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  • john123
    Member
    Post count: 30

    Dr. Corenman:

    I was rear ended in a MVA 2 years ago. Pre-existing bi-lateral pars fracture. Grade 1 spondylothesis with annual tear, disc herniation at same level L5,S1.

    Soft tissue damage left side of neck where seat belt crossed chest. disc bulge c2/c3, c5/c6 – minor

    no real back pain after the car accident, but was unable to exercise due to PCS (my back flared up about 4-5 months after accident) I now wear a rigid back brace every day for support; I can hardly walk without it, but with it I feel ok….

    When PCS symptoms go away for a few weeks, I continue to try some light walking for 4-5 minutes and have continued to have PCS set backs. ie. fatigue, difficulty concentrating, headaches, photsenstitivity, throbbing/pressure in head, sensitivity to impact/walking stiff neck.

    I seem to be able to walk ok through grocery store with a cart wearing brace. Standing straight up without brace on, I feel like my heel of my foot is smashing the ground when I walk.

    I believe if I can walk/exercise again I can rebuild my back.

    I get relief from PCS symptoms with consistent, medical, trigger point massage but never permanent relief and not enough to get walking again. I hvae chronic muscle tightness left shoulder blade and neck.

    1.) Are PCS symptoms generated from back, neck, head ?

    2.) Do I treat neck or back first?

    3.) I did see a chiro for neck which helped, but symptoms PCS reappear? Is there a specific Chiro that I should look for if at at all?

    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Post concussion syndrome is separate and distinct from spine injury but both can occur in the same accident. Post concussion syndrome (PCS) is considered a shearing injury of the brain components (nerves and surrounding supporting tissues) that causes brain dysfunction. Normally, the symptoms are as you note and typically resolve after some time. If they do not resolve, a visit with a neuropsychologist or psychiatrist would be in order.

    I am not a fan of full time brace wear. This device may stabilize your spine but at the expense of muscle deconditioning. A thorough rehabilitation program would be a better investment.

    Your neck pain could be from injury to the spinal structures. You are now two years out from this injury with significant symptoms and I think you need a consultation with a spine surgeon and a neuropsychologist.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    john123
    Member
    Post count: 30

    Thank you for the reply. I have consulted with neurosurgeon who have recommended ALIF for spondy.

    Neurologist – said that concussion symptoms are mimics from muscle spasm and stiffness in neck, which makes sense after seeing what some NHL players have gone through. I usually have no headaches or memory problems.

    Neuropsych has recommended further imaging which may or may not show anything.

    How do you explain being able to walk perfectly fine leaning over a grocery cart at a store with the brace on vs generating symptoms walking straight up with the brace off??

    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    Walking using a shopping cart causes you to flex at your lower back and support some of your torso weight on the cart itself. This has two effects. One, of course is that the spine is partially unloaded (less stress loading on the spine). Less load on the spine reduces compression and shear forces which reduces pain.

    The other action that forward flexion produces is opening of the central canal and foramen as well at loading anterior structures and reducing load on posterior structures. If the painful structures are posterior (pars fractures or facets), forward bending reduces stress on them. If there is stenosis (narrowing) of the central canal or foramen, this action will also open the channels that transmit the nerves.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    john123
    Member
    Post count: 30

    Thank you, this makes more sense.

    If I am walking upright, without brace on, walking heal to toe instead of bent over – wouldn’t the spine be then fully loaded?

    If my back muscles are very atrophied and spondylothesis is mobile, could it create enough inflammation to generate headaches, dizziness, from impact from walking ?

    At this point I don’t know what direction to go in ?

    Perhaps I should try another form of exercise? Any suggestions?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    The spine is fully loaded whenever you are upright or even bent forward as long as you are not using aids to walk (cane, walker or shopping cart). Without the use of aids, the portion of the spine that is loaded changes with different positions. When fully upright, there is approximately 30% load on the facets and 70% on the discs in the lower back. If you bend forward, the load increases on the discs and decreases on the facets. Visa versa if you extend backwards.

    Dizziness and headaches are not associated with the lower back. However, increased pain can be associated with these symptoms. Post-concussion syndrome is highly associated with dizziness and headaches.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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