A question we hear from patients who are about to receive an epidural injection for lower back and leg pain is “can I have chiropractic adjustments after the injection”? The simple answer is yes. The chiropractic treatment in concert with the injection may provide greater relief from lower back and leg pain. This article gives a brief overview of what an epidural injection for lower back and leg pain entails and the principles of how chiropractic treatment recommendations can be helpful in the resolution of the pain.
Why am I Scheduled for an Epidural/
You may be referred by your chiropractor or medical physician for an epidural if your lower back and leg pain (sciatica) has not been responding to the current treatment protocols, has reached a plateau or is getting worse. Various medical clinicians are able to perform the procedure. This includes but is not limited to pain intervention specialists, orthopedists, neurologists, neruoradiologists and anesthesiologists.
Conditions That May Respond to an Epidural
Conditions that are commonly treated include:
- Disc Herniation – neck, middle and lower back discs
- Spinal Stenosis – narrowing of the openings where the nerves leave the spine or the central canal where the spinal cord is located
- Synovial Cysts – small sacs of fluid in the joints of the spine
The benefits and risks must always be considered with an epidural procedure. Your medical pain specialist will inform you of the potential side effects. These can include the following:
- Puncture of the Dura or Covering Around the Spinal Cord – results in the “epidural headache”
- Damage to the Nerve Root
- Side Effects of the Steroid – anxiety, sleeplessness and increased localized pain
These side effects are very infrequent, but potential risks should be discussed with your clinician.
How Does an Epidural Work?
The steroid is injected along the inflamed nerve at the site of disc herniation. This helps to clean out the chemical irritation material contributing to the leg or arm pain. After the procedure flexion-distraction (F/D) chiropractic manipulation or adjustments can be helpful to the patient who has undergone this treatment.
Chiropractic Care Post Epidural
The value of chiropractic care after the epidural is to assist in moving the injected steroid material along the nerve root and reduce intradiscal pressure in the disc. After the injection begins to show a positive effect, the chiropractic adjustments improve the biomechanics and dysfunction of the area. The doctors at Coon Rapids Chiropractic Office utilize flexion/distraction adjustments for the care and treatment of post epidural injection.
- Cervical – Dr. Jim Brandt has published a case study in a peer reviewed, indexed open access journal. The case study includes successful treatment of disc herniation with arm pain.
- Thoracic – Middle back pain that may have pain radiating along the course of a rib toward the sternum or breast bone.
- Lumbar – Dr. Jim Brandt presented a case study at a national symposium on lumbar disc herniation and spondylolisthesis. The case study title is “Pain from Spondylolisthesis and Disc Herniation in a 37 year old Female Relieved with Cox Technic”.
Repairing the Injured Disc
The posterior wall of the disc where the herniation occurred may take a few months to repair and heal. There is a danger of reoccurrence when increased pressure or stress is applied to the disc. The tear in the disc will cause the disc material to extrude or leak out creating a new incident or relapse of symptoms. It is a goal of conservative management of the disc herniation to reduce the intradiscal pressure long enough to promote healing.Disc repairs can occur with implementation of the following:
- Decreasing the intradiscal pressure with flexion-distraction adjustment to the spine
- Proper exercise for strength and help in delivering nutrition to the cartilage, ligaments and disc material
- Lower back support or brace worn in the acute stages to decrease pain, help prevent re-injury and expedite patient reactivation to as normal a lifestyle as possible
There are 3 phases that patients experience with injury to the disc. These stages are:
- Acute or Inflammatory Stage – Doctors try to control the inflammation from the tissue injury and help with the repair or healing process. The first goal is to control the pain. This can take anywhere from a few days up to 14 days. The epidural may be recommended during this stage.
- Disc Repair Stage – Collagen or the material necessary to begin the repair begins within a few weeks and may continue for several months. During this period good nutrition and encouraging the good alignment of collagen with flexion/distraction adjustment will promote a return of disc strength and help prevent reoccurrence of the symptoms.
- Disc Remodeling Stage – This can last from a few months to a year or more. During this time frame the rehabilitation process and self-care protocols become very important for healing. Flexion/distraction adjustments help to promulgate the proper alignment of the collagen fibers.
Disc and Nutrition
Research has shown the importance of several nutrients for disc repair. These nutrients include:
- Glucosamine and Chondroitin Sulfate
- Vitamin C
The proper portions of nutricuticals are essential to maximize absorption and utilization. Some supplements may have an adverse effect, produce an allergic reaction or be contraindicated with current medication being taken. Ingredients from shell fish such as glucosamine or sulfur based products including chondroitin sulfate or manganese sulfate may be dangerous. Consult your primary care provider to be sure these products are safe to take.
If you have received an epidural and the inflammation is lessening, chiropractic adjustments help with the repair of the disc and assist with the remodeling process of the disc. Chiropractic care will include nutritional recommendations and exercises for building core strength. Recommendations for a return to work, recreation and normal activities of daily living will be outlined.
Dr. Ryan Brandt and Dr. James Brandt have experience in treating patients who have received an epidural injection for the symptoms of disc herniation.