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dr. flanagan, just curious and always respect your input. when it comes to thoracic outlet syndrome from your point of view would chiropractic be a treatment option of course depending on how bad it is. i'd assume you have treated tos. would you mind shareing any thoughts of a connection to this with some individuals.

I succesfully treated many cases of thoracic outlet and cervical-brachial syndromes. TOS can be caused by a multitude of problems related to the spine and muscle such as pelvic tilts, scoliosis, shoulder tilts, neck and shoulder injuries, tight muscles, arm injuries, clavicle injuries, herniated discs, drooped shoulders, tight tunnels etc. I corrected, mobilized and counter-strained the structural strains in the spine and used traction and different types of electrotherapies to control pain and inflammation as well as for rehabilitation of injured tissues, which further included exercises such a stretching and strengthening.

Morning all,
Dr F I have noticed that there are allot of PwMS's MRI's that show disc bulges and wonder if this is common for anyone or more common in degenerative diseases?

My thought was about the chances of the bulge having an effect on the flows of CSF and/or blood?

I assume that the imaging would be a challenge because of the different modes required for each investigation then to super impose to give and understanding of any interaction?

It also seems common for the symptoms we have to be related to the bulge, by that I mean that the symptoms exist from the bulge down very often and is it possible that it is two different causes such as flow and inflammation that combine and create a big picture disease such as 'MS'?

The combination of symptoms in diseases such as MS, Alzhiemers, Parkinsons, Fibro etc seem to be so entwined that it is really showing how important the *Flanagan assessments* are to find the 'best management' for such a board range of disabilities that compound and progress.

If there is a plan for treatment of the pieces of disability rather than writing off treatments due to the dx of for instance 'MS' it seems that the chances of improvement or stabilising rather than cascading is a HUGE GOAL for us all.

Even the situation I have found myself in where there are many factors that are combining such as the bacterial CPn infection or for others the finding of Lyme or co-incidence infections, then that process of dx has such a huge part to play in the prospects of any patient!

Again in my situation the history of sports injury and alignment issues had to be thoroughly investigated and worked with before writing off the symptoms as being 'MS'.

Even more so is the finding by having a Doppler assessment of the basic vascular returns to assess the total return flow of blood from the brain and a calculation of the comparison to 'normal people' has given more direction for treating a left sided flow deficit when supine. Again a thorough assessment will determine if there is hope of improvement.

To also check the CSF flows and compare this finding will be a future stage inspection as the other known factors are managed as best possible first.

The brief clinical overview/tests that Neurologists perform in a very brief interview plus the imaging done by MRI in essence are not telling either the 'specialist' or the patient much at all in reality.

** Seems to me the 'Flanagan assessment methods' need to be EXPRESSED to the wider medical community so that a 'real' assessment can be made for patients! **

Have a great day everyone,
Nigel

Hello Nigel,
Disc buldges are common in aging patients. They are not common in young patients. If they cause no signs or symptoms then they aren't a problem. MS affects relatively young patinets. Disc buldges in MS patients, or any patients with associated signs and symptoms, should always be investigated as to their cause. Disc buldges can affect venous blood flow in the epidural space leading to chronic ischemia and degenerative processes if severe enough. I suspect that disc buldges also affect CSF flow. Chronic inflammation from spondolytic bone spurs, as in Blossom's case, can also cause local adhesion and tethering of the dura of the cord and nerve roots to the spur. Local tethering can further cause L'Hermitte's sign. Anyone with neurodegenertive conditions needs a thorough systems review and thorough physical examination. I don't know how the doctors treat such complicated cases, such as Dania's for example, based on such scanty information.

QUOTE DR. FLANAGN-Anyone with neurodegenertive conditions needs a thorough systems review and thorough physical examination. I don't know how the doctors treat such complicated cases, such as Dania's for example, based on such scanty information.[/quote]



that's the problem--"they don't" and even though they have no answers as to why say in my case i could show them how much positioning effected movement they shrug their shoulders or ignore or give such a lame reply that makes no sence at all. they've got this so called degree in neurology that should have give them a hint some where along the line that bad flow, pinched, twisted, spurs, tilted pelvic etc. just might be causeing some if not all of the symptoms. after all the spine is the light house of body. instead of acknowledging the patient as an individual they put most in a bushel and whip out the drugs. that's not treating. that's second guessing. and who pays for this and suffers--we the patients.

i know in my heart of hearts that if myself, dania, poet, nizer and so many others would have had - as Nizer referred to--A DR. FLANAGAN ASSESSMENT - then treated accordingly--we would not be in the shape we are now.

to add more there are not many chiro.'s if any that are a total package for our needs.--there we go again--"DR. FLANAGAN'S TEACHING-TREATING CLINIC."

I think my biggest obstacle in getting any doctor to look at my complaint of the pain from my SI joint is because of the W/C. Once they see that, it is all they can focus on. they all ask "why the W/C? And if I answer, all they see is MS. I guess one cannot have another health problem and if you do, it falls in the MS box. Saw my family doctor on Tuesday. He only checked my vision (even thou I have never had any vision problems) and my reflexes. NEVER looked at my misaligned pelvis and shoulders, anterior rotated and upslip of my leg. Never looked at the fact the one leg is much shorted than the other. So many more symptoms for the SI joint problem. But never looked at them. Nothing but my eyes and reflexes.

An orthopedic doctor that performs SI Joint minimally invasive surgery told me to get a SI Joint block test.
http://si-bone.com/patients/ifuse_impla ... ery_video/

6 months wait to have an SI JOINT BLOCK TEST????? Willing to go private but cannot find a place.

Nobody wants to work too hard. Treating complex cases with neurodegenerative conditions requires a great deal of time, knowledge and expertise. It's easier for medical doctors to compartmentalize cases into diagnostic categories so they can fit into fifteen minute office visits that require no thought and minimal examination skills. It's easy to write a prescription and you don't go home physically tired. Lazy chiropractors prefer to ask the occiput, the feet or the muscles for answers to questions they don't know and knowledge they don't have and are unwilling to learn. The problem is that the list of possible answers they can get from asking the occiput, feet and muscles are limited by their knowledge. I prefer to spend my time pouring through a patient's case history and doing a thorough exam.

A sacroiliac block test is a poor and very limited way to examine the lumbar spine, pelvis and femur complex. The pelvis should be examined standing (if possible), seated, supine and prone. All the standard orthopedic test should be performed. The pelvis should be thorought palpated for tender points in the ligaments and mucles. Muscles of the thighs, hips and legs should be tested. X-rays are also required. They should be taken standing if possible.

uprightdoc wrote:Nobody wants to work too hard. Treating complex cases with neurodegenerative conditions requires a great deal of time, knowledge and expertise. It's easier for medical doctors to compartmentalize cases into diagnostic categories so they can fit into fifteen minute office visits that require no thought and minimal examination skills. It's easy to write a prescription and you don't go home physically tired. Lazy chiropractors prefer to ask the occiput, the feet or the muscles for answers to questions they don't know and knowledge they don't have and are unwilling to learn. The problem is that the list of possible answers they can get from asking the occiput, feet and muscles are limited by their knowledge. I prefer to spend my time pouring through a patient's case history and doing a thorough exam.

A sacroiliac block test is a poor and very limited way to examine the lumbar spine, pelvis and femur complex. The pelvis should be examined standing (if possible), seated, supine and prone. All the standard orthopedic test should be performed. The pelvis should be thorought palpated for tender points in the ligaments and mucles. Muscles of the thighs, hips and legs should be tested. X-rays are also required. They should be taken standing if possible.

I would get all the tests you suggest if someone would do them. I agree with you, the a totally assessment is the way to go. If only I could find someone who would do it.

I don't know if it is logistically possible, but if I had a detailed case history and some basic x-rays of the spine I would be willing to do an evaluation myself.

Did your GP make any comments about your reflexes? Are they brisk or slow etc.? Do he notice any abnormal reflexes?

uprightdoc wrote:I don't know if it is logistically possible, but if I had a detailed case history and some basic x-rays of the spine I would be willing to do an evaluation myself.

Did your GP make any comments about your reflexes? Are they brisk or slow etc.? Do he notice any abnormal reflexes?

He had no comments. I think my reflexes are almost none existent. What basic X rays would you need? And I will relay the info to my doctor.
I just discovered another interesting thing. MY left leg is anterior rotated and my knees are clamped shut. I put an 8 inch wedge in between my knees. And now I can sit in my W/C and I have no pain on my butt plus I no longer feel there is someone pushing my face onto the floor or have to hold on to one of my arms on the W/C in order to prevent me from this happening.

Minimal or absent reflexes suggest peripheral, not central, nerve or muscle problems. Brain and cord problems tend to cause hyperreflexes and upper motor neuron signs such as Babinski, Oppenhiem, Chaddock and Hoffman signs as well as clonus. My imaging wish list for you would include: 1) anterior to posterior (AP) and lateral views of the cervical and lumbar spines, as well as the pelvis; 2) brain and cervical MRI.; and 3) thoracic and lumbar spine MRI. I don't know how they can work on a case like yours without such basic information.

Weakness in protaganist muscles (primer mover) will cause spasms and contractures in their opposing antagonist muscles. For example: weakness in the triceps muscle will cause the arm to curl up due to lack of opposition to the biceps muscle. Certain neurological conditions cause patients to walk with characteristic gaits due to weaknesses, imbalances and contractures. It sounds as though your inner adductor muscles are unapposed by the lateral abductor thigh muscles. They should be manually tested and the source of the failure localized. In addiiton to using manual muscles tests I like to use electrical stimulation of motor points to test muscles for innervation and denervation. I find it to be more accurate and clinically useful than EMGs for motor problems.

Babinski, Oppenhiem, Chaddock and Hoffman signs as well as clonus

I remember Babinski from high school biology, but what are all these other signs? I know I have lots of Babinski on the left and I wish I could intentionally curl the other toes upward. It's all part of foot drop, if I am correct in thinking your reference to the inner adductors is the calf muscle on the groin side, as that is the one of mine that is almost gone from atrophy. It is responsible for dorsiflection. I have used those walking-assisting electro-simulators and they successfully dorsiflect my foot. But the nerves are on the opposite side from that muscle so I wonder if I am using it or not. The point being if I cannot do it intentionally I would like to restore some of that muscle electrically if I can. Is this what is going on, or would I need an implant on the inside calf to get to the right nerves, because they are deeper under the muscle? I am unclear on why the nerves are placed where they are.

Oppenheim and Chaddocks are variations of Babinski done on the lateral malleolus and medial tibia. Hoffman's sign is done by flicking the middle fingertip and watching for flexion of finger muscles. The calf doesn't have inner adductor muscles. It has plantar flexors and extensors, and foot invertors/pronators and everters/supinators. Dorsiflexion is controlled by the anterior tibialis on the medial side and the peroneus tertius on the lateral side. You don't want to stimulate the nerve to dorsiflex the foot. You want to stimulate the motor points, which tend to be located near the belly of the muscle. I don't know why things were placed where they are but despite all the shortcomings the design of the body is fairly exceptional and hard to duplicate. Moreover, we may get some electric storms today so I don't want to complain to loudly as I might find myself dodging some lightening bolts.

uprightdoc wrote:I don't know if it is logistically possible, but if I had a detailed case history and some basic x-rays of the spine I would be willing to do an evaluation myself.

dania, I'm so happy for you!
Btw, did you happen to notice the time of Dr. Flanagan's post? You seeing him is definitely meant to be!

I will talk to my doctor and ask for the wish list. I cannot stand for more than a minute and never completely upright. Must be holding on to something. How do you want these x rays taken?
When the doctor was testing my reflexes, most did not move at all some just a bit but none were hyper.
When I have someone lift my upslipped left leg and pull it, then rotate the foot to the left side (as it is always rotated inwards) always pulling at the same time and then placing it back, you can see the pelvis, leg and foot are straighter. And the burning from the pinched nerve at my groin disappears. I am now placing a much wider wedge in between my knees and it is soooo much faster and easier to stand. If I truly have MS this should not make a difference.