Did you know that research finds that treatments like spinal epidural steroid injections can dramatically increase your risk of a spinal fracture?
These injections are very commonly used by pain management and other doctors to help people with spinal pain.
Each epidural steroid injection increased risk of a spinal fractures by 21% according to a paper published in The Journal of Bone & Joint Surgery.
This is a serious problem and a very high risk factor.
It can lead to much more pain, disability, and possibly even surgery depending upon the type of fracture(s)/breaks.
Even if it does not lead to surgery or even a fracture, the loss of bone strength now puts you at much greater risk of injury in the future particularly if you have some type of trauma like a motor vehicle accident or a fall.
We need to protect our bones and soft tissue by making them stronger, not weaker.
Bone fractures in the spine are the most common fracture in patients with osteoporosis. An estimated 750,000 people suffer from these painful, often debilitating fractures every year.
Age, in and of itself, leads to losses of bone and muscle mass.
About 40% of women age 80 and older experience fractures in the spine.
The added losses by having steroid injections puts you at much greater risk of problems with osteoporosis in the future as well as right now.
The reality is that at times these types of treatments may help people.
Here’s the big BUT though.
We should do all other more conservative treatment first because it’s safer and very likely to help you get better so you don’t need to do more aggressive, riskier treatments.
Understanding The Treatment Scale
The following is a list of the most conservative, least likely care to cause problems to the most aggressive, most likely to have complications and side effects in order of treatment options starting with the safest.
- Chiropractic, Massage Therapy, and Physical Therapy
- Over the counter pain relievers including ibuprofen, naproxen, aspirin, and tylenol
- Prescription medications that also have varying degrees of safety and risk (including NSAID pain relievers, muscle relaxers, oral steroids, and opiates)
- Various types of injections, including steroidal injections mentioned above
- Surgery
All treatments have some use. We recommend starting at the top of this list and progressively moving down as appropriate.
It’s important though to give each treatment enough time to work before jumping to a next treatment. All treatments take some time to help you.
Chiropractic Helps The Majority Of Spinal Related Pain
Spinal adjustments are one of the best ways to reduce your pain, improve your function, and improve your quality of life.
It makes sense to start with chiropractic care because very likely this will take care of the problem without medications, injections, or surgery.
This is generally true even if the pain is severe, if there is a nerve that is ‘pinched,’ with arthritis, degenerative discs, or disc bulges and disc herniations.
Chiropractors are very good at reducing pain (and improving function) BUT we don’t focus on improving pain. We improve the cause of the neck pain or back pain.
The cause of your pain can not be assumed just by looking at an x-ray or an MRI. Often an MRI may show a large disc herniation that is not really the source of the problem. The opposite is occasionally true where a small disc injury is causing major problems.
It depends.
This is why a good evaluation is critical.
The healthcare provider can not simply look at an MRI, tell you to touch your toes, and tap your knee to look at one reflex. It’s not enough to know what’s wrong.
The only way to know is to do a good functional exam looking at everything including the area of pain (but beyond this local area as well), the nervous system, the way you move, the way each individual joint moves (or doesn’t move), and much more.
Without looking at these other things, we can not know what is happening with you that is causing the pain regardless of the type of doctor or specialist that you see, chiropractor, MD, or surgeon.
Pain Is Related To Losses Of Movement
We’ve known since the 60s when pain researchers Melzach and Walls published their gate theory of pain that movement closes the pain gate.
Lack of movement allows it to open meaning more ‘pain’ signals reaching your brain.
Chiropractors are the undisputed champions of evaluating the movements, particularly of each of the small spinal joints of your spine joints that can lose their motion due to traumas and repetitive stresses.
*This is one difference compared to PTs/physical therapists
Other differences between PTs and chiropractors include that…
- Chiropractors have a greater focus on these small, often painful spinal joints and segments.
- Plus chiropractors use highly effective methods of manipulation/chiropractic adjustments to restore the movements.
- Chiropractors are licensed to diagnose your condition,
- Chiropractors can order tests, read x-rays, MRIs, and labs,
- Chiropractors do not need a referral from an MD to treat people.
- Chiropractors are able to evaluate, diagnose, and treat as necessary.
- Chiropractors also tend to look to address the mechanical dysfunction first before moving into rehabilitation because losses of motion can and should be better restored before trying to stretch and strengthen a dysfunctional joint.
This is even though physical therapy can be effective for many problems.
Abnormal Joint Movement and Biomechanics
Ultimately this can lead to pressure on discs and nerves leading to irritation, inflammation, swelling, and a lack of spinal motion leading to the pain gate being thrown wide open.
Medications and injections do not change the physical problem.
These medications are designed to chemically improve a symptom, not the underlying problem.
Chiropractic is recommended before moving on to riskier treatments such as spinal injections.
Reference
A Retrospective Analysis of Vertebral Body Fractures Following Epidural Steroid Injections
The Journal of Bone & Joint Surgery. 95(11):961–964, JUN 2013
Shlomo Mandel;Jennifer Schilling;Edward Peterson;D. Rao;William Sanders;
https://insights.ovid.com/pubmed?pmid=23780532
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