.com‘s advice should recognize that there is such a thing as opportunity cost. That means all decisions have a cost that includes the cost of not choosing another thing. If you spend 6 months going through the medical whirlpool and seeing ten different people, all who recommend drugs or surgery, then there is a likelihood you will get scared out of your mind and prematurely poison yourself with drugs unnecessarily or subject yourself to surgery when you could have easily avoided it. Research shows that going to a chiropractor vs. going to an orthopedist with back pain strongly influences whether or not you end up getting spinal surgery. Obviously, do not limit yourself to working with people who are predisposed to view people as surgical candidates. Hammers see lots of nails when they look around. It is also smart to not look into all the invasive stuff first because that probably won’t instill much hope in you as far as recovery goes. Thinking about surgery is detrimental to your health if you do not need surgery, and that thinking will undoubtedly cause you to fail at conservative approaches such as increasing your activity level, seeing a personal trainer, or getting your back adjusted by a chiropractor.

If you have what you consider bad back pain with associated leg pain and you are contemplating surgery or chronic drug use, and you HAVEN’T come to our office and given us a try, then you should probably think long and hard about trying chiropractic. And HEY, to be clear and honest, choosing chiropractic carries an opportunity cost, too. You delay possibly much-needed surgery! Sounds scary, right? It does, and you are in pain, so by all means be scared for a moment. But don’t let your fear make your decision for you. Think soundly and rationally and then make your choice. You can try coming to Park Bench and seeing if we can get you back to your old self, and if we think you are in need of surgery then we will tell you upfront or as your case unfolds whether or not you should get a surgical consult or consider more invasive options, or if you should try something like acupuncture, massage, or a personal trainer. We can and will direct you to those other professionals if we think you’d benefit from it.

Many of those conditions above, in fact ALL of them, will quite possibly be OK with conservative treatment. For example, PLL microtearing isn’t something you can do surgery on, or would want to. It’s a mild sprain of a large spinal ligament that will cause significant pain and dysfunction in the short-term but unlikely to have much of any long-term problem. If you continually tear the PLL then your spine will be in bad shape as you get older, but one untreated episode won’t sideline you for very long. Like any sprain proper rehab is important, and when it comes to ligaments like the PLL the rehab involves controlling inflammation and using the ligament fully as it heals by having that area adjusted and ensuring normal full joint motion. Piriformis syndrome, SI joint, subluxation, misalignment, annulus fiber inflammation…all of these things are things that will respond just fine in nearly all cases with conservative chiropractic care. There is truly no need for a medical doctor to provide what a medical doctor can provide these cases, unless you want prescription pain medicine. As far as advice on exercise or posture or spinal health, do not look for much of that from your MD, but do expect it from a DC. Nothing against the MD’s of the world, they are way better at what they do than we could ever be – DC’s just aren’t trained and experienced at doing typical primary care provider stuff. But when it comes to physical health a typical DC knows much more and can provide much more treatment than an MD can.

Now, there are some causes of back pain with associated leg pain that may represent serious and dangerous underlying conditions, but those instances are rare. Things like cauda equina syndrome, spinal cord impingement or possible cancer/tumor, and spinal fracture can all be ruled out with a few simple questions and any chiropractor can recognize and handle these emergencies. In cases in which the differential diagnosis includes those scary things we will consider the possibility and order additional imaging or testing is such a thing would be prudent. All those things are real emergencies and you would literally witness me call the ambulance for you while you sat in my office if I thought you had an unstable spinal fracture or cauda equina syndrome. X-rays can be ordered and fractures, cancer, or tumors can be ruled out. I am sure MD’s are as good at DC’s in recognizing these things, and it’s unlikely that you have one of those conditions, anyway.

As for numbness or tingling or weakness in the legs, that can result from a lot of the things I listed above, also. They can also represent serious underlying conditions, but are quite unlikely to. Chiropractors routinely treat those conditions I listed a few paragraphs up, and the likelihood of your problem being one of the uncommon and dangerous emergencies is pretty miniscule, so you would be irrationally discounting chiropractic and missing out on that option if you were to take the advice of the M.D. in this About.com article. Often, the numbness and tingling is just “sciatica”, and if there is weakness it is more likely because it hurts to use the leg muscles because your back is a wreck. Weakness caused by pressure on the spinal  cord or severe herniations (sequestrations) or numbness in the groin with altered bowel or bladder control is easy to ferret out by asking questions or examining the patient. If you have trouble controlling your bladder or bowel since your back issue started, or if your groin or “saddle” area is numb, or if you wake up at night sweating and in pain that isn’t relieved by medication, then we will rule out scary stuff before or as we proceed with your case. But, again, these are relatively rare problems, extremely less common than sciatica or muscle spasm.

And that is why not all advice on the Internet is worth taking. Whether starting with a MD or a DC for your back pain with associated leg pain, or numbness and tingling, or even apparent weakness, you should be careful to think about how your treatment plan will end. Will it end with surgery, or long-term drug use, or will it end with you feeling just fine? Both your MD and your DC may be capable of guiding you to feeling better without surgery, but one of those two is specially-trained to do just that and the other has very little interest in the spine, almost no practical experience with a detailed physical examination of the spine, and has no treatment options for you other than referring you out or giving you medication. And when they refer you after the medication fails to fix your physical problem, will they refer you for a course of supervised exercise at a PT office, or for a neurological or surgical consult? Will they refer you to a chiropractor – I hope so!

ULTIMATELY, the path that you should be taking is this:

CONSERVATIVE CARE –> MORE INVASIVE OR DRUG-BASED CARE –> SURGERY

All providers agree with that, from PT’s to MD’s to Orthos to Neuros. They all agree. It is a well-established guideline that is obviously the best way to go for all non-emergency cases.

The definition of the term “conservative care” can be debated, but it encompasses all non-opioid medications and all non-surgical treatments. In other words, Tylenol or Motrin can be considered conservative, as can physical therapy or chiropractic or massage or acupuncture or exercise. Once you start using strong or addictive painkillers, sleeping pills, muscle relaxers and things like that you are no longer utilizing conservative care. You are supposed to start with conservative care and only when that fails do you progress to the more intensive options. Only when those intermediately intensive options fail do you consider surgery.

So, where are you on that pathway? Have you honestly tried conservative care? Have you been honest with yourself at increasing your activity level if you know full well that you lay around too much and don’t take physical care of yourself? Those are the foundations of conservative care, and chiropractic can strongly complement that foundation.

If you followed About.com‘s expert advise you will probably end up skipping chiropractic care entirely because going to your MD means going somewhere that doesn’t specialize in conservative care in the first place. Most back pain with associated leg pain, or associated numbness or tingling, and even apparent weakness, is NOT an emergency and your experienced chiropractor has probably seen dozens and dozens of similar cases, the large majority probably ending quite well without surgery or drugs.

Since this article is all about not taking all Internet advice on health as quality advice, you should of course feel entirely welcome to disregard everything in this article and go hit up Google and do your own thing!