It’s Only Natural

Chapter III:

The Low-Back Syndrome

When I first graduated from The Western States College of Natural Medicine some forty-seven years ago, I had planned to devote most of my practice to nutrition, the use of herbs, homeopathic specifics, and the counseling of marriage and sexual difficulties. Owing to its proximity to my home, I established my first office in one of the suburbs of Seattle, Washington. Most of my patients were teamsters or aircraft workers, or were employed in local shipyards.

Many problems brought to me by this hard-working group of people centered on the low back. These low-back problems, and other difficulties related to it, composed well over half my early practice. Because a fledgling physician can't pick and choose his patients, to subsist it was necessary for me to develop methods to correct this distressing orthopedic difficulty rapidly.

Although I was a trained and licensed chiropractor as well as a naturopath, I soon discovered there was much more to these low-back problems than mere adjustment. Not only was it imperative for me to correct these difficulties in order to build a successful practice, but it was also necessary to do so as rapidly as possible and with an absolute minimum of time loss for the patient. Most of my patients lived from pay check to pay check, and even a few days off work could materially upset their budgets. Therefore out of pure necessity for my own survival, I was forced to develop methods of treating this common and agonizing problem with speed, yet at the same time keeping the patient ambulatory and productive.

The low-back syndrome, and in particular sacroiliac slippage (subluxation, dislocation), is not only common in those doing heavy labor, but is also one of the most common and often ignored conditions that can beset all of us. It wasn't surprising therefore to find when we started the Healing Research Center that while our patients now came from all walks of life, a very high percentage of them, at one time or another, were afflicted with this rather troublesome disorder.

The ramifications of this difficulty extend well beyond a simple backache. I find that the sacroiliac slip is capable of initiating many other reflex symptoms apparently unrelated to the low back. In fact, a good third of all these patients have symptoms that occur in some apparently unrelated portion of the body. Even a casual listing of these must include such conditions as enigmatic headaches and neck difficulties, tension in the upper shoulders, stomach upsets, hernia-like pains in the groin, shooting pains down the leg, knee difficulties, and pains in the feet and ankles.

Menstrual difficulties in puberty and in the immediate post pubertal period frequently are complicated by this condition, and the menstrual problems almost invariably improve once the sacroiliac distortion is corrected. In many of these patients with discomfort in a part of the body other than the low back, previous practitioners have rarely corrected the sacroiliac subluxation. Usually only the symptom area was treated, and thus only partial success was achieved.

In the earlier days of medicine, syphilis was known as the great masquerader-it could cause a great variety of symptoms and physical abnormalities, and it took an astute physician to find the true cause. Today, the sacroiliac distortion can act in the same manner. This slippage is so common that one of the first physical checks we make on any patient, no matter what his difficulty, is to ascertain the integrity and mechanical functioning of these joints. If this area is in subluxation, all other work the doctor may do for his patient will fall short of his desired expectations until this infirmity is properly corrected and joint stabilized.

The pelvis is made up of three bones-two large ilia (singular, ilium) and the sacrum (Fig. 1). The following relationships are important to our subject: The spine, and therefore the whole of the trunk of the body, sits on the sacrum. Each ilium articulates with the sacrum, one on either side, in a joint that is more dependent on the integrity of the ligaments than on any bony apposition. The femur (upper bone of the leg) articulates on each side with the corresponding ilium in a socket called the acetabulum. The two ilia meet in front at an articulation (joint) called the symphysis pubis, which is a simple butting style articulation and is also supported mainly by ligament structures. The interrelation of these various structures and its importance to anyone with a low-back problem will be made apparent shortly.

The classic subluxation of this area is a slipping or sliding of the ilium on the sacrum, upward or downward, and either one side or both (Fig. 2). There are theoretically eight possibilities for movement in this area, although, in practice, two of these account for most of the difficulties. Either ilium may move upward or downward on the sacrum. The left ilium may move upward while the right ilium moves downward, and vice versa.

The most common subluxation occurs when one ilium moves upward or downward. If the situation remains for more than a few days, the ilium on the other side will usually move in the opposite direction because of the instability produced by the first subluxation. The situation in which both ilia move either upward or downward is uncommon, although it does occur and can often make diagnosis very difficult unless the physician is aware of its possibility.

Now let us examine why such displacements occur and what consequences may attend their occurrence. Many investigators of the body's mechanical integrity believe that the sacroiliac articulation was formed when man began to walk upright; the horizontal position of this joint in lower animals rarely causes difficulty. Although I don't entirely accept this evolutionary explanation, I agree that the sacroiliac is more susceptible to strain and subluxation than any other joint in the body.

We have here two bones that are seemingly slapped together and then surrounded by strong fibrous bands (ligaments) to keep them in proper alignment. On top of this, the joint is located in an area where it is subjected to almost constant strain, even in an only moderately active person. As long as the ligaments remain firm and taut, however, the joint is still serviceable; but if these fibers lose some of their integral strength, the joint becomes most susceptible to slippage and subluxation. Luckily within the past few years, we have discovered certain nutritive elements that can help sustain and rebuild this ligamentous integrity. Thus, it is now possible to stabilize sacroiliac joints that were once overly susceptible to subluxation.

The sacroiliac problem usually doesn't arise from heavy lifting, but rather from twisting or turning motions. When the body is in this position, the sacroiliac joint is opened slightly, one set of muscles pulling on the ilium, while another pulls on the sacrum. If at this time movement is made in just the right manner, the sacroiliac joint will slide. If the slide causes impingement on a nerve, pain can be almost instantaneous. Such pain usually occurs as a dull aching sensation in the low back, on the side of the slippage. It may occur as a pain radiating down the back of the leg (sciatic nerve) or around the side and to the front of the leg (anterior cural nerve). The patient may actually hear a click when the joint slides, or there may be no noise sensation.

Although pain may occur with the movement of this joint, it is possible for the joint to move in such a manner that no nerve is impinged on. In this situation, the person does not usually know when the slippage takes place. Later in the day, he may begin to notice some sensation in the back or in the leg on the affected side. This sensation usually manifests itself as a vague uneasiness in the hip and low back. Numbness or mild tingling down the leg may occur along the nerve pathways already described. At times the condition may not be noticed until the patient attempts to rise from a sitting position, only to find that his back is stiff and must be "loosened" before he can move properly.

The extent and intensity of the symptoms can vary widely from one patient to another, even though the basic subluxation is the same. Some patients are in such severe pain that they can't move from a reclining position without great difficulty. At the other extreme, some experience only a slight discomfort that seems to leave after a few days, only to bother them occasionally if they place a mild strain on this part of the back.

Those with more severe pain are the luckier of the two; they are forced to seek professional help and seek it rapidly. If they are attended by a man trained in manipulative therapy, their condition should respond to his help, and they'll be back in shape shortly.

On the other hand, if they seek help from one not so oriented, rest and muscle relaxants usually are prescribed. This in time will relieve the acute inflammation and enable them, after a somewhat longer period, to return to their regular activities. They'll find, however, that they're constantly having some low back difficulty on the side of the slip that will continue until they consult someone versed in correcting the mechanical slippage.

Of patients who have moderate difficulties from this subluxation, some will seek professional manipulative help and overcome their difficulty, but many will undergo no treatment or ineffective treatment, remaining mildly aware of a "weakness" in the low back. We often discover this type of patient during an ordinary physical examination. Frequently they have completely forgotten when or how the original injury occurred. Many have come to accept the residual pain and stiffness as a sign of aging. Strange to say, I hear this same remark even from some patients in their 20s and 30s. Most of these patients respond rapidly to manipulative therapy and are very pleased to find that their so called aging aches and pains are nothing more than a simple misaligned sacroiliac.

At this point, I'd like to explain just exactly why I called this condition "the great masquerader." When a sacroiliac articulation becomes subluxated, there is a tilting of the base of the sacrum (Fig. 3). This in turn causes a lateral bending (scoliosis) of the spine. If the sacroiliac subluxation is corrected within a few days of its original occurrence, or at the most a few weeks, the spine will return rapidly to its normal position and there will be little difficulty beyond that manifested in the low back itself.

On the other hand, if the subluxation persists, as it so often does, the spine in time must compensate to correct for this tilt because the balancing action of the semi-circular canals in the inner ear requires that the head be carried vertically or the person feels unstable. If the base of the spine is tilted, the only way the head can be carried vertically is for other portions of the spine, particularly the lower cervical (neck) and upper thoracic area, to tilt in the opposite direction. When this occurs, it is very easy for abnormal nerve pressures, muscle spasms, and tensions on affected ligaments to produce symptomatic problems in the shoulder, upper back area, and neck. Frequently these will reflex to cause headaches that don't respond readily to ordinary forms of therapy.

It is often their neck difficulties and/or headaches that finally bring the patient to our office. Upon examination we find our old friend, the sacroiliac subluxation. Natural treatment of the upper back, along with correction of the original sacroiliac subluxation, soon gives us a patient who is symptom-free in both areas.

If this upper-back scoliosis is allowed to persist, a variety of structures are eventually affected that may involve, through irritated nerve pathways, the various internal organs. When a patient has had sacroiliac subluxation for many years, it becomes almost completely impossible to track down the full ramifications of the malalignment. In our own treatment, we correct the pelvic distortions and then make every effort to relieve the various nerve irritations and organ disorders that remain. We usually have excellent success with this type of person, although it does take time for him to gain complete recovery. Of course, it would have been easier for both patient and physician had this relatively simple problem been taken care of years earlier.

When pelvic rotation occurs, not only does the difficulty reflex upward, but there are also manifestations from the pelvis downward. Through a group of nerves called the pelvic plexus, it is possible for the bowels and the urogenital organs to be affected. Unexplained constipation may suddenly occur in these patients. Bladder irritation and urinary incontinence (the inability to retain urine) aren't unheard of. I've even had an occasional case of impotency that seemed to be aggravated by this subluxation. Pains similar to so-called ovarian pains can be mimicked by this slippage, and, in my experience, it is also possible for these nerve irritations to cause true congestion of the female organs.

The most frequent problems in the lower portion of the body stemming from this subluxation occur in the legs, knees, and feet. In some manner not yet fully understood, this condition may cause blockage or sluggishness of venous return, usually on the affected side. If the patient tends to have varicose veins, the condition can be intensified by this subluxation. I have had patients in whom this restriction of fluid return was so severe that the leg swelled to half again its normal size and looked very much like thrombophlebitis. When the pelvic malalignment is corrected, however, the leg rapidly returns to its normal size within a few days, and all signs of fluid congestion disappear. It is possible that this condition is due to lymphatic congestion rather than venous congestion. Whatever its cause, it is rapidly corrected by the simple pelvic manipulation.

The knee is often involved when the pelvis slips. At least 50 per cent of all so-called knee problems I have seen in the last 40 years have been due to sacroiliac problems. These affected the knee, either through the postural changes due to this condition, or by direct impingement on the nerves supplying the knee.

Because sacroiliac shifts change the center of body weight, the greater proportion of this weight usually falls on the leg of the affected side, which in turn places abnormal stress on this knee with each step. The longer the sacroiliac is out of alignment, the longer stress is placed on the knee and the greater the possibility of trouble. If the pelvic subluxation is allowed to persist for months or years, permanent knee damage can be caused demanding treatment of both the pelvis and knee. Even with the best treatment, returning such a patient to a completely symptom-free status is difficult, though persistence usually will be rewarded.

When the knee problem is caused by nerve impingements, complete recovery, usually rapid, attends the pelvic correction. Even here, however, the speed of recovery depends on how soon the pelvic slip is corrected after the injury.

Foot and ankle problems due to the sacroiliac condition sometimes occur. Nerve-pressure symptoms are the most evident, usually occurring as numbness, tingling, or even as burning sensations felt throughout the foot. Occasionally, ankle weakness or pain occurs owing to the change in body weight distribution. These problems usually respond more rapidly than knee conditions, and they don't generally cause the knowledgeable practitioner much difficulty.

It isn't practical here to describe all the conditions that may stem from this subluxation. The ones I've described are the most common.

In addition to difficulties that may occur in an otherwise normal patient, many patients already have pre-existing ailments that may become aggravated or intensified when this condition is superimposed. One of the most common of these diseases is arthritis.

If part of the body is affected by both the slippage and arthritis, all the previously mentioned conditions can be intensified. For example, cervical (neck) arthritis may be intensified by a superimposed scoliosis. Such an aggravation can occur at any point of stress in the body. The knee is a very common area for arthritis to be intensified by a sacroiliac problem. In all these cases, it is first necessary to correct the pelvic problem, and then specific therapy can be used to overcome the aggravation of the arthritis. When such arthritic areas become aggravated, they don't necessarily subside of their own accord after the cause of the aggravation is removed. Frequently additional therapy is required.

Statistically the most common condition "stirred up" by the sacroiliac slip is a compression of the disc between the last lumbar segment and the sacrum, or between the last two lumbar segments The discs in this area of the spine are subjected to the greatest wear and tear of any in the body, and it is here that the thinning process so frequently associated with age is first observed. Because this disc thinning develops slowly, the body has time to adapt, and many times the patient is only vaguely aware of difficulty in this area. If a sudden sacroiliac subluxation occurs, such acute stress will often precipitate a reaction in the disc area, and the patient will suffer acute pain, which is only slightly relieved by correction of the sacroiliac subluxation. Whenever we have a patient whose back corrects very well posturally but whose painful symptoms don't improve considerably after the fourth treatment, we routinely request an X-ray of the lower back. In 75 to 80 per cent of these patients, we find some degree of disc degeneration. With proper natural therapy, most of these patients can be made symptom-free without surgery. This subject is described in more detail in the next chapter on traction therapy.

Sacroiliac Treatment

The basic treatment for this condition is very simple for any manipulator (chiropractor naturopath, or adjusting osteopath) worth his salt. Mere replacement of the joint, however, is not sufficient therapy in most cases, for almost invariably the joint soon slips out again. Only when the joint is stabilized can we consider the condition truly corrected.

A stabilized joint is one that has been replaced in correct alignment, had its inflammation reduced to a normal status, and its spastic muscles returned to normal muscle tone, enabling the ligamentous structures to regain their full integrity. Sometimes such a state is easily and rapidly attainable. In other instances, only through long and arduous work on the part of both physician and patient can such true stabilization be achieved.

The sacroiliac subluxation may be replaced in a variety of ways. The well-known lumbar roll with its Gonstead variations is perhaps as useful as any, although I have seen patients in whom only a direct thrust over the sacroiliac joint itself was effective. In some, a rotary leg movement is useful, and in certain cases only the very mild Gilete move proves to be possible. By the use of a proprietary rotation move perfected at our Center we are able to painlessly correct many sacroiliac subluxations that defy all other methods.

Because the actual correction should be left strictly to the professional, I won't dwell on the details here. Some bits of information, however, a patient should know in order to help the physician stabilize his condition. In my long experience with this subluxation, I find that after the first replacement the joint usually slips again within twenty-four hours. I have found nothing effective to prevent this re-slippage. In our own Center, we insist the patient return a day or two after the original correction for his second treatment. In 75 to 80 per cent of all patients, the joint will begin holding after the second treatment. What causes this I don't exactly know but it is my belief that the body isn't able to create the necessary healing rapidly enough to hold the joint with the first treatment. However, most systems seem capable after second correction to reduce inflammation sufficiently to hold the correction.

I stress this point of the need for a second and even a third treatment for this condition because many practitioners are aware of the simple nature of the sacroiliac subluxation and will make the proper adjustment, but fail to follow the patient's progress until the joint is stable. They frequently say, "That's back in place now. If it causes you any further trouble, get in touch with me." Unfortunately, the joint will probably slip within a day or two, and the patient, still suffering pain, often will assume this pain is just muscle or nerve irritation. After a week or two, when the pain doesn't disappear, the patient will return to his physician (or seek another one because he thinks the first physician didn't correct his problem). All too often this scenario will be repeated again and again. New patients often come in and tell us, "Oh my hip is always out of place." All this means is that the previous physician knew how to replace the joint but not how to stabilize it.

If this joint is corrected a second time within two or three days, it will usually hold. However, if the interval between the first treatment and the second is a week or longer, inflammation in the area may well return to the same degree as before the first replacement. If this occurs, this late second replacement must actually begin all over again. This situation is often repeated again and again, the patient returning to the physician once a week or so for months, resulting in only partial improvement in the condition. In our offices, we watch the sacroiliac patient closely until we know the joint is back in place and the attendant inflammation is reduced sufficiently so that there is only minimal chance of further slippage.

After the sacroiliac articulation remains in position, we request the patient to return at least once more to assure us that the joint is stabilizing and to enable replacement of the lower lumbar vertebrae, which are almost always put into a minor twist or rotation by the sacroiliac subluxation. While the sacroiliac is misplaced, the muscle tension on these vertebrae prevents correction. Only after the sacroiliac joint has been in place a day or two is it possible to replace these rotated lumbar vertebrae.

After this last correction, if the patient is relatively pain-free and the muscle tension seems minimal, he is discharged. However, he should be told that the sacroiliac joint will be sensitive and weak for a week to ten days, even after a proper correction, and he must take care in its use during this period or he risks another subluxation. In can take this time for the supporting ligaments to return to normal tone and until this happens the joint is weaker than normal and more susceptible to slippage.

At the time of the first replacement, each of our patients is warned to refrain from certain types of movement that may cause the joint to slip again. We usually suggest that he refrain from any form of twisting to the side, particularly to reach or to pick up anything. If he wants to pick something up, we suggest that he face the object, bend down directly in front of it (bending the knees at the same time), grasp it, and then rise the same way.

The patient is also requested to make all efforts to keep his knees together, or one in front of the other, as much as possible. The patient should refrain from any form of movement that moves one knee laterally (out to the side) from the other. One of the most common movements to be avoided is the usual method of getting into a car. The sacroiliac patient should not get into a car one leg at a time. Rather, he should open the car door, turn around, sit down on the seat, and then bring in both legs together keeping the knees close together. He should get out of the automobile in the reverse order, keeping both knees together and moving both legs at the same time. This last admonition is difficult for the patient to remember. He will carefully get into the car and drive to where he's going, only to forget entirely our instructions when he gets out. However, it is just as important to exit a car properly as it is enter it correctly.

If you ever have a sacroiliac problem remember these precautions and observe them; they have proven invaluable for all our patients.

Although manipulation of the low back is the basic and essential therapy for sacroiliac subluxation, other modalities are of great help in most patients. We often begin therapy with short-wave diathermy, which is a specific deep penetrating form of heat used to relax the muscles and ligaments in the affected area. This makes our correction easier and more thorough. After correction, we use ultra sound to help reduce inflammation in the affected area, and then sine wave to help control pain and aid in achieving greater mobility. Recently we have added the new Low Level Laser Therapy to our more traditional modalities. This new marvel has allowed us to heal some difficult sacraliliacs in days that used to take weeks. All these modalities are discussed at length in Chapter **. I mention their use here only to describe our full therapy program.

The therapy just described is usually adequate for sacroiliac disorders that are seen within a few days of the original accident and that are only moderately severe and don't cause many complications. At least half our cases, however, don't fall into this category; with these, greater skill, care, and experience are needed to produce sacroiliac stabilization.

Where the condition has existed for a week or more, we often find a fairly high degree of muscle irritation and spasm present. In these instances, the modalities mentioned previously prove extremely helpful. We also utilize a method of muscle goading and relaxation. In this treatment, a lubricant, usually olive oil, is rubbed into the patient's lower spine, and the large muscle groups contiguous with the pelvis are then deeply massaged by the practitioner. Sometimes these areas are exquisitely tender, and great care must be exercised at first. But as therapy progresses, the muscles lose much of this sensitivity and the patient's pain greatly diminishes. In these spastic patients, more treatments than the basic three are usually needed for proper stabilization. Generally, the program should not run much beyond six treatments, however. If six treatments have been given with the sacroiliac in place and the patient is still having difficulty, there is probably something else involved, perhaps a mild disc problem (see Chapter 4).

In some patients, the sacroiliac joint won't stay in place by the third treatment, or it may stay in for a few days and then slip out. Where the joint has been out of place for some time, it is common for it to react normally for the first three treatments, only to slip out again within a week or so as the patient resumes his usual activities. It usually requires an extra replacement, or at the most two, to finish stabilization in this patient, and he usually makes rapid recovery after this second set of corrections.

Some sacroiliac joints continue to slip out of alignment, even with the most careful replacements and diligent use of the other modalities. In this type of patient, the ligaments that hold the articulation in place have been so overstretched that they won't return to normal by our usual therapeutic methods. The joint thus remains loose and doesn't hold an adjustment. This type of patient at one time was the bane of all manipulators. Nothing seemed to correct their problem completely. Luckily, within recent years, it has been discovered that the mineral manganese, (along with other synergistic nutrients) if used in fairly large but nontoxic doses, helps to normalize their ligamentous function and, used along with the basic sacroiliac therapies, enables joint stabilization.

To help these patients further, we may need to fit a man's six inch elastic rib belt around the pelvic area. This is fit outside the underclothes, to add support to the weakened ligaments. These patients are instructed to wear this belt day and night, until we think satisfactory ligament tone has been established.

This treatment usually produces satisfactory joint stabilization within a few days. The belt usually can be discontinued in four or five days, though some patients must wear it a week or two. Usually, the manganese dosage is reduced after a few weeks, but we suggest that these patients continue a low dosage of this supplement for at least a year, because ligament problems, perhaps owing to their poor blood supply, repair very slowly. If the tablets are discontinued before complete stabilization is achieved, the joint may once again become loose, making another sacroiliac subluxation a distinct possibility.

Even with the foregoing therapy, some patients don't improve completely. These are of two general types. First is the patient whose sacroiliac isn't capable of staying in place, even with support and the use of the manganese supplementation. The second type is one whose articulation defect is corrected but whose symptoms remain or even become worse.

In the first instance, we usually have a patient whose body tone is so poor that it can't hold these structures in proper position, or we have a patient who has a sacroiliac inflammation that produces a constant swelling that interferes with proper setting of the joint. We occasionally have someone with a congenital anomaly, someone like my wife, who was born with a very small amount of the surface between the sacrum and ilium actually articulating. In her case, the bony articulating surfaces are seemingly insufficient to produce the proper surface for a normal joint.

Each of these cases requires individual professional care. They all can be helped by natural methods and although the treatment may be more involved than what I have described, it is usually very successful.

The second type of case is more common than the first and luckily is easier to correct. When a sacroiliac has been adequately corrected and the patient given sufficient time for the inflammation to subside-usually ten days to two weeks- he should be pain-free with normal movement fully restored. If free movement is still restricted and the pain, though improved, still considerable, we insist on an X-ray of the lumbosacral area.

We have certain X-ray views taken in a postural or standing position. The bottom of our film is parallel with a platform at the base of the X-ray machine, on which the patient stands. Four views are taken, an AP (front to back), a lateral (through the side), and two obliques (at an angle through each side of the back).

The standing AP tells us whether there is any anatomic difference in leg length, any spinal curvature, arthritis, ankylosis, or spurring of the spine. It also shows us the integrity of the hip socket, and from it we can visualize the sacroiliac joint to determine if any pathologic or congenital problems are there. This view also shows us if any pelvic rotation still remains.

The lateral film provides us with the most information about the disc integrity. Disc thinning or narrowing is best demonstrated in this view. Spinal lordosis (swayback), straight military spine, tipping, and arthritis may also be seen in the lateral view.

The oblique view is used to determine the integrity of the articulating surfaces-the points at which the lumbar vertebrae are joined together. Arthritis in these areas is common and will cause difficulty. Owing to deviations in the spine itself, sometimes caused by sacroiliac subluxation, these articular surfaces (called facets) may jam, a situation caused by an irregularity of pressure where these two vertebrae meet. This situation can cause a variety of problems in the low back and can be greatly aggravated by a sacroiliac slip.

The most common X-ray finding is a disc thinning between the last lumbar and the first sacral segment; next most frequent is a short leg. This short leg (anatomic short leg), must be differentiated from the apparent short leg found in sacroiliac subluxation. If the sacroiliac joint slips upward and backward, it tends to draw the leg on that side upward (Fig. 2). Conversely, if it slips downward and forward, it tends to draw the leg downward. In this manner, an upward sacroiliac on the right gives the appearance of a short leg on the right, and a downward sacroiliac on the left gives the appearance of a long leg on the left. When the proper sacroiliac correction is made, these apparent short or long legs correct themselves automatically. An anatomic short leg is actually shorter than the other leg and can only be detected accurately by a postural X-ray. It is possible for an anatomic short leg to produce many of the symptoms that we have heretofore attributed to sacroiliac slippage. This is especially true of the knee symptoms and of problems related to upper trunk scoliosis.

For a true anatomic short leg, the best therapy is the judicious use of heel lifts. We usually begin with a very small lift and gradually, week by week, increase its size until we have brought the patient to a point where he can accept a lift approximately half the size of the leg shortage. Any attempt to build the lift higher usually upsets the physiology of the spine to such a degree that its use is not justified.

Because of its frequency, I have taken the time to discuss lift therapy. However, I don't recommend that you experiment with this treatment. A lift should be used only after its need is fully demonstrated by postural X-ray. There is no other way to my knowledge of accurately ascertaining whether a lift is needed. If a lift is used where the real problem is a pelvic distortion and not an anatomic short leg, the basic condition is intensified and the reflex symptoms may worsen.

Of all the conditions we find on the postural X-ray examination, the compressed disc is the most common. Two basic types of disc problems afflict the lower back. One is the slowly developing chronic form known as a degenerated (narrowed) disc. The other is the herniated or slipped disc. In this latter form, the jelly-like substance in the center of the spinal disc forces its way through the tougher surrounding material and protrudes into the spinal canal. This pressure may even irritate the spinal cord itself. This condition may come on very suddenly; in 80 per cent of cases it corrects itself after a period of complete bed rest. In severe cases, the orthopedist may need to perform an operation. In this operation (laminectomy), the surgeon cuts through the back of the vertebra and removes this offending gelatinous disc center. The main hard fibrous section of the disc is left intact, and often the patient experiences a very dramatic and much appreciated sense of relief after surgery.

Most disc cases we encounter aren't of the herniated variety but rather are the degenerating or thinning variety. In this case, the whole disc-particularly the outer tough circular layers-is compressed or thins from wear and tear. Bed rest is not particularly helpful for these patients, except for an occasional acute manifestation. Once the disc thins to a certain point, there develops a steady nerve impingement due to a telescoping of the normal nerve opening, because as the disc thins the vertebra above settles down on the vertebra below. When this occurs, the normal opening formed by these two vertebrae for the spinal nerve is narrowed, and the bones may put sufficient pressure on the nerve to cause pain along the nerve pathway.

Because this situation occurs slowly over the years, this area of the body makes every attempt to adapt to keep the nerve and its allied elements from injury. However, if a patient with such a disc problem suddenly suffers sacroiliac subluxation, a sudden shift in the pressures on the disc area is produced, usually aggravating the area to such a degree that severe muscle spasm and nerve inflammation ensue. Even though this patient seeks professional care soon and the sacroiliac subluxation is corrected, he is usually left with an irritation of the pre-existing degenerated disc.

Because the Healing Research Center is noted for its success with difficult low-back cases, we see a good percentage of these patients. Often the patient has had a history of back trouble for years, though until recently it was readily corrected with a few treatments by his local chiropractor or osteopath. Now he has what seems to be the same old sacroiliac slip, but his physician is not able to help. He is at a loss to explain his physician's sudden incompetence. The truth is that not his doctor but his back has changed. His slowly degenerating disc has finally reached a point where the body can no longer adapt to its pressure.

An operative procedure can be used on these patients; however, it isn't as universally successful as the laminectomy, nor anywhere nearly as simple. In this procedure (called a fusion), the surgeon cuts into the back, removes what he can of the degenerated disc, spreads the opening, and puts a section removed from the patient's own bones or bone dust into the area between the vertebrae to ankylose (fuse) the two vertebrae together, producing an artificial disc between the two.

In the State of Washington, a very thorough survey a few years ago taken of all industrial low-back cases showed that the operation was successful in only 50 per cent of cases-at least half the workers undergoing this operation were never able to return to work. Knowing the odds against such an operation being successful, we very rarely recommend it.

In a recent survey of all acute back treatments by the U.S. government the same results were found and they recommended that fusion operations be used seldom.

Physiotherapeutic methods can be used to keep most of these patients productive and relatively comfortable. We are able to return most of them to full activity completely pain free.

Chapter four is devoted to this and similar disc problems, but because many of these patients are found during the treatment of a superimposed sacroiliac disorder, I thought it best to begin the discussion here. Here too the new Low Level Laser Therapy has proven to be of great help. As one eighty year old patient who was treated with this Laser for an old chronic disk compression, "For the first time in many years the Laser made my back feel normal again."

I have written much about such an apparently simple problem because of its high incidence and because many otherwise highly competent physicians almost totally disregard it. If you have any unresolved vague problems in the neck, shoulders, back, knees, legs, or feet, I suggest you find someone versed in manipulative therapy to check the integrity of the sacroiliac articulation. Don't be surprised if he confirms that you too are one of the multitude having this simple but rather aggravating condition.