Much more pain post spine decompression, why?

June 10, 2012 9:33 AM

Spinal decompression therapy - lots of pain/worsening symptoms afterward. Normal? What next?

Hi folks, this Q is for my wife. She has a lot of back pain, but never has had trauma like a car accident or anything. Hasn't done anything that really seems like it would cause it. She is 6' 1". Anyway, she had a bad flare up a few years ago, couldn't walk, stabbing pain in lower back. Got muscle relaxers, laid for a few days. Got better and stayed better.

Fast forward a few years until a few months ago. Lots of pain started again. Much much worse when sitting. She has to sit at her office job. She is also a child/wedding photographer, so lots of moving around. It kept getting worse, not debilitating like before, but pretty bad, especially stabbing pains down leg when sitting at her office. She started last week at a physical therapy/chiropractor place in the same building as her general practitioner doctor, who recommended this place.

He diagnosed her as having thin disks at L4/L5 and at L5/S1. He began decompression therapy, basically a big machine that gently pulls on your body. Session one created soreness, sometimes quite sore, but the back symptom that brought her there was lessened. Session two showed even more improvement. Some soreness and also a few bouts of the real back pain that brought her to the doc, but much less than in past days/week. Then on Thursday a nurse put her on some apparently slightly different machine that does one long pull, rather than staggered pulls. I don't know what these machines are called.

Thursday night she felt very strange/terrible. Almost a shock like feeling like after she did a marathon a few years ago. Friday, lots of low back pain, stabbing pain, pain down the leg. Saturday she HAD to shoot a wedding. It was one of the more tough things I've ever seen someone do. 12 hours. She did it. Had to be lifted into and out of the limo, yelled out in pain once during the shoot! Yike....

So today, she's in a lot of pain as one would expect. Real trouble walking, terrible pain getting into and out of car. She's basically disabled at this moment on the couch.

WTF! This treatment was supposed to help. And did at first . She is taking alleve and is very worried, as am I. She has to go to her office job tomorrow and really needs some muscle relaxers. We called this physical therapist/chiro's he just called back. Said it is a flare up, that muscles get fatigued from this process. Recommended we head over to urgent care to get some strong pain reliever/muscle relaxer/anti inflamatory and then to come in tomorrow to see him.

Has anyone else experienced problems with this type of therapy? Seems that whatever they did thursday caused a major flare up. We really need some answers!!!! Anyway, anyone's thoughts or experiences would be appreciated. Sounds like the chiro thinks this is just a bad flare up. It does seem like that is what it is...

posted by Salvatorparadise to health & fitness (19 answers total)

I don't think you should go back, find another doctor for a second opinion. I would not go to a chiropractor, this sounds beyond what they usually handle.
posted by meepmeow at 9:44 AM on June 10, 2012 [1 favorite]

She should really think about taking a sick day to go visit her GP. There are drugs that might help (my husband's dealing with a lower back disk flare up right now, and he's on methylprednisolone for a couple of days). And going back to the chiro seems crazy.

Stabbing pain down the leg is a bad sign.
posted by leahwrenn at 9:56 AM on June 10, 2012 [1 favorite]

her GP recommended this guy
posted by Salvatorparadise at 10:09 AM on June 10, 2012

Stabbing pain down the leg sounds like sciatica, and it could be that the trauma and inflammation caused by the new treatment puts pressure on the nerve. So it very well could be the case that in a few days she will feel much better as the inflammation subsides.

I think, though, that she should see a doctor who will give her an MRI so she can better see what is going on with her spine and sciatic nerve (if indeed this is sciatica, and this description sounds a lot like it is).

I have had debilitating sciatica and chiropractic treatment was next to useless for it. I had successful surgery. I have also had different types of back pain for which chiropractic treatment, including traction, has been very successful. You can expect that if she goes to an MD, the MD will be very hostile to chiropractic treatment. This is why getting an MRI can be really useful information. If the MRI shows an obvious impingement on the nerve, then medical treatment makes sense and the ability of the chiropractor to treat is limited. But it also could just be muscle inflammation causing this new discomfort and a prescribed anti-inflammatory and rest will be a big improvement.
posted by MoonOrb at 10:16 AM on June 10, 2012

again, her MD recommended this chiropractor and physical therapist. we just went to urgent care, she got a load of stuff. Major pain killer, major steroid, major muscle relaxer. Three different types of meds. She will be good to go in no time. We're going to insist on an MRI before going further with traction.
posted by Salvatorparadise at 12:41 PM on June 10, 2012

Seconding get another opinion, all caps. This isn't anything to mess with.

Anecdata: I'm confident to say that (my wife's) debilitating back pain (exactly the same general symptoms as you describe), in connection with some decompressing quackery, was ultimately what destroyed my first marriage.

(After getting off the decompressing machine, one day, my then-wife fainted in my arms. Not romantic. It took me an enormous effort to put her down without ruining her back even more, and mine to boot, and then we needed around three hours to get her from the floor on to a camping mattress.)

[This is not to say that these methods are always useless or anything. Who would I be to make such a claim? But the picture as you describe it seems to suggest that in your case something else needs to be done.]
posted by Namlit at 1:00 PM on June 10, 2012

Your wife sounds like me. I've been told that being taller than average (I'm just shy of 6' even) can be a contributing factor in women to back issues, especially in that area. I've had 3 back surgeries, due to Cauda Equina Syndrome. I have a congenital defect in that area of my spine, which makes the spaces in those disc areas very small, which makes me prone to massive herniation.

There does not have to be any indication of trauma to be in massive and intense pain. One of the things that was the straw that broke my back was simply getting out of a chair. If you are prone to issues in that area, you have a lower threshold for what will put you in pain.

Has she had an MRI? Been to see either an Ortho or Neuro doctor? I would get diagnostics before you go any further with treatment, as it could be making things worse, instead of better. I'm not a doctor, but it sounds like she has a herniated disc.

If she begins to have issues relating to her bladder or she loses feeling in her 'seat' area, please go to the ER immediately.

For me, surgery was my only option. But there are usually many other things that can alievate pain before surgery. Steroid injections, anti-inflammatories and other treatments are usually recommended before surgery.

And honestly? Her pain and the acute nature of her problems are probably not being helped by the Chiropractor.

Please feel free to memail me if you want to chat more.

I wish your wife the best, and tell her that she'll get through this. Rest, rest, rest as much as she can.
posted by carmenghia at 2:04 PM on June 10, 2012

PT here. MD-owned PT clinics are often not the best, as the MD benefits financially from the PT referral. In many states, physician-owned PT clinics (POPTS) are illegal for this reason. The questions I have: was it a physical therapist or a chiropractor who provided this treatment? Did a nurse provide treatment? It is not okay in most states for a nurse to be providing physical therapy services, and this is a big red flag for me as a PT.

I would find an independent PT who can evaluate your wife's symptoms themselves and provide a second opinion. The treatment you describe is not appropriate for all low back pain, and can, in some cases, make it worse.

There are board-certified specialist PT's, I would suggest finding an orthopedic specialist. They have the letters OCS after their name. Good luck, I hope your wife feels better.
posted by jennyjenny at 2:27 PM on June 10, 2012 [1 favorite]

Do some Googling into Spinal Decompression Therapy. My understanding is that it's not widely accepted by the medical community. There isn't a lot of literature out there in support. Plus it's usually exorbitantly expensive (not sure if that's the case with your wife's treater). In any event, I'd stick with more traditional and proven measures.
posted by Pomo at 2:45 PM on June 10, 2012

thank you everyone
posted by Salvatorparadise at 4:14 PM on June 10, 2012

My back issues were corrected by seeing a PT (physio is the term here). There was no decompression, no severe pain or lethargy or shocky symptoms. Months of exercises and stretching out my hip flexors (that was the cause of the limp and the hip/leg pain) and ultrasound therapy on the muscles of my back. 10 months or so of that fixed 10+ years of pain, restricted movement and occasional debilitating flare ups.

The one rule my physio had was "if it hurts, it's doing damage". So if the hip flexor started really hurting (not just stretching but pain) we stopped there. Or I stopped walking. Or whatever. I never came out of therapy in pain - sore and sometimes wobbly, but a fifteen minute walk was part of the recovery period. If I had gotten any serious pain, that was a sign to not do whatever we just did. Simple as that.

So please see someone else.
posted by geek anachronism at 4:48 PM on June 10, 2012

Those machines are pretty much quackery, and I'm aghast that her GP sent her to a chiropractor. For what the thing supposedly does, she'd be far better off simply getting an inversion bench and hang from it every day. But, it's still a temporary bandaid, as are her pain meds.

How did the GP diagnose her? Did he image her spine? If he didn't order imaging, he's just blowing smoke. Yes, it could be thinning discs. Or, she could have a full-blown herniation. Pain down the leg is nothing to mess with. She needs to see a neurologist.
posted by Thorzdad at 4:52 PM on June 10, 2012

What jennyjenny said. The whole thing sounds sketchy. I've also been a PT patient, and my experience was very much like geek anachronism's.
posted by moira at 5:13 PM on June 10, 2012

we're appreciating all this feedback. it can be very scary to have such pain, and it leads to desperation. and, we also came into this trusting docs. :(
posted by Salvatorparadise at 5:17 PM on June 10, 2012

Chiropractors often call themselves "PTs" or "physical therapists" without actually being licensed. Chiropracty is a "science"--it is not evidenced-based, regulated, or strictly controlled by a governing body. When the practice first began it was based in a lot of "woo science". An increasing number of chiros are now trying to follow evidence-based practices and get true medical training, such as obtaining a physical therapy degree (which is regulated and evidence-based). But you do not know what kind of chiro you're getting unless you know a lot of people who have used yours.

Sometimes there is soreness after effective chiro or PT sessions, but not like your wife is describing. She needs to see a different GP, as clearly this one is either ignorant of the quality of the chiro or not looking out for her best interests. If you can find a doctor who works with a lot of athletes you are more likely to find a quality PT--athletes are generally focused on not just achieving the bare minimum of recovery, but regaining full use of their body to continue playing sports. So the people athletes like are often the ones that are the best.
posted by schroedinger at 5:24 PM on June 10, 2012

Veteran of two disc surgeries here. Successful, I might add.

Stay away from the chiros. A good one knows their limitations, a bad one can really screw you up. Sounds like she needs to see a neurologist and have imaging done. I was able to stave off the first surgery by seeing an excellent certified PT, but eventually surgery was the only option. They were very conservative the first time around--perhaps too much so. The second time was the charm. Core body strength after is the solution to any more back pain.
posted by BlueHorse at 5:31 PM on June 10, 2012

just wanted to add;
there are reasons to get imaging like MRI and many reasons not to. Have your new doctor figure out if you really need it. Indeed, MRI is overused and leads to excess concern and excess surgery.
Don't trust me: read uptodate on it.
posted by dougiedd at 7:16 PM on June 10, 2012

Yeah, have to chime in to say it sounds like the pain I had when I had sciatica caused by a severely herniated disc. The only thing that helped (and I pretty much tried everything) was surgery.

Good luck to her.
posted by pyjammy at 8:03 AM on June 11, 2012

we made an appointment for a new family doc at a big, well respected local hospital system here in Central Ohio. She'll start with her new GP there, and go from there. They have a very big system that offers just about everything, including what is seen as the best surgery/medical center for spinal/neurological issues
posted by Salvatorparadise at 11:05 AM on June 11, 2012