Chiropractor Back Care of NYC

Certain neck, mid back, low back, or other spinal conditions respond poorly to conventional care.  One proposed theory for this is that, as a result of past or present injury, adhesions and scar tissue have built up around spinal joints and within the surrounding muscles and causes chronic pain.  Patients undergo various treatments, such as physical therapy, chiropractic care, epidural injections, back surgery, or other treatments that do not address fibrous adhesions. Some patients feel temporarily better with these treatments, but their pain often returns.  In general, patients selected for manipulation under anesthesia are those who have received conservative care for six to eight weeks. If limited or no improvements in symptoms or objective findings have occurred, then manipulation under anesthesia may be an appropriate alternative.  Prior to treatment, protocols of diagnostic testing should document the nature of the diagnosis, support the need for treatment and eliminate questions of psychosocial factors that can influence pain response. In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram or nerve conduction velocity test may be ordered.

anesthesia therapy include the following:

1.  Breaking up scar tissue (adhesions) both in and around the spinal joints, commonly   caused by multiple injuries or failed back surgery

2.  Decreasing chronic muscle spasm

3.  Overcoming hyper-sensitivity of injured areas that makes the patient unable to cooperate for effective treatment

4.  Stretching persistent shortened muscles, ligaments, and tendons

5.  Relieving pain and radiating symptoms from damaged intervertebral discs

In general, patients selected for manipulation under anesthesia have received a minimum of six to eight weeks of conservative care. Additionally, there are a number of specific indications and contraindications that need to be considered prior to undertaking manipulation under anesthesia.

INDICATIONS INCLUDE:

• Neck, mid back and low back pain
• Chronic muscle pain and inflammation
• Acute and chronic muscle spasm
• Decreased spinal range of motion
• Chronic fibrositis
• Nerve entrapment
• Pseudo-sciatica
• Sciatica where disc bulges/herniations
• are contained less than 8mm
• Failed back surgery
• Chronic occipital or tension headaches
• Conditions where narcotic pain relievers are of little benefit

CONTRAINDICATIONS INCLUDE:

Contraindication to anesthesia is determined by current medical literature and is the responsibility of the anesthesia department at the surgical center.  Specific contraindications to manipulation of the spine under anesthesia include:

• Malignancy or any metastasis to bone
• Tuberculosis of the bone
• Fractures including direct manipulation of old compression fractures
• Acute inflammatory arthritis
• Acute inflammatory gout
• Uncontrolled diabetic neuropathy
• Syphilitic articular or periarticular lesions
• Gonorrheal spinal arthritis
• Excessive spinal osteoporosis
• Evidence of cord or caudal compression by tumor, or by disc herniation beyond 8mm in lumbar spine & 3-5mm in cervical spine.
• Widespread Staph or Strep infections
• Infectious bone disease
• Signs of symptoms of aneurysm
• Bleeding disorders

The patient should experience an immediate increase in range of motion, even though there is usually some temporarily added muscle soreness similar to the feeling of having completed an aggressive exercise session.  In cases involving symptoms caused by disturbance from adhesions and shortened tissues there should be a significant change, either immediately or within a short period following the procedures.

In efforts to minimize the reformation of adhesions, passive manipulation and active exercises are prescribed.  Some use of additional therapies may also be prescribed, such as:

• Electrical muscle stimulation
• Ultrasound
• Hot moist packs
• Massage

The most important post operative care is an active rehabilitation program, starting within one to two weeks after the manipulation under anesthesia procedure and lasting for a minimum of four to six weeks.