So this is just one example that I tried to make a very important point that for any doctor to determine what is the best scenario to deal with a goal, nagging low back pain, he/she will need to conduct a detailed patient history followed by a focused physical examination in order to attain a complete understanding of its exact precipitating factors and root cause.
Then and only then can possible remedies and recommendations be entertained. I hope this will shed some light to your question.
Essentially with Gout, a modification in your diet and a keen awareness of certain triggering foods will typically keep the condition from propagating to a severely symptomatic situation.
With that being said, you must understand the fact that their are "bad apples" in every profession. With my 20 plus years of experience in this field, I can confidently state that not all chiropractors are top tier doctors in providing relief of back pain. However, that is not to say that we are not the most well trained to manage such a situation because we are!
You just have to be extremely diligent when researching the specific educational background, amount of training/experience and previous work history when trying to find the best doctor of chiropractic to manage your condition.
Another possibility that is quite common cause of knee pain is "shin splints" or a strain of the Tibialis Anterior muscle. This condition is also exacerbated by walking long distances, running, walking up and down the stairs.
So the treatment would absolutely be dependent on the definitive diagnosis. If the diagnosis is indeed Osgood Schlatter's disease, then the recommended treatment multi-dimensional (supportive, RICE-Rest Ice Compression & Elevation, NSAIDs and a Podiatric referral is absolutely warranted).
If however, the diagnosis is Shin Splints, then the treatment would be:
1) Education to avoid all aggravating factors to allow the injury to heal in the shortest amount of time possible.
2) Hydration to allow the muscle cells to function at its optimal capacity.
3) Rest as only time will allow this muscle to regenerate.
If the condition is due to a strain of the Anterior Cruciate ligament or the Medial Collateral ligament (the most common cause of organic knee pain), then an MRI is warranted to determine the extent of damage, thus allowing the practitioner to make the clinical decision accordingly.
**NOTE: In many of my previous cases of non-organic/pathologic causes of knee pain that is misdiagnosed as a ligament strain issue when in reality, it is almost always due to the compensatory muscular hypertonicity of the Vastus Medialis muscle insertion. This can often lead to generalized knee pain in a young healthy adult.
-If this happens to be the case, I would locate and carefully palpate the insertion and the belly of the muscle to check for it's resting tension.
-If it happens to be increased, then a technique termed, "Active Release Technique" when done properly would always resolve the patient's knee pain instantly. This technique has also been proved to be very effective in tendonitis cases as well.
Think of it this way, when you have a network of physician's all working together for a common goal which is much better as opposed to when you only have one particular type of physician. Like the old saying goes, "2 heads are better than 1." In the situation that I'm envisioning, 3-4 heads is much better than 1.
And so for your 5 year old, the answer would be absolutely yes that a chiropractor can be of help to your child but it would be of great benefit to your child if the chiropractor that you chose would be open to referring you to physician's in the other musculoskeletal disciplines to provide the best care for your child as possible.
Also, be wary of the chiropractors that are not keen enough to consider the immaturity of your child's musculoskeletal system and they just get your 5 year old into different positions and start torquing that body into different contorting positions. That is not my philosophy as to how I would go about treating a young child.
Personally, with a keen understanding that until the child's growth plates are closed, than your child's musculoskeletal system is considered to still be growing and immature. That means that it is not all completely calcified into bone. Especially in a 5 year old, there are many portions that are still cartilaginous that are maturing into calcified bone.
When one start messing with a child's maturation of their musculoskeletal system by manual chiropractic manipulations, there's a possibility that the chiropractor can stunt the growth of the child. So how would I go about with my manipulation of this 5 year old?
It has been proven that with application the "Activator technique" on the lowest setting, that this particular technique the most non-invasive, however it is also he most efficient method to manipulate the subluxated segments back into its normal resting position, thus allowing for the maximal nerve supply to the cells and tissues thus maximizing the overall musculoskeletal homeostasis and allowing for the child's optimal growth.
1) My question to you is, where is the exact location of your pain your pain?
2) Is your pain located at the FRONT PORTION of your ankle?
3) Did the pain arise gradually over time or or was the onset of your pain more sudden? Does any activity with prolonged weightbearing always bring on the pain?
4) What are the factors that bring on the pain? What have you done to find relief?
5) Have you ever experienced any similar incidence prior to this episode?
6) Is it affecting only one side or is it affecting both sides?
7) Is the pain localized to one specific area of the foot or does it radiate to another area causing a generalized pain and tenderness?
8) In your own words, how would you characterize the pain that you are experiencing? This is a very important question because the different foot disorders all have their specific character of pain.
9) Does it hurt when you attempt to flex your foot upward towards your shin?
10) Have you noticed any signs of acute inflammation? Redness, painful to touch, warmth over the area of involvement and swelling.
These are some of the more important questions that I would ascertain prior to arriving at any definitive diagnosis. Certainly I would have a small list of differential diagnosis as a possibility, which would include:
1) Plantar Fasciitis
2) Tibialis Anterior strain
3) Achilles Tendonitis
4) Premature Degenerative Joint Disease of the Foot
5) Posterior Tibial Tendonitis vs. Anterior Tibial Tendonitis
After ruling out all of the other common causes of foot and ankle pain in which I would rule in only one to arrive at a definitive diagnosis, depending on which one it is, then I would plan and treat the condition accordingly.
Let's just say that the diagnosis of Anterior Tibial Tendonitis is correct for education sake. Understanding the fact that patients with "high arched" feet are more prone to suffer from this particular condition then a custom foot orthotic would certainly serve to benefit you to find relief. If that is not sufficient then a walking boot is the next option.
If, however, neither of these options are helpful, then a Podiatric consult or a Surgical consult would be warranted for sure.
Are you a diabetic? Is the symptom on one side or is it on both sides? Do you have any back pain. Have ever been diagnosed with the Herpes virus. Sometimes, a space occupying lesion can cause paresthesia when it encroaches on the brain or spinal cord so a CT scan and/or MRI would be crucial in the diagnosis.
And finally, nerve compression syndromes, for example, Meralgia Paresthetica is a common cause of unilateral anterolateral thigh paresthesia due to the entrapment of the Lateral Femoral Cutaneous nerve. So this is the reason why the history and exam is crucial in answering this question in better detail.
Also, a radiographic examination of the foot is also important to rule out an arthritic condition which is a common cause of ankle pain.
A shoulder radiograph would provide some information as to determine if there is a structural cause of the imbalance. Correction can only be made when the root cause is detected. If it is a muscular issue, then exercises (stretching and strengthening) would be the best answer. If the cause is due to a bony defect, then a surgical option must be ascertained.
So with my background and training, I can answer this question without any preconceived notions and/or biases.
How would I personally approach this case? Well for one, I would ask your father how long has he been experiencing this back and hip pain. With his pain, what has it limited him from doing? Is he bedridden? Is he able to perform his normal activities of daily living without any issues or problems. Has he attempted to explore any alternative form of therapies such as chiropractic, physiotherapy or acupuncture? Would he like to entertain the possibility of giving one of these form of alternative form of therapy a try?
If he is all in with chiropractic, then, I would perform a thorough history, a complete physical examination and an x-ray of the Lumbosacral region to determine the extent of structural damage and also ascertain if he need a more detailed examination such as an MRI of the same region.
Depending on those results, I would prepare a "Review of Findings" with the patient. A typical R.O.F consist of 4 important aspects:
1) What is the nature of the condition and extent the extent of the damage.
2) What are your father's options? Both with traditional and alternative treatment. What are the pro's and con's of each?
3) The length of the treatment plan? Including the realistic timeline goals.
4) The cost of therapy from the initial consult to the final examination.
Then, I would leave it up to the patient to make an informed, educated decision as to what would be best for him,
The treatment of this condition for an older age female would be to adjust the rib that has been subluxated. For the pain, I would recommend a mild Non-steroidal anti inflammatory, such as Ibuprofen However, due to it's chronic effect on the liver, it must be taken cautiously. Then, for stability, I would recommend wearing some type of corset or brassiere to prevent further subluxations of the rib.
1) Start by sitting on your seat with you feet comfortably planted on the ground shoulder width apart.
2) Then feel the small of your back, while contracting your abdominal muscle, consciously push in the small of your back while you're feeling the curve of your lumbar spine increase. Hold that position for one to two seconds, then release.
3) Perform this exercise periodically throughout the day while your in the sitting position. Over time, you'll begin to experience an improvement in your overall posture. A decrease in you low back pain.
Also, postural-wise, I would educate my patients regarding avoiding acquiring, "Upper Cross Syndrome". That is the very common slouched forward upper extremity posture due to the imbalance in hypertonicity of the Pectoralis and Anterior Deltoids musculature as opposed to the weak, laxity of the Posterior Deltoid, Posterior portion of the Trapezius, Supraspinatus and Rhomboid muscles in the back.
the remedy for this condition is to decrease the hypertonicity of the anterior muscular structures and strengthen the posterior muscular structures to create a more harmonic relationship and a better symbiotic relationship between the agonist and the antagonist structures.
I've been suffering from scoliosis since I was 19 years. I am now 32 years old. Will this problem be corrected with surgery?
Depending on the angle, this will essentially provide the practitioner as how to proceed. A Cobb angle of 10 degrees or less is always considered mild and would be a great candidate for strictly alternative therapies (chiropractic, physiotherapy and/or acupuncture). Cobb angle between 10-15 degrees is also a candidate for alternative therapy, however, the practitioner may want to consider an Orthopedic consult depending the the rate of progression over time, the character and frequency of symptoms. If the Cobb angle is greater than 15 degrees, this is an absolute indication for an Orthopedic consult because it is possible that the curvature is severe enough that it will start to impinge on and affect certain internal organs.
For example, if it is a mid thoracic scoliosis with a Cobb angle of 22 degrees, the thought is that it could theoretically affect the lungs. And so the typical patient in this situation could present with dyspnea with or without exertion, shortness of breath and cyanosis. If the scoliosis is in the lumbar region, the areas of concern would be the kidneys, liver, intestines and reproductive organs.
So, it all depends on the Cobb angle and the only way to appropriately arrive at the correct angle is via a standing scoliosis screening x-ray.
1) Education level
2) Professional background, experience and level of training
3) Look inthe more common social media platforms and research to see if the doctor has a professional facebook profile, linkedin profile and/or any of the other social media outlets.
-Sometimes, you'll have access to their Curriculum Vitae which essentially is a complete resume of their educational and employment background.
-This will give you a better understanding of the overall history of the doctor and give a you a piece of mind knowing that you are trusting your health and livelihood to a person who is qualified to provide you with the best service possible.
The second time that you should undergo an X-ray is during the re-evaluation to document your progress in response to the treatment protocol. From my experience, this should be at a minimum of 4-6 months from the initial radiograph and that is basically it. At no time should you have to undergo 5 set of radiographs in a span of 2 months. No, no and no!
To say that the radiation can definitely lead to problems in the future is not accurate at this point in time. It could, however it is a bit premature to ascertain such a statement. However, the likelihood of your chances of having a sequelae in the future from this incident is definitely increased. I can make that statement with confidence.
Also, the skill, knowledge and experience of the person taking your radiographs is a significant factor. Were the settings correct? Did he/she use the proper shielding? Does he/she know how to interpret the charts when making their determination as to the setting to be utilized? All of these play an important role in shooting a high quality radiograph and thus minimizing your exposure to radiation.
I would also think that if you continue to go to the same physician that overexposed you to those X-rays, I would be confident in saying that your back pain would deteriorate and worsen with time. The reason being is that in my 25 years plus in the healthcare industry, I have never been associated with a physician who would do such a thing or heard of such an instance where this would be the case.
With that being said, I would not be confident in thinking that this particular physician would be skilled enough or have the knowledge to properly address your health concerns.
First, what is the age of your husband? Is the bone growth at his ankle the only site of involvement? Has he ever been diagnosed with Gout? Is there anybody in his immediate family afflicted with Gout? Where exactly on his ankle is the growth? Does his symptoms intensify with consumption of red meat, wine, cheese or any other particular food?
A focused examination of the site of involvement and an X-ray of the growth is warranted prior to making any treatment decision to remedy his situation.