Advanced Physical Medicine specializes as Chiropractors of Spinal Rehabilitation in Gilbert Arizona. The restoration of spinal form and function is a complicated process. It is not just one protocol for temporary symptom relief, but a systems approach to achieve a long-term and positive result. Injuries and/or displacements of the spine require special treatment and in the proper sequence to restore the spine’s form and function. The role of water intake, supplements, warm-up stretching exercises, force-over-time traction, and isometric-demand exercises, as well as the use of controlled vibration in modern treatment, cannot be refuted. Individual therapies used by themselves are of little benefit in restoration of spinal soft- and hard-tissue form and function in the spinal screw matrix closed kinetic system. Therefore, understanding and using proven protocols is appealing.
Tragedy in the Operating Room
The importance of using non-invasive correction of spinal form and function before resorting to surgery is evident when considering the following statement from orthopedic surgeons, Anthony DePalma, M.D., and Richard Rothman, M.D., Ph.D., Professors of Orthopedic Surgery, Jefferson Medical College, Thomas Jefferson University. They state: “No operation in any field of surgery leaves in its wake more human wreckage than surgery on the lumbar discs. The situation becomes even more pathetic in the realization that at the start, in most instances, is a healthy, self-sufficient individual. Many of these patients are subjected to numerous operations, and after each operation the patient is worse.”
A randomized trial,32 published as “Surgical vs Non-Operative Treatment for Lumbar Disc Herniation,” states, “Lumbar discectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the effects of the procedures relative to non-operative care remain controversial.”
Value of Muscle Rehabilitation
Before launching directly into proven non-invasive correcting procedures, we will first look briefly at a study on lumbar multifidus muscle changes and the role these muscles take in the processes of spinal displacement, rehabilitation, and correction.
A study of the correlation between magnetic resonance imaging (MRI) changes in the lumbar multifidus muscles and leg pain, reported in The Journal of Clinical Radiology,15 was conducted to investigate the relationships between lumbar multifidus (MF) muscle atrophy and low back pain (LBP), leg pain, and intervertebral disc degeneration. In the assessment of the lumbar spine by MRI, changes in the paraspinal muscles are frequently overlooked.
A retrospective study of 78 patients, aged 17–72, presenting with LBP with or without associated leg pain was undertaken. The MRI images were visually analyzed for signs of lumbar MF muscle atrophy, disc degeneration, and nerve root compression. The clinical history in each case was obtained from case notes and pain-drawing charts.
The results of the study showed that MF muscle atrophy was present in 80% of the patients with LBP. This correlation between MF muscle atrophy and leg pain was found to be significant. However, the relationships between MF muscle atrophy and radiculopathy symptoms, nerve root compression, herniated nucleus pulposus, and number of degenerated discs were statistically not significant.
The study concluded that, when looking for atrophy of MF muscle when assessing MRI images of the lumbar spine, the examination of paraspinal muscles should be considered. This may explain the referred leg pain in the absence of other MRI abnormalities.
Remember, the global spine and spinal unit, rather than segmental displacements, are the real spinal displacement complexes. They cause:
• Nerve root compression.
• Hypo-mobility, especially of the lumbar spine, with eventual hard- and soft-tissue pathology. This leads palpation examiners to believe segments are fixated.
• Change of fast-twitch phasic muscle fibers to slow-twitch, especially of the multifidus muscle on the convex side of the subluxation configuration.
• Atrophy of muscles, especially the multifidus on the concave side of the spinal subluxation configurations.
• Normal spinal motion is coupled; that is, lateral flexion and rotation occur as one motion. The multifidus muscle is both a powerful flexor and rotator of the spine.