Q:

Dr. M

I had a patient last night(a repeat pt.) who lifted a pan yesterday at work 
and hurt her back, she came in and got adjusted,went on IST for 10 minutes 
and when she stood up went into severe muscle spasms (over her L5 iliac 
crest area bilaterally)that lasted on and off for 2 hours....I'm not sure 
that we went into this in school but we tried massage and rest, but nothing 
worked. We finally sent her to the emergency room with her husband and after 
all kinds of xrays and tests, they told her that she was just having 
unexplainable violent spasms and gave her some mm relaxers.Have you ever had 
a pt go into spasms like this and what can I do in the future to try to 
relieve them.

A:

Thanks for the e-mail. I've been a chiropractor for over 21 years and have seen a good deal 
of weird things. I once had a patient .. also a regular maintenenace patient .. who had a 
history of off and on lower back spasms. One day as he was getting off my table .. he went 
into such a deep and painful lower back spasm that he was unable to get and fell to his 
knees. No matter what I did (ice .. Activator .. massage) the spasm wouldn't leave and he 
couldn't get up without tremendous pain. Possibly if he didn't weigh a ton .. I might have 
helped him up .. but there was no way. Worse .. he was in my only adjusting room. Since 
we both realized this would pass and he wasn't placing blame on me .. I just had him kneel 
there while I used my exam room to adjust people. To make a long story .. after the day 
was complete .. about an hour or so .. his wife came to the office and we both helped him 
up and to his car and by the time he was home he was okay. 

Had another experience .. much like yours .. a patient called prior to my lunch break asking 
if I would see one of his employees who just strained his lower back in their carpentry 
shop. The guy came in and was in acute distress .. I placed him on the table and realized 
that anything I'd do (forget setting him up for an x-ray) would hurt him worse (my 
judgment call .. he had a blown (hot) lumbar disc). So I placed ice on him and waited a few 
minutes. The ice aggravated it further and he just couldn't be touched at all without worse 
pain. Well .. it was lunch time and I was hungry .. so the decision was made to get him 
home to cool down his disc and then proceed wih care .. but we couldn't move him at all. I 
called 911 .. the ambulance came and scooped him off the table and transported him to a 
local hospital. While on a gurney in the hospital hallway waiting to be seen the spasm 
stopped .. his pain was almost gone and so was he. The following day he came back to my 
office and began care.

The stories will always be similar .. we work with structure and there will be times that a 
patient or four will have an adverse reaction .. a non related to your care spasm .. 
whatever. What could you have done or do?? Use proper judgment .. keep in 
communications .. document everything if you think a potential risk concern is possible 
and just carry on.

Remember .. the medics at the hospital have the shots and muscle relaxors .. they see 
things like this daily. They hit the nail on the head .. "unexplainable violent spasms."

Now .. take a few extra moments and go over anatomy with this patient. Relate structure to 
function with emphasis on the paraspinal support system. Be clear that unexplainable 
violent spasms are a reaction to a chronic level of instability resulting into a subluxation 
pattern with defensive posturing. This requires necessary corrective/maintenance care.  
Hang in there .. you dis okay and go with the flow. The patient probably appreciated your 
referring them to the ER. We have limited tools in crisis settings .. this is where the medics 
have a place. Afterwards .. and with a bit of education .. we excel to correct the cause

Have a Great Day

Dr. M